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Study Backs Teen Access to Confidential Reproductive Health Services

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There’s what’s right and what’s real, and much of the debate about reproductive rights in this country, especially in regard to minors, centers around the relative priorities assigned to “right” and “real” and the government’s appropriate role in each.

A review of public policy, research, and public/professional opinion from the last thirty years regarding mandated parental involvement in minors’ sexual and reproductive health care published yesterday by the Guttmacher Institute comes down firmly on the side of “real,” stating “the evidence shows that policies forcing parental involvement in either abortion or contraceptive services can pose a significant threat to teenagers’ health and well-being.”

Yet such policies, particularly in relation to abortion, continue to be promoted at the state and federal levels due to efforts to legislate what is “right.”

“Of course, all parents hope that their teenage daughters would consult with them about making the decision to have an abortion,” says Cynthia Dailard, Guttmacher senior public policy associate. “And, in fact, most teens do. But you can’t legislate good family relationships. If we want to protect young women’s health and safety, enabling them to access confidential reproductive health services when necessary — including both birth control and abortion — is critically important.”

Confidentiality for minors is at stake in two key arenas this November: in California, the ballot includes an initiative that would amend the state constitution to require that parents be notified 48 hours before a minor can have an abortion.

In addition, the U.S. Supreme Court is scheduled to hear oral arguments in the case of Ayotte v. Planned Parenthood of Northern New England, which concerns a notification law in New Hampshire that lower federal courts have ruled unconstitutional because it does not contain an exception for cases in which the abortion is necessary to protect a young woman’s health.

Among the findings of the Guttmacher Institute paper:

-Most teens already inform their parents before seeking prescription contraceptives or having an abortion.

-Faced with a requirement that their parents be notified before they get contraceptives, teens say they would be more likely to have unsafe sex than to forgo sex.

-Mandatory parental involvement may lead to teens having abortions later in pregnancy, when abortion is more risky.

-Forcing teens to inform their parents that they are pregnant or seeking an abortion may place some at risk of physical violence or abuse.

-Forcing teens to inform their parents that they are pregnant or seeking an abortion may place some at risk of physical violence or abuse.

The review found “no persuasive evidence” that laws mandating parental involvement improve family communication or relationships, discourage teens from having sex or lead pregnant teens to choose childbirth over abortion.

While public policy has long protected the right of minors to receive birth control confidentially, 34 states currently require that a minor involve her parents before obtaining an abortion, and the U.S. House of Representatives has passed legislation (now pending before the Senate) that would impose a strict parental notification requirement for minors’ abortions even in states that have rejected such a policy.

“Policymakers and the public should think carefully about these issues,” says Dailard. “Our review of the field clearly shows that placing ‘parental rights’ above young people’s health needs can have disastrous consequences – without doing a thing to help young people talk with their parents or discourage them from having sex.”

Medical Statements on Teen Access to Confidential Care
American Academy of Family Physicians: “Concerns about confidentiality may discourage adolescents from seeking necessary medical care and counseling, and may create barriers to open communication between patient and physician. Protection of confidentiality is needed to appropriately address issues such as…unintended pregnancy.” (Adolescent Health Care, 2001)

American Academy of Pediatrics: “Health care professionals have an ethical obligation to provide the best possible care and counseling to respond to the needs of their adolescent patients…This obligation includes every reasonable effort to encourage the adolescent to involve parents, whose support can, in many circumstances, increase the potential for dealing with the adolescent’s problems on a continuing basis….At the time providers establish an independent relationship with adolescents as patients, the provider should make…clear to parents and adolescents [that]…confidentiality will be preserved between the adolescent patient and the provider. (Confidentiality in Adolescent Health Care, 2004)

American College of Obstetricians and Gynecologists: “The potential health risks to adolescents if they are unable to obtain reproductive health services are so compelling that legal barriers and deference to parental involvement should not stand in the way of needed health care for patients who request confidentiality. Therefore, laws and regulations that are unduly restrictive of adolescents’ confidential access to reproductive health care should be revised.” (Access to Reproductive Health Care for Adolescents, 2003)

American College of Physicians: “In the care of the adolescent patient, family support is important. However, this support must be balanced with confidentiality and respect for the adolescent’s autonomy in health care decisions and in relationships with health care providers. Physicians should be knowledgeable about state laws governing the right of adolescent patients to confidentiality and the adolescent’s legal right to consent to treatment.” (Ethics Manual: Fourth Edition, 1998)

American Medical Association: “Our AMA…reaffirms that confidential care for adolescents is critical to improving their health….When in the opinion of the physician, parental involvement would not be beneficial, parental consent or notification should not be a barrier to care.” (Confidential Health Services for Adolescents, 2004)

Society for Adolescent Medicine: “Confidentiality protection is an essential component of health care for adolescents because it is consistent with their development of maturity and autonomy and without it, some adolescents will forgo care….Health care professionals should support effective communication between adolescents and their parents or other caretakers. Participation of parents in the health care of their adolescents should usually be encouraged, but should not be mandated….Laws that allow minors to give their own consent for all or some types of health care and that protect the confidentiality of adolescents’ health care information are fundamentally necessary to allow health care professionals to provide appropriate health care to adolescents and should be maintained.” (Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine, 2004)

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About Eric Olsen

  • MCH

    E.O.;

    Apologies for being off topic, but I know you’re a former baseball umpire and I got a question about the controversial call in the White Sox/Angels game the other night.

    Part of the debate is whether the ball hit the dirt before Paul caught it. If a guy swings and misses at the third strike, what difference would it make if the ball hit the ground before the catcher catches it? It wouldn’t constitute a dropped ball, even if it bounced first, because he caught it, right?

  • Eric Olsen

    that IS off-topic, but if it did hit the ground, which I don’t think it did, the rules say the batter is out when “A third strike is legally caught by the catcher; ‘Legally caught’ means in the catcher’s glove before the ball touches the ground.”

    But what is odder still about the whole thing is that the umpire called the batter out on teh swing. That should have been it.

  • MCH

    Thanx, that’s the way I saw it, too.

  • Eric Olsen

    by last night the announcers weren’t even pretending that the umpire didn’t blow the all

    AND teens should have access to confidential reproductive health services

  • http://jonsobel.com Jon Sobel

    Very wise distinction between what’s right and what’s real. Unfortunately legislating what’s right via state or church law dates back at least to the fourth century. One could say it has a bit of a toehold in our culture.

  • Dr. Kurt

    Ah yes, the good old days… when girls were sold as brides before they hit puberty, handily eliminating these new-fangled sins… back when a wealthy adult male could rape any unwed poor child he wanted, and buy his way out of it for a few bucks. A quick stop at the confession box & he could whistle his way to his next victim.
    The only thing surprising about this report is the fact that thousands of men will see it as an affront to their ongoing attempt to control female bodies. “Right” my butt – since when is superstitious ignorance right?

  • Eric Olsen

    Dr. Kurt, I was using “right” as a general term for morality and the supposition that having to involve their parents in efforts to deal with the consequences of sexual activity would be an incentive for teens to not do such things in the first place, a supposition this study clearly refutes.

    And Jon, yes, there is certainly a long history of legislating morality, but the trend, at least since Prohibition, is to also look at the consequences of that legislation, which those who keep pushing this “parental involvement” legislation seem to be ignoring

  • http://www.blogcritics.com T A Dodger

    And Jon, yes, there is certainly a long history of legislating morality, but the trend, at least since Prohibition, is to also look at the consequences of that legislation, which those who keep pushing this “parental involvement” legislation seem to be ignoring

    Honestly, I get the feeling that some of the people who support this legislation would support it even if they accepted that it didn’t result in fewer abortions. Some people seem to think women and girls who are sexually active should be made to feel ashamed of themselves, and who better to do that than Mom and Dad?

  • Dr. Kurt

    Sorry, Eric – I wasn’t clear on your point. You are correct about the tendency for in-power groups to legislate their version of morality upon others, regardless of the facts. Thanks!

  • http://UK Kelly

    As a teenager myself I think that teenagers should have the right to confidential advise. The main reason most teens do not confide in their parents are because they feel ashamed and unworthy. Also many teens come from disfunctional families and may not want to talk about such private matters with their parents and we cannot legalise good family relationships.

  • Eric Olsen

    that’s about exactly what the study said Kelly – take care of yourself