Preventing Teenagers from Getting Contraceptives
Unless They Tell a Parent Puts Teens at Risk
Today, in every state, sexually active teenagers can get contraceptives to protect themselves against unplanned pregnancies and sexually transmitted diseases - even if they can't talk about sex with their parents. But some state and federal lawmakers want to take away teens' ability to protect themselves. They want to prevent sexually active teenagers from getting birth control unless they first tell their parents.
These proposals would radically alter long-standing public health policy and put teenagers at risk. Studies show that preventing teens from getting contraceptives unless they tell a parent won't stop teenagers from having sex. It will just drive them away from the services they need to protect themselves, leading to higher rates of unintended pregnancies and sexually transmitted diseases (STDs), including HIV. For these reasons, the leading medical organizations oppose laws that would require teens to involve their parents before they can get contraception. Such laws would endanger teens' health and lives and violate their rights.
Preventing Teenagers from Getting Contraception Unless They Tell a Parent Doesn't Decrease Sexual Activity; It Just Makes It More Dangerous.
Some people say that allowing teenagers to get contraceptives without first telling a parent encourages them to become sexually active and that, conversely, requiring teenagers to tell their parents before they get birth control would discourage sexual activity. But research about how teenagers behave flatly contradicts this theory. Teenagers don't become sexually active because they can go to a family planning provider and get contraceptives confidentially. In fact, on average, young women in the U.S. have been sexually active for 22 months before their first visit to a family planning provider.1 And studies show that making contraceptives available to teenagers does not increase sexual activity. Students in schools that make condoms available without requiring parental notification are less likely to have ever had sexual intercourse than students at schools that don't provide condoms confidentially. Moreover, in schools where condoms are readily available, those teens who do have sex are twice as likely as other students to have used a condom during their last sexual encounter.2
The research thus shows that requiring teens to tell a parent before they can access contraceptive services doesn't reduce their sexual activity - it will just put their health and lives at risk. For example, a recent study published in the Journal of the American Medical Association looked at what sexually active teenage girls seeking services at family planning clinics in Wisconsin would do if they could not get prescription contraceptives unless the clinic notified their parents.3 The results are important for anyone who cares about teenagers' well-being:
As this research shows, guarantees of confidentiality are one of the prime factors influencing whether a teenager will seek vital health services. In fact, in a nationwide study, the leading reason teenagers gave for not getting health care they knew they needed was concerns about confidentiality.5
Preventing Teenagers from Getting Contraception Unless They Tell a Parent Puts Teenagers' Health and Lives at Risk.
Cutting off teenagers' access to contraceptives doesn't stop them from having sex, it just drives them out of doctors' offices. When teenagers don't visit family planning providers, not only do they forego contraceptive services, they also miss or dangerously postpone screening and treatment for STDs, routine gynecological exams, and other vital health care services. Teenagers are already a high risk population:
If teenagers are prevented from getting contraceptives unless they involve a parent, these alarming numbers are likely to increase. A sexually active teen who does not use contraception has a 90 percent chance of getting pregnant within one year. In a single act of unprotected sex with an infected partner, a teenage girl has a 1 percent risk of acquiring HIV, a 30 percent risk of getting genital herpes, and a 50 percent chance of contracting gonorrhea.10
Leading Medical Groups Oppose Government Mandates That Would Prevent Teenagers from Getting Contraception Unless They Tell a Parent.
Medical experts caution that when teenagers cannot obtain contraceptives without involving a parent, they are less likely to protect themselves from unintended pregnancy and STDs. For this reason, the leading medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Public Health Association, and the Society for Adolescent Medicine, among others, oppose laws that would require teens to involve a parent.11
These groups have been vocal opponents of efforts to impose parental notification or consent requirements in federally funded programs. As these experts explained in a recent letter to Congress:
"Most teens seeking services at [federally funded programs] are already sexually active. Mandating parental involvement is likely to discourage many teens from seeking family planning services, placing them at an increased risk for sexually transmitted diseases and unintended pregnancies. Studies indicate that one of the major causes of delay by adolescents in seeking contraception is fear of parental discovery and that many would avoid seeking services altogether if parental involvement were required."12
Preventing Teenagers From Getting Contraception Unless They Involve a Parent Will Not Improve Family Communication.
The government cannot mandate healthy family communication. Federal law already requires health care providers in federally funded family planning clinics to encourage teenagers to talk to their parents about their health care decisions. Many teens, however, simply will not seek contraception if they cannot obtain it confidentially. Some justifiably fear that disclosure to their parents will lead to abandonment or abuse. Some simply have no caring and responsible parent to whom they can turn. Others live in families where sexuality is never openly discussed. As the New Jersey Supreme Court found, laws mandating parental involvement in teenagers' reproductive health care decisions ""cannot transform a household with poor lines of communication into a paradigm of the perfect American family.""13 Preventing teenagers from getting contraception unless they talk to a parent won't magically change these families; it will just result in teens having unprotected and unsafe sex.
Preventing Teenagers From Getting Contraception Unless They Involve a Parent Violates Teens' Rights.
The United States Constitution protects a minor's right to privacy in obtaining contraceptives. In Carey v. Population Services International, the Supreme Court relied on minors' privacy rights to invalidate a New York law that prohibited the sale of condoms to adolescents under 16. The Court concluded that the ""right to privacy in connection with decisions affecting procreation extends to minors as well as adults.""14
The Court held that the state interest in discouraging adolescents' sexual activity was not furthered by withholding from them the means to protect themselves. As Justice John Paul Stevens explained, to deny teenagers access to contraception in an effort to impress upon them the evils of underage sex is as irrational as if ""a State decided to dramatize its disapproval of motorcycles by forbidding the use of safety helmets."" The Constitution forbids this kind of ""government-mandated harm.""15
Following the principles articulated in Carey, lower courts have invalidated parental involvement requirements for contraception. In Planned Parenthood Association v. Matheson, for example, a federal district court recognized that teenagers' ""'decisions whether to accomplish or prevent conception are among the most private and sensitive,'"" and concluded that ""the state may not impose a blanket parental notification requirement on minors seeking to exercise their constitutionally protected right to decide whether to bear or beget a child by using contraceptives.""16
In addition to minors' constitutional rights, two of the most important sources of federal family planning funds in the nation - Title X and Medicaid - mandate confidentiality for teenagers seeking contraceptive services in those programs. Federal courts have consistently ruled that parental consent and notification requirements impermissibly conflict with this mandate.17
Moreover, virtually every state has passed laws permitting teenagers to obtain care for STDs without involving a parent and most have express legal provisions guaranteeing confidential access to contraceptives as well. Even in those states without express laws, teens still have a constitutional right to access confidential care. Forced parental involvement would represent a dangerous reversal of long-standing public health policies.18
Endnotes
1. Linda Hock-Long, et al., Access to Adolescent Reproductive Health Services: Financial and Structural Barriers to Care, 35 PERSP. SEXUAL & REPROD. HEALTH. 144, 144 (2003).
2. Susan M. Blake, et al., Condom Availability in Massachusetts High Schools: Relationships With Condom Use and Sexual Behavior, 93 AM. J. PUB. HEALTH 955, 957 (2003).
3. Diane M. Reddy, et al., Effect of Mandatory Parental Notification on Adolescent Girls' Use of Sexual Health Care Services, 288 JAMA 710 (2002).
4. Id. at 712.
5. Cathy Schoen, et al., The Commonwealth Fund Survey of the Health of Adolescent Girls (Nov. 1997), available at http://www.cmwf.org/programs/women/asoleshl.asp; Schoen, et al., The Health of Adolescent Boys: Commonwealth Survey Findings (Jun. 1998), available at http://www.cmwf.org/programs/women/boysv271.asp; see also Jeannie S. Thrall, et al., Confidentiality and Adolescents' Use of Providers for Health Information and for Pelvic Examinations, 154 PEDIATRICS & ADOLESCENT MED.. 885, 885 (2000); Carol A. Ford, et al., Foregone Health Care Among Adolescents, 282 JAMA 2227, 2227-28 (1999); Laurie S. Zabin, et al., Reasons for Delay in Contraceptive Clinic Utilization: Adolescent Clinic and Nonclinic Populations Compared, 12 J. ADOLESCENT HEALTH 225, 229 (1991).
6. Donna Futterman, Youth and HIV: The Epidemic Continues, 8 PRN NOTEBOOK 21 (2003).
7. ALAN GUTTMACHER INSTITUTE, FACTS IN BRIEF: TEEN SEX AND PREGNANCY (1999) [hereinafter AGI].
8. Kathleen L. Feroli & Gale R. Burstein, Adolescent Sexually Transmitted Diseases: New Recommendations for Diagnosis, Treatment, and Prevention, 28 AM. J. MATERNAL/CHILD NURSING 113, 114 (2003).
9. STANLEY K. HENSHAW, ALAN GUTTMACHER INSTITUTE, U.S. TEENAGE PREGNANCY STATISTICS WITH COMPARATIVE STATISTICS FOR WOMEN AGED 20-24 5 (2003).
10. AGI, supra note 7.
11. AMERICAN MEDICAL ASSOCIATION, POLICY H-75.998: OPPOSITION TO HHS REGULATIONS ON CONTRACEPTIVE SERVICES FOR MINORS; AMERICAN MEDICAL ASSOCIATION, POLICY H-60.965: CONFIDENTIAL HEALTH SERVICES FOR ADOLESCENTS; American Public Health Association, Policy Statements Adopted by the Governing Council of the American Public Health Association, 9001: Adolescent Access to Comprehensive, Confidential Reproductive Health Care, 81 AM. J. PUB. HEALTH 241 (1991); Society for Adolescent Medicine, Position Paper on Confidential Health Care for Adolescents, 21 J. ADOLESCENT HEALTH 408 (1997); Society for Adolescent Medicine, Position Statements on Reproductive Health Care for Adolescents, 12 J. ADOLESCENT HEALTH 657 (1991); see also AMERICAN ACADEMY OF FAMILY PHYSICIANS, AAFP POLICIES ON HEALTH ISSUES: ADOLESCENT HEALTH CARE (2001); AMERICAN ACADEMY OF PEDIATRICCS, Policy RE9151: Confidentiality in Adolescent Health Care (1989); Committee on Adolescence, American Academy of Pediatrics, Policy Statement RE9841: Contraception and Adolescents, 104 PEDIATRICS 1161 (1999).
12. Letter from American Academy of Family Physicians; American Academy of Pediatrics; American College of Obstetricians and Gynecologists; American Medical Association; American Public Health Association; American Society of Reproductive Medicine; American Medical Women's Association; and Society for Adolescent Medicine to House Appropriations Committee, U.S. House of Representatives (Jun. 18, 2003).
13. Planned Parenthood v. Farmer, 762 A.2d 620, 637 (N.J. 2000).
14. Carey v. Population Servs. Int'l, 431 U.S. 678, 693 (1977) (plurality opinion).
15. Id. at 715-16 (Stevens, J., concurring).
16. Planned Parenthood Ass'n v. Matheson, 582 F. Supp. 1001, 1008, 1009 (D. Utah 1983) (quoting Carey, 431 U.S. at 685); see also Parents United for Better Schs., Inc. v. Sch. Dist. of Philadelphia Bd. of Educ., 978 F. Supp. 197, 209-10 (E.D. Pa. 1997) (holding that Constitution forecloses an interpretation of state law that would require parental consent for a teenager to obtain contraceptives), aff'd 148 F.3d 260 (3d Cir. 1998); T.H. v. Jones, 425 F. Supp. 873, 880-82 (D. Utah 1975) (holding that state regulation requiring parental consent for contraceptives violates teenagers' constitutional right to privacy), aff'd mem. on statutory grounds, 425 U.S. 986 (1976); cf. Doe v. Irwin, 615 F.2d 1162 (6th Cir. 1980) (rejecting claim that parents have constitutional right to notification when their children seek contraceptives through a publicly funded clinic).
17. E.g., Jones v. T.H., 425 U.S. 986 (1976), aff'g mem. on statutory grounds, 425 F. Supp. 873 (D. Utah 1975); County of St. Charles, Missouri v. Missouri Family Health Council, 107 F. 3d 682, 684-85 (8th Cir. 1997); Planned Parenthood Ass'n v. Dandoy, 810 F.2d 984, 986-88 (10th Cir. 1987); Jane Does 1 through 4 v. Utah Dep't of Health, 776 F.2d 253, 255 (10th Cir. 1985); New York v. Heckler, 719 F.2d 1191, 1196 (2d Cir. 1983); Planned Parenthood Fed'n v. Heckler, 712 F.2d 650, 656-63 (D.C. Cir. 1983).
18. Heather Boonstra & Elizabeth Nash, Alan Guttmacher Institute, Minors and the Right to Consent to Health Care, GUTTMACHER REP. ON PUB. POL'Y, Aug. 2000, at 4, 5.