Adolescents' Access to Reproductive Health Services and Information
09.03.10 - Young women face particular obstacles to accessing reproductive health services and information. In addition to laws requiring parental involvement before a minor can obtain an abortion, they may face state laws and policies that: (a) threaten their confidentiality when seeking any reproductive health services; (b) hinder their access to contraception; or (c) deny them age-appropriate sexuality education at school. The Center works to protect adolescents' rights and health by fighting to prevent passage of these laws and policies, and by challenging them in court where possible.
Confidential Health Services
Placing barriers on teens' access to confidential health services directly endangers their health and welfare because it deters them from seeking the reproductive and sexual health-care services and information they need to prevent unwanted pregnancies, protect their mental and physical health, and avoid sexually transmissible diseases.
In the last decade, under the guise of trying to protect teens from sexual abuse, several states have attempted to use child abuse and statutory rape reporting laws to prevent teens from accessing confidential reproductive health care services. For example, in 2003, the Kansas Attorney General construed the state's child-abuse reporting law to require that doctors, school counselors, therapists and other professionals report any sexual activity involving a minor under the age of 16 as evidence of sexual abuse. The law was so broad as to require a psychologist to report a teen who disclosed that she had "made out" with her same-aged boyfriend. The Center brought a lawsuit against the A.G.'s interpretation, and succeeded in getting it blocked by a federal court. In another example, in 2005, the Attorney General of Indiana and state Medicaid investigators attempted to obtain the medical records of teens served by a family planning clinic, allegedly to investigate accusations that the clinic had failed to properly report cases of abuse.
The constitutional right to privacy protects adolescents' access to and use of contraception. Forced parental involvement in teens' contraceptive decisions endangers teens' health and violates their constitutional rights. Research shows that requiring minors to tell a parent before they can access contraception delays or prevents them from seeking reproductive health services, but does not reduce their sexual activity. When teenagers do not seek reproductive health services, they forego not only contraceptive services, but also testing and treatment for sexually transmitted infections, routine gynecological exams, and other vital health care. Consequently, the nation's medical and public health organizations consistently oppose forced parental involvement in minors' efforts to seek contraception. These groups include: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women's Association, and The Society for Adolescent Health and Medicine.
Nonetheless, over the past three decades, state legislatures have repeatedly attempted to restrict teens' access to reproductive health care by trying to impose parental consent requirements on minors seeking contraception through clinics funded by Title X and Medicaid. However, because Title X and Medicaid protect teens' privacy and explicitly prohibit parental consent requirements for teens seeking contraception, those attempts have thus far been invalidated when challenged in court. Nevertheless, in both 2007 and 2009, federal legislation was introduced in the House that would have required Title X family planning clinics to provide written notice to a parent or legal guardian before providing an adolescent with any form of contraception. Fortunately, those bills did not make it out of the House committee.
Abstinence-only education programs taught in U.S. public schools suffer from numerous flaws, including that they are ineffective in causing teens to remain abstinent; they provide students misinformation and fail to provide information necessary to avoid pregnancy and sexually transmitted infections; they ignore the needs and circumstances of lesbian, gay, bisexual, and transgender youth; they propagate religious values; and they harm the health and well-being of girls by teaching gender stereotypes as "facts."
Since 1982, the federal government has spent over 1.5 billion dollars on grants and matching grants to promote the teaching of abstinence-only-until-marriage education programs. Recipients of much of this funding must comply with guidelines that preclude them from teaching comprehensive sex education. Abstinence-only education teaches that abstinence from sexual activity is the only way to avoid pregnancy out-of-wedlock, sexually transmitted infections, and other associated health problems.
By contrast, comprehensive sex education not only presents abstinence as a positive choice, but it also teaches minors how to prevent pregnancy and sexually transmitted infections, should they engage in sexual activity. Comprehensive sexual education programs help to reduce the rates of maternal mortality, abortion, adolescent pregnancies, and HIV/AIDS. The failure to provide students with comprehensive sex education raises serious public health and human rights concerns, especially since the U. S. has one of the highest rates of teen pregnancy in the developed world and because almost half of the 19 million new sexually transmitted infections each year occur among young people ages 15 to 24. The Center therefore advocates that the federal government and the states cease funding and implementing abstinence-only programs and instead provide students with comprehensive sexuality education.