Adolescents Obtaining Abortion Without Parental Consent: Their Reasons and Experiences of Social Support.

CONTEXT: Most states require adolescents younger than 18 to involve a parent prior to obtaining an abortion, yet little is known about adolescents' reasons for choosing abortion or the social support received by those who seek judicial bypass of parental consent for abortion. METHODS: In-depth interviews were conducted with 20 individuals aged 16-19 who sought judicial bypass in Texas between 2015 and 2016 to explore why they chose to get an abortion, who they involved in their decision and what their experiences of social support were. Data were analyzed thematically using stigma and social support theories. RESULTS: Participants researched their pregnancy options and involved others in their decisions. They chose abortion because parenting would limit their futures, and they believed they could not provide a child with all of her or his needs. Anticipated stigma motivated participants to keep their decision private, although they desired emotional and material support. Not all male partners agreed with adolescents' decisions to seek an abortion, and agreement by some males did not guarantee emotional or material support; some young women described their partners' giving them the "freedom" to make the decision as avoiding responsibility. After a disclosure of their abortion decision, some participants experienced enacted stigma, including shame and emotional abuse. CONCLUSIONS: Abortion stigma influences adolescents' disclosure of their abortion decisions and limits their social support. Fears of disclosing their pregnancies and abortion decisions are justified, and policymakers should consider how laws requiring parental notification may harm adolescents. Further research is needed on adolescents' experiences with abortion stigma.

Young Women's Experiences Obtaining Judicial Bypass for Abortion in Texas.

PURPOSE: Like many states, Texas requires parental consent for adolescents under 18 to access abortion care. Adolescents who cannot obtain parental consent can try to obtain a judicial bypass of parental consent through the court system. Little is known about adolescents' experiences with the judicial bypass process. Working with Jane's Due Process, an organization providing legal representation for adolescents, we explored adolescents' experiences with the judicial bypass process. METHODS: We conducted phone interviews with 20 adolescents, 16-19 years old in Texas between September and December 2016 about their experiences trying to obtain a judicial bypass. Data analysis included inductive and deductive coding based on theories about engaging with the court system and stigma regarding abortion and adolescent sexuality. RESULTS: In addition to unpredictability and logistic burdens such as finding time away from school and arranging transportation, participants described the bypass process as "intimidating" and "scary" and described judges and guardians-ad-litem who shamed them, "preached" at them, and discredited evidence of their maturity. Data suggest adolescents internalize stigma and trauma they experienced through rationalizing both the need for the bypass process and disrespectful treatment by authority figures. CONCLUSIONS: We found the bypass process functions as a form of punishment and allows state actors to humiliate adolescents for their personal decisions. The bypass process was implemented to protect adolescents from alleged negative emotional consequences of abortion, yet our results suggest the bypass process itself causes emotional harm through unpredictability and humiliation. Despite participants' resilience, the process may have negative consequences for adolescent health.

Treatment of unaccompanied minors in primary care clinics - caregivers' practice and knowledge.

BACKGROUND: By law, the provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents. In 2004, the Head of the Medical Administration Unit in the Ministry of Health issued Circular No. 4/2004 regarding the treatment of un-accompanied minors in primary care clinics. This circular aims to expand on the law, and permits the treatment of certain minors without parental attendance or consent. The circular does indicate that parents should be notified of the treatment retroactively, and provides cases in which it is possible to avoid notification altogether. The objectives of this study were: (a) to examine the scope of treatment of unaccompanied minors in primary care clinics; (b) to examine caregivers' knowledge of the provisions of the law and of the circular; and (c) to examine the implementation of the law's and the circular's provisions relating to the treatment of unaccompanied minors in primary care clinics in the community. METHODS: In a cross-sectional study, we surveyed 158 doctors and nurses from primary care clinics of the Haifa and Galilee districts of "Clalit Health Services". Respondents were selected via a snowball method, with attention to ensuring a heterogeneous clientele and geographic dispersion. RESULTS: Treatment seeking by unaccompanied minors is an existing and even widespread phenomenon. The vast majority of unaccompanied minors were in effect treated without parental consent. The main reason for minors' solitary treatment seeking was parents being busy. In 40% of the cases, where minors were treated without the presence and consent of their parents - parents were not notified of the fact. None of the respondents correctly answered all questions regarding the relevant provisions of the law and circular, and only 10% answered all the questions regarding the circular's parental notification requirements. CONCLUSIONS: The Israeli legal arrangement, pertaining to the provision of treatment to minors without the consent of their parents, is vague, unclear to medical and nursing practitioners and limited in terms of the needs of the minors themselves, as well as the needs of the medical system. There is a need for methodical and coherent regulatory thinking on the subject, as well as more thorough education of both nurses and physicians, in order to ensure the rights and interests of minors as well as the rights of their parents.

The Impact of a Parental Notification Requirement on Illinois Minors' Access to and Decision-Making Around Abortion.

PURPOSE: This study aims to examine the impact of a parental notification (PN) requirement on the frequency, timing, and out-of-state travel of minors seeking abortion, as well as changes in who minors involve in their decision, support received, and decision certainty. METHODS: We analyzed administrative and medical records of 1,577 women obtaining an abortion before and after implementation of a PN requirement at one Illinois facility. Using multivariate regression within a difference-in-differences framework, we quantified changes in the number and timing of women seeking care, frequency of parental awareness and support, travel from out-of-state, decision certainty, and anticipated coping among minors 17 years and below compared with young adults (YAs) aged 18-20 years. RESULTS: A smaller proportion of abortions to women ages 20 years and under post-law were among minors (39%-33%, p = .017). Compared with YAs, minors experienced a larger increase in parental awareness (71%-93% [minors] vs. 53%-58% [YAs], p < .000]; however, parents' support for the decision was unchanged. The proportion of minors certain of their decision went from 77% pre-law to 71% post-law (p = .099) compared with 82% pre- and post-law among YAs (p = .798). Compared with YAs, a larger proportion of minors obtained second trimester care post-law if coming from another state (21%-31% [minors] vs. 23%-16% [YAs], p = .022). CONCLUSIONS: Illinois' PN requirement was associated with a decrease in the number of abortions among minors, delayed care for those from out-of-state, increased parental awareness of the pregnancy, and no change in parents' support.

Patient portals and young people: addressing the privacy dilemma of providing access to health information.

Patient portals enable people to access their health information electronically, but concerns about confidentiality and privacy breaches, particularly for young people, may be impeding portal adoption in New Zealand. This paper considers the legal and ethical framework relating to health information privacy and informed consent in New Zealand, and proposes an approach to implementing patient portals for young people. Shared portal access (where both a young person and their parent or guardian have access to the young person's portal) may be appropriate for young children whose parents or guardians are responsible for their health care. However, as children mature and their capacity to make health care decisions increases, general practitioners will need to consider shifting to independent portal access by competent young people. The circumstances of each young person, including their best interests and rights, cultural needs and their views on information disclosure should be taken into account.

[Health professionals may have a dilemma about confidentiality healthcare of adolescents].

Confidentiality is paramount in healthcare, yet according to Danish guidelines, health professionals have to inform parents about their child´s situation until the age of 18 years. This is in contrast to Danish legislation regarding informed consent, where adolescents aged 15 years can consent to treatment. Young people value confidentiality, although they are unaware of the current guidelines. International guidelines on youth-friendly health services recommend split visits and confidential care while at the same time acknowledging parents' caretaking role, especially in adolescents with chronic illness.

Contraception for HIV-Infected Adolescents.

Access to high-quality reproductive health care is important for adolescents and young adults with HIV infection to prevent unintended pregnancies, sexually transmitted infections, and secondary transmission of HIV to partners and children. As perinatally HIV-infected children mature into adolescence and adulthood and new HIV infections among adolescents and young adults continue to occur in the United States, medical providers taking care of such individuals often face issues related to sexual and reproductive health. Challenges including drug interactions between several hormonal methods and antiretroviral agents make decisions regarding contraceptive options more complex for these adolescents. Dual protection, defined as the use of an effective contraceptive along with condoms, should be central to ongoing discussions with HIV-infected young women and couples wishing to avoid pregnancy. Last, reproductive health discussions need to be integrated with discussions on HIV care, because a reduction in plasma HIV viral load below the level of detection (an "undetectable viral load") is essential for the individual's health as well as for a reduction in HIV transmission to partners and children.

Fichero 120: la base de datos de Perfiles de ADN del Instituto Nacional de Toxicología y Ciencias Forenses de personas afectadas por la sustracción de recién nacidos / File 120: The Database of DNA profiles from the National Institute of Toxicology and Forensic Sciences of people affected by the subtraction of newborns

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The effect of parental involvement laws on teen birth control use.

In Volume 32, Issue 5 of this journal, Colman, Dee, and Joyce (CDJ) used data from the National Youth Risk Behavior Surveys (NYRBS) and found that parental involvement (PI) laws had no effect on the probability that minors abstain from sex or use contraception. We re-examine this question, augmenting the NYRBS with data from the State Youth Risk Behavior Surveys (SYRBS), and use a variety of identification strategies to control for state-level time-varying unmeasured heterogeneity. Consistent with CDJ, we find that PI laws have no effect on minor teen females' abstinence decisions. However, when we exploit additional state policy variation unavailable to CDJ and use non-minor teens as a within-state control group, we find evidence to suggest that PI laws are associated with an increase in the probability that sexually active minor teen females use birth control.

Parental Notification/Consent for Treatment of the Adolescent.

A continuing debate exists in both law and medicine regarding an adolescent's capacity to make rational, independent decisions. This is particularly true concerning an adolescent's capacity to make an informed decision with regard to abortion. Neuroscience research responds to the question by noting that the area of the brain involved in critical thinking and decision-making does not reach full maturity until the early to mid-twenties. Consequently, teens are more likely to act impulsively, rather than with rational and goal-oriented thought. Relying upon outdated information, medical organizations have generally maintained that most teens are fully competent to understand the risks and consequences of, and give informed consent to, medical procedures including abortion without parental knowledge, involvement, or consent. The American College of Pediatricians examines the data and challenges this position, emphasizing the important contribution of parents in advising their adolescent children about such life-changing decisions.

School-Based Body Mass Index Screening and Parental Notification in Late Adolescence: Evidence From Arkansas's Act 1220.

PURPOSE: In 2003, Arkansas enacted Act 1220, one of the first comprehensive legislative initiatives aimed at addressing childhood obesity. One important provision of Act 1220 mandated that all children attending public schools be screened for their body mass index (BMI) and the information sent home to their parents. Since then, eight other states have adopted similar school-based BMI screening and notification policies. Despite their widespread adoption and implementation, there is a dearth of empirical studies evaluating such policies, particularly for adolescents. The aim of this study was to evaluate whether adolescents, who had been previously screened in early adolescence, experienced changes in their health outcomes if they continued to receive screening and reporting throughout late adolescence (11th and 12th grades). METHODS: Secondary data from the Centers for Disease Control's Youth Risk Behavior Survey were analyzed using the method of difference-in-differences. Changes in outcomes between 10th and 12th grade were compared between a group of students who received screenings throughout 11th and 12th grades versus a later comparison group who were exempt from screening and reporting requirements in 11th and 12th grades. RESULTS: BMI screening and parental notification during late adolescence, given prior screening and notification in early adolescence, was not significantly related to BMI-for-age z-scores, the probability of being in a lower weight classification or exercise and dietary intake behaviors. CONCLUSIONS: Exposing 11th and 12th graders to BMI screening and reporting, given that they had been exposed in prior grades, was not associated with adolescents' health outcomes.

Association between the New Hampshire parental notification law and minors undergoing abortions in northern New England.

OBJECTIVE: To assess the association of the 2012 New Hampshire parental notification law with patterns of abortion in northern New England minors. METHODS: This was a retrospective cohort study examining all minors undergoing abortions at Planned Parenthood clinics in Vermont, New Hampshire, and Maine from 2011 to 2012. RESULTS: The number of abortions among minors in New Hampshire decreased from 95 to 50 (47%, 95% confidence interval [CI] 37.03-57.88; P=.015) from 2011 to 2012. Minors residing in Massachusetts, which has a parental consent law, accounted for 62% of this change. Abortions among New Hampshire minors decreased by 19% (from 57 to 46, 95% CI 10.05-31.91; P=.707), and minors did not seek more abortions at Planned Parenthood clinics in Vermont or Maine. The average age, gestational age, and number of second-trimester cases did not change. Parental awareness of the abortion increased from 2011 to 2012 in New Hampshire (54%, 95% CI 44.21-63.96 to 92%, 95% CI 80.65-97.36; P<.001); however, there was no difference in the overall rate of adult involvement during the study period. Four (8%) minors in New Hampshire used the judicial bypass option. CONCLUSION: Implementation of the New Hampshire parental notification law correlated with a decrease in minors undergoing abortions at Planned Parenthood clinics in the state, largely as a result of a decrease in the number of minors coming from Massachusetts. There was an increase in parental involvement but no change in overall adult involvement, and use of the judicial bypass option or minors crossing state lines was uncommon.

Knowledge of state-level abortion laws and regulations among reproductive health care providers.

OBJECTIVE: To assess the accuracy of knowledge of state-level abortion laws and regulations among clinicians who provide reproductive health care. METHODS: Members of several reproductive health professional organizations completed a self-administered survey. Respondents were asked if laws and regulations were present in their state. Responses were graded according to the Guttmacher Institute's monthly publication State Policies in Brief: An Overview of Abortion Laws. RESULTS: Three hundred forty-one surveys were completed. Fifty-nine respondents met exclusion criteria and were excluded. Of the remaining 282, most (80.1%) were physicians, and over half (55.0%) reported currently providing abortion services. Most (86.5%) considered themselves to be informed about abortion laws and regulations in their state. Knowledge of laws and regulations involving spousal involvement, mandatory waiting periods, and availability of private insurance coverage was high (77.0%-86.2%). Receiving reminders of state abortion laws and regulations was associated with significantly more accurate knowledge of parental notification and spousal consent laws, mandatory waiting periods, and availability of Medicaid and private insurance coverage (all p < .05). Receiving reminders and being a provider of abortion services were independent predictors of better knowledge of state abortion laws and regulations among clinicians who provide reproductive health care. CONCLUSION: Clinicians who provide reproductive health care had highly accurate knowledge of some abortion laws and regulations, but less accurate knowledge of others. Reminders of laws and regulations may increase knowledge among clinicians. Given the importance of accurate information, evaluation of mechanisms to increase knowledge of abortion laws and regulations may be warranted.

Do parental involvement laws deter risky teen sex?

Parental involvement (PI) laws require that physicians notify or obtain consent from a parent(s) of a minor seeking an abortion before performing the procedure. Several studies suggest that PI laws curb risky sexual behavior because teens realize that they would be compelled to discuss a subsequent pregnancy with a parent. We show that prior evidence based on gonorrhea rates overlooked the frequent under-reporting of gonorrhea by race and ethnicity, and present new evidence on the effects of PI laws using more current data on the prevalence of gonorrhea and data that are novel to this literature (i.e., chlamydia rates and data disaggregated by year of age). We improve the credibility of our estimates over those in the existing literature using an event-study design in addition to standard difference-in-difference-in-differences (DDD) models. Our findings consistently suggest no association between PI laws and rates of sexually transmitted infections or measures of sexual behavior.