The Reproductive Rights of Minors by Allison Crews
Although teenagers in the United States are expected to make mature adult decisions while being criticized for behaving wildly and irrationally and are required to take legal responsibility for their actions, they are still denied the basic rights of citizens. They are denied the right to vote, the right to serve their country, and, in early adolescence, the right to drive. And, in most states, teenagers are denied the right to control their own reproduction. While some argue that such limitations are placed in order to protect the lives and safety of the youth, this argument seems fairly illogical when applied to the concept of reproductive rights and protections. An unfair burden is placed on teenagers in our society; they are forced into socially constructed roles of reckless immaturity while being pushed towards an abrupt thrust into a harsh and responsibility-laden adult world. Even when teenagers choose to adopt the adult role of parent, and thus accept adult responsibilities, they are denied the right to be treated as equal to parents of majority age. Unrestricted access to affordable and reliable birth control would enable teenagers to make more positive life decisions, and help aid them in protecting their bodies and taking preparatory adult responsibilities, hence helping to aid them in the often volatile transition between childhood and adulthood.
Adolescents are sexual by nature, as are humans in any stage of development. As their hormone levels surge and they begin grappling with adult roles and expectations about sexual behavior, many teens become sexually active. According to the Journal of Marriages and Families (63:669), teenagers are becoming sexually active at increasingly younger ages, the number of sexual partners being taken is steadily increasing, and only a very small percentage of teenagers (1 in 5) are virgins when they reach the age of majority. Politicians, concerned citizens and lawmakers are becoming more aware of and disturbed by teenage sexual behavior. And rightly so. Teenage sexual behavior has many serious risks attached, for both the individual adolescent and society as a whole. Unintended pregnancies and sexually transmitted diseases result from sexual activity in adolescents. In the United States, over 1,000,000 teenager girls get pregnant every year (Teen Pregnancy Prevention Initiative). Yet, surprisingly, as the rates of teenage sexuality have soared, teenage pregnancy rates have plummeted. The national teen pregnancy rate dropped by 21% between 1991 and 1999 (Luker, 73), and the California teen pregnancy rate dropped 9% in the one-year period between 1995 and 1996 (Teen). What could cause this disparity between increasing rates of teenage sexual activity and decreasing rates of teenage pregnancy? The steadily decreasing rate of teenage pregnancy in America can be accredited almost solely to the increased access to and use of contraceptives and reproductive health services by teenagers (Glasser). According to training material published by the Teen Pregnancy Prevention Initiative, "the overwhelming majority of teens (88.1%) say that it is important for teens to use contraception each and every time they have sex." In the past three decades, teenagers have been afforded more and more control over their reproductive health, and society is beginning to reap the benefits of this reallocation of control from parents and the state to those whose bodies are in danger. But towards the end of the 1990's, a conservative backlash against adolescents' newly allowed reproductive rights and the reproductive rights afforded to all women could be felt across the nation, and many new restrictions were placed on adolescents' reproductive freedoms.
1997 and 1998 saw two new bills introduced to congress, both requiring that parental consent be given before contraceptives were dispersed by any program receiving federal funding (Glasser). On the same token, Senator O'Malley (R, Illinois) introduced a senate bill that would "revamp" the Birth Control to Minors Act, which would restrict birth control availability so that only teenagers who were either married, parents or already pregnant, or had received parental consent could have access to contraceptives (ILEagles, 1999). With these new restrictions on access to birth control, the risk of the teenage pregnancy rate rising, once again, is high. Beyond this obvious possible repercussion of increased reproductive restrictions, remains the fact that when teens are disallowed access to reproductive health care, they are less likely to use potentially life-saving barrier methods of birth control. Thus, responsible sexual decision-making and adult-like thinking is discouraged.
Teens who do become pregnant may soon have even less options available to them, when deciding which course of action to take in regards to their pregnancy. The U.S. House of Representatives and U.S. Senate voted in June of 1999 to pass a measure that would federally restrict a woman's legal right to a safe abortion (Kennedy, 24). This measure, called the Child Custody Protection Act would restrict the right of any person other than a legal parent to bring a minor across state lines for a reproductive medical procedure, making such an act a federal misdemeanor if the minors home state had "parental notification" laws in place. Besides the obvious infringement on the rights of young women, this measure has the potential to lead to physical threat and endangerment to young women living abusive or incestuous households. Even in non-abusive households, the risk of a teenager seeking an illegal abortion in the hopes of sparing their family the "embarrassment" of an unplanned and premarital pregnancy increases (Bell, 116+). Such illegal abortions increase the chance of life-threatening complications arising as a result of the procedure. When faced with the difficult situation of an unplanned pregnancy, young women often feel ashamed, isolated and scared during the early stages of pregnancy, and can have a terribly difficult time deciding whether they should abort the pregnancy or carry the child to term, without the added stress of being legally forced to inform her parents of the pregnancy.
Even when a young woman chooses to carry her pregnancy to term, undue restrictions are placed on her right to attain medical care for herself and her unborn child. Shockingly, twenty-three states have statutes in place that restrict a pregnant adolescent from "obtaining prenatal care and delivery services without parental consent or notification"(Boonstm and Nash, 2000). Doctors practicing within these states are not legally allowed to provide obstetric care for pregnant minors without written parental consent, even in a desperate situation in which birth is imminent. Yet, our social standards continue to dictate that teenage mothers be held "responsible" for their actions or risk falling prey to vicious social stigma and vilification. When teen mothers do allow the state and their parents to take part in their prenatal decision-making, they are seen as weak, immature, and incompetent (Maynard, 59-68). However, teen mothers living in most states are given little choice BUT to relinquish control over their reproductive and parental decision making to their parents and the government. Once a pregnant teen gives birth, her choices and options as a parent continue to be limited. Only twenty-nine states and the District of Columbia allow parents of minority age the same decision making rights as adult parents. In the twenty-one states which do not legally view teen parents as equals to adult parents, a parent under the age of eighteen must continue to obtain parental permission to seek healthcare for her own child (Boonstm,Nash). The dichotomy of the socially constructed restrictions placed on pregnant and parenting teenagers and the reality of the responsibilities that teen parents must take on is glaring and inexplicable. How can one be expected to act as a mature adult, when all of the rights of mature adults are denied them? Such denial of rights leads to unfair stereotypes and marginalization of teen parents, who are restricted in their freedoms while being expected to act responsibly, and are left little legal choice but to fall into dependence on their parents and society. These dueling expectations and realities lead to increased incidences of "failure" in teen parents, who may feel helpless at trying to defy social stereotypes when social structure and political legislation keeps them stigmatized and dependant.
Even the American College of Obstetricians and Gynecologists believes that adolescents should be afforded equal and confidential access to reproductive health care and family planning services. In their published policy on adolescent health care, the ACOG states:
"Health professionals have an obligation to provide the best possible care to respond to the needs of their adolescent patients. This care should at a minimum, include comprehensive reproductive health services, such as sexuality educations, counseling[and] access to contraceptivesLegal barriers that restrict these services should be removed. The potential risk 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."
Despite the many restrictions placed on teenagers who are seeking reproductive health care, several options for receiving contraceptive and reproductive services do exist for teenagers in various states. Most notable is Title X, an addition to the Public Health Service Act, which was enacted by Congress in 1970 (Gold). This program remains the only federal program designed to provide family planning services to low-income women across the country. Title X was enacted to fulfill the need for reproductive health services amongst the economically disadvantaged in the United States, who reported having more babies then they wanted and could financially care for, due to their limited access to effective birth control. Title X provides grant money in order to support a network of clinics that, in turn, use the money, in part, to staff personnel and subsidize the cost of contraceptives for low-income women. More than 4,500 family planning clinics received money from Title X in 1999. Women taking advantage of this program pay a nominal fee or no fee at all, based on their personal income. Surprisingly, minors seeking family planning services through Title X clinics pay fees based on their own incomes, not those of their parents, despite state restrictions on their access to birth control elsewhere. Title X guarantees confidentiality to all clients, regardless of age. Because of this, many teenagers who would not otherwise have access to birth control have sought the family planning services provided by Title X funded clinics. In 1981, the Reagan administration tried to make parental notification of all reproductive health services a requirement for all clinics receiving Title X funds (Feminist). However, the Federal District Court clearly saw that such legislation would be unconstitutional, and minors maintain the right to access family planning services provided by Title X clinics.
Another option available to teens seeking reproductive health care in some areas is school-based clinics and health centers. In 1999, 1,135 school-based health centers and clinics existed in the United States (Dailard). School based health centers can be found in 45 states (excluding Nevada, North and South Dakota, Idaho and Wyoming) and the District of Columbia. These health centers are largely funded by the state, with limited federal funds coming in through maternal and child health care block grants and a small number of federally funded programs, such as the Healthy Schools/Healthy Communities program. These school-based health centers most often provide reproductive health services, but 2 out of 3 require parental consent to obtain such services. Typically offered reproductive health services include pregnancy testing (provided at 9 out of 10 locations), STD testing and treatment, HIV testing, gynecological exams and Pap smears. 2 out of 10 school-based clinics even offer prenatal care. However, contraceptive services seem to be publicly viewed as different from other reproductive health services, and are prohibited in 3 out of 4 school clinics. Not surprisingly, a vast majority of clinics that do not offer contraceptives do so out of force, not choice. 96% percent of such clinics were prohibited from distributing contraceptives by either the school district, the school itself, or the state (Dailard). However, more clinics offer contraceptives to students today than have in the past. Julia Graham Lear, program director of the Making the Grade grant program offers the idea that the HIV/AIDS crisis of the 1990's helped to solidify, in the minds of many decision-makers, the idea that teenagers need unrestricted access to barrier methods of contraception. She says:
"The price was too high in many communities for parents and educators to ignore the changing norms. More students were becoming sexually active, and it became apparent that there was an increasing need to bring reproductive health services to high school students in a way that addressed their very real problems" (Dailard).
Despite these restrictions, Title X-funded clinics and school-based clinics remain a valid means for teenagers to obtain reproductive health care services that might otherwise be denied them.
Clearly, we understand that teenagers (not all, but most) will become sexually active. To deny the fact that teenagers always have been, and always will be, sexual beings with the ability to love, procreate and nurture, is to deny a great truth of humanity and is to risk putting the lives of our youth in danger. When teenagers are denied access to basic family planning services, their chances of contracting an STD, such as HIV/AIDS, or becoming unintentionally pregnant increase. Even once a teenager falls victim to the consequences of unprotected (or under-protected) sexual activity, they remain limited in their options and rights. Because of these limitations, the problems caused by their sexual indiscretions are further dramatized, and teenagers are left in the murky quagmire between adolescent restrictions and adult responsibility. Although some resources are available to teenagers seeking family planning services, many teenagers go without access to basic contraceptives, and are thus denied the basic rights of a citizen. Only when teenagers are given full access to a wide range of effective birth controls, will the social ills associated with teenage sexual activity and teen pregnancy begin to dissipate.
ACOG Adolescent Health Care Page. American College of Obstetricians and Gynecologists. 13 Nov. 2001.
Bell, Karen and Bill Bell. "States Should Not Require Parental Notification Laws for Abortion." Teenage Sexuality. San Diego: Greenahaven Press, 2001. 116-121
Current Legislation. Eagle Forum of Illinois. 15 Nov. 2001 http://www.ileagles.net/Ilpolitics/99galeg.htm
Dailard, Cynthia. Minors and the Right to Consent to Health Care. Alan Guttmacher Institute. 16 Nov. 2001. http://www.agi-usa.org.pubs/ib_minors_00.html
Davis, Erin Calhoun and Lisa V. Friel. "Adolescent Sexuality: Disentangling the Effects of Family Structure and Family Context." Journal of Marriages and Families. 63 (August 2001): 669-685
Feminist Campus Activism Online: SAM Unit 2-Struggle for Change (Restrictions on Contraceptives). Feminist Majority Foundation. 13 Nov. 2001 http://www.feminist.org/sam2_restrictions.asap
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Gold, Rachel Benson. Title X: Three Decades of Accomplishment. Alan Guttmacher Institute. 16 Nov. 2001. http://www.agi-usa.org/pubs/ib_1-01.html
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Kennedy, Miranda. "Mother, May I?" Ms. Oct.-Nov. 1999:24-25
Luker, Kristin. "The Extent of Teen Pregnancy is Exaggerated." Dubious Conceptions: The Politics of Teen Pregnancy. Caimbridge, MA: Harvard UP, 1996. Rpt. In Teenage Sexuality. San Diego: Greenhaven Press, 2001. 69-77
Maynard, Rebecca. "Teenage Pregnancy is a Serious Problem." Teenage Sexuality. San Diego: Greenhaven Press, 2001. 59-68