AAP affirms adolescents’ rights to confidential care when seeking abortion: policy
Adolescents have the right to confidential care when seeking abortion services, according
to a position reaffirmed by the Academy in an updated policy statement.
The stance is in line with other professional medical societies such as the American
Medical Association, the Society for Adolescent Health and Medicine, the American
Public Health Association and the American College of Obstetricians and Gynecologists.
The Adolescent’s Right to Confidential Care When Considering Abortion, from the Committee on Adolescence, is available at http://dx.doi.org/10.1542/peds.2016-3861 and will be published in the February issue of Pediatrics.
Effects of state policies
Since 2011, states have been enacting more restrictive policies on abortion services
than seen in previous decades. In 2015, 38 states required parental involvement in
a minor’s decision to have an abortion. The Supreme Court has declared it to be constitutional
for states to develop their own mandatory parental notification laws for minors seeking
abortion services provided a judicial bypass process is in place.
The mandatory parental notification law is rooted in preservation of family communication
and in the physical and emotional well-being of adolescents. However, research has
shown that these laws have the opposite effect. Minors, particularly younger adolescents,
are likely to involve a trusted adult when seeking abortion services regardless of whether a state law mandating parental notification is in place. Adolescents choosing
not to involve parents do so because of their ability to accurately predict a family
crisis stemming from severe anger and rejection.
It also has been found that the proportion of adolescents seeking abortion services
in the second trimester has increased in several states where mandatory parental notification
laws are in place. Rather than having a beneficial health impact, these laws may delay
care, leading to a second trimester procedure that not only is more medically complex,
but also associated more with psychological sequelae compared to abortion services
in the first trimester.
While the judicial bypass process may seem to be a reasonable compromise, adolescents
find this process to be an obstacle in accessing health care. This process has been
described as burdensome, humiliating and stressful. Importantly, it has been found
that adolescents often are not made aware of this process in states requiring mandatory
Concerns related to adolescent decision-making ability often are questioned when considering
the need for mandatory parental involvement. Currently, laws allow adolescents to
make independent medical decisions during pregnancy and for their children. The policy
statement points out, therefore, that it is consistent to protect the right of adolescents
to seek abortion services confidentially, without mandatory parental notification.
The Academy advocates a strong family relationship and holds the belief that parents
generally act in the best interest of their children.
Adolescents have the right to confidential care when considering abortion services.
Health care professionals are in a position to facilitate family communication and
should strongly encourage a pregnant adolescent to seek guidance from a trusted adult
when considering all pregnancy options.
Concern for incest or abuse should be raised when a younger adolescent resists parental
involvement when seeking abortion services.
It ultimately is the pregnant adolescent’s right to decide who should be involved
in the decision-making process and what the outcome of the pregnancy will be.
Dr. Menon, lead author of the policy, is the liaison from the North American Society
for Pediatric and Adolescent Gynecology to the AAP Committee on Adolescence.