Everybody's Doing It

This year, congressional and state lawmakers will likely consider whether to require family planning clinics that receive federal funds to notify parents when teens seek birth control. Now, a new study suggests that such laws would result in more teens having unprotected sex.

Only two states – Texas and Utah – require clinics that are funded by the state to notify parents before giving teens prescription contraception such as the Pill and Depo-Provera. Three other states – Virginia, Minnesota and Kentucky – considered similar legislation last year.

In Congress, bills have been introduced every year since the late 1990s to change confidentiality rules at family planning clinics to exclude teens. This year, there is more support in the Senate for such legislation, reproductive rights advocates say.

"I suspect parental consent is on the to-do list for the coming year," said Cynthia Dailard, senior public policy associate at the Alan Guttmacher Institute in New York, an advocacy and research group that supports reproductive choice.

This week, a study conducted by the institute and published by the Journal of the American Medical Association of more than 1,500 young women under 18 in 33 states suggested that teens would forgo birth control if they needed parental consent. Nearly one in five female teens surveyed at federally funded family planning clinics would either use no birth control or unreliable methods such as withdrawal if parental notification were required. Allowed multiple responses, seven percent said not having sex would be one of their responses to a law requiring that they tell a parent that they were seeking prescriptive contraception. Forty-six percent would seek condoms as an alternative birth control.

"We know that kids wouldn't stop having sex," said lead study author Rachel Jones, senior research associate at the institute. "Instead, we would have more kids having unprotected sex."

Surprisingly, 60 percent of the girls surveyed said their parents knew they were visiting a family planning clinic. The younger the girl, the more likely her parents knew she was at the clinic. Persuading teens to notify their parents about their sexual activity and reproductive health is preferable to mandating it, Jones said.

"Family planning clinics are doing a good job of encouraging teens to talk with their parents about sex and contraception," she said.

Still, 70 percent of teens whose parents did not know they were at the clinic said they would not seek prescription birth control if parental consent were required. Among the reasons teens cited for not telling their parents they visited the clinic was a desire to be self-sufficient and a fear of disappointing parents.

The Guttmacher study supports the results of smaller state and city studies on parental consent and contraception. The study authors, however, admit that the findings are based on hypotheses of what teen girls would do, not what they have done in response to parental notification laws.

Groups supporting parental notification such as Concerned Women for America and the Family Research Council said the study was biased because the Guttmacher Institute is affiliated with Planned Parenthood, which operates family planning clinics nationwide.

The parental notification debate in Congress centers on clinics that receive federal funding through Title X of the Public Health Services Act of 1970. Title X family planning clinics must offer confidential care regardless of age. Title X funds 4,500 of the 7,000 family planning clinics nationwide. The clinics served nearly 1 million teens under age 18 in 2001. Texas and Utah prohibit the use of state funds for clinics that don't require parental consent.

Rep. Todd Akin, a Republican from Missouri, introduced a bill in 2002 that would require parental notification at least five business days prior to giving contraception services to teen girls at clinics funded under Title X. Amendments including parental consent requirements for teens to access family planning services have also been introduced.

Supporters of parental notification say that allowing minors to keep their reproductive decisions secret erodes parent-child relationships and helps mask abuse. McHenry County, Ill., about 50 miles northwest of Chicago, has mandated parental notification since a 1997 case shocked the community. A 12-year-old girl who was being raped by her 37-year-old teacher received Depo-Provera shots at the county clinic. The teacher was making the girl's appointments and driving her to the clinic.

Rules under Title X did not allow the clinic to inform the young woman's parents that she was getting the contraception shots. The teacher, William Saturday, pled guilty to criminal sexual assault charges and was sentenced to 10 years in prison. He served less than half that sentence and is now living in the county as a registered sex offender.

"The Title X grant aided in his crime," McHenry County Supervisor John Heisler told a 2002 Congressional hearing on Title X. "It is shocking to think that a federal grant program can circumvent our state code."

McHenry County now refuses about $50,000 a year in Title X funding so it can require parental consent. But the law intending to protect minors could have had an unintended consequence. The county teen pregnancy rate has increased since the policy was enacted, while the teen pregnancy rate in surrounding counties declined, according to a 2004 study in the American Journal of Public Health.

Dr. Vinny Chulani, director of the division of adolescent medicine at Orlando Regional Medical Center in Florida said in his experience parental notification can prevent teens from seeking needed medical care. He recalled diagnosing two 16-year-old girls with advanced cases of the human papilloma virus that can lead to cervical cancer. He said neither girl has had treatment to prevent cervical cancer because they need parental permission.

"The distant threat of cervical cancer is easier to bear than the immediate threat of revealing their sexual activity to their parents," Chulani said.

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