LETTER TO THE EDITOR:
Without a doubt, young people under the age of 18 are capable of making informed health care decisions about their bodies, and yes, this includes abortion care.
It’s not uncommon that I care for young people as an Obstetrics & Gynecology resident physician. Due to the sensitive nature of my job, the majority of the care I provide can be done confidentially without parental notification or consent.
During a busy clinic afternoon, I see a 16 year old patient. They confide that they would like testing for sexually transmitted infections. We talk about birth control, and after weighing the pros and cons, they decide they want a Depo-Provera injection to prevent pregnancy. After a quick shot by the nurse, they are on their way-- no parental notification necessary.
Later that weekend, I’m on call on Labor & Delivery. A 14 year old patient comes into triage and is in active labor. They’re admitted and choose to get an epidural. Later in their labor course, a cesarean section is recommended. After the risks, benefits, and alternatives are discussed, they sign the consent forms without parental notification.
The next week, I’m in clinic again talking to a 17 year old and informing them of a positive pregnancy test. They look down, and I can see their face go through a series of mixed emotions. After a minute or two of silence, they look up and state without hesitation, “How can I get an abortion?”. I can feel a heaviness in the room as I explain that they can get abortion care, but only after parental notification.
In the state of Illinois, the Parental Notice of Abortion (PNA) Act requires a healthcare provider to notify an adult family member (parent, grandparent, step-parent living in the home, or legal guardian) at least 48 hours prior to performing an abortion for a patient under 18. The law creates a judicial bypass for those who cannot notify an adult family member. With judicial bypass, a young person can schedule a court hearing and ask a judge for permission to have an abortion without parental notification.
According to the Guttmacher Institute, in 2016, the pregnancy and abortion rates in Illinois among young people ages 15-17 were 15 per 1,000 and 5 per 1,000 people capable of becoming pregnant, respectively. The CDC also reports that 75% of pregnancies were unintended among young people aged 15 to 19 years. Although rates of pregnancy in young people ages 15-17 declined 44% between 2008 and 2011, these statistics demonstrate that accesible abortion care has been and continues to be an important consideration in health care for many young people.
Abortion care continues to be one of the most controversial, polarizing, and stigmatized topics when it comes to health care, and politics in general in the United States. Perhaps, it’s because of the sensationalized and intimate nature of the topic that harmful restrictions such as PNA are put into place under the guise of protecting young people. However, decades of research demonstrate the quite the opposite is true.
Young people in Illinois are recognized as autonomous, independently-thinking beings when it comes to a number of personal health care issues from sexual health care, mental health care, and substance abuse care. When a young person becomes pregnant, they are further recognized as emancipated individuals. This means they can consent for any general health care, can parent, and can place a pregnancy up for adoption without parental notification. However, the one exception under this law is if they choose to terminate the pregnancy. We trust young people in all health care circumstances to make decisions for themselves, except related to abortion care-- a safer procedure than a cesarean section or even a vaginal delivery.
Additionally, research consistently demonstrates that young people voluntarily involve a parent when faced with an unplanned pregnancy. When a parent is not involved, usually another trusted adult such as a teacher, neighbor, coach, or health care provider is involved in their decision-making process. There are very real concerns for those who choose not to involve a parent, these include fear of homelessness, abuse, or being coerced into parenting against their will. This presents a significant safety issue to young people.
Although judicial bypass was put into place to prevent harm from parental notification, it adds significant barriers to accessing abortion care. Besides delaying the procedure itself, there are massive logistical hurdles to navigating this process such as obtaining transportation to attend a hearing. This process only adds significant stress to an already nerve-wracking experience.
Many major medical organizations such as the American Medical Association and American College of Obstetricians and Gynecologists oppose laws forcing parental involvement in health care decision-making for young people. Healthy family relationships cannot be legislated, and there is only more damage done in an already difficult health care decision to an already vulnerable population of people.
Every day, I work closely with young people who astonish me with their strength to contemplate their future goals and how an unintended pregnancy falls into that plan. Young people are absolutely capable of struggling with complex medical decisions and arriving at informed choices that are right for themselves with the assistance of people that they voluntarily choose to confide in. For these reasons, PNA needs to be repealed now.
Kathryn Thomas, MD
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