Is Mandatory Parental Involvement for Abortion Good Public Policy?
States seem to understand very well how important it is to assure a young person of privacy in seeking care related to such sensitive areas as sexual activity, pregnancy and delivery, and STD treatment. What is more, state laws frequently authorize a minor to consent to surgery, drug therapies and hospitalization for physical and emotional problems -- all of which may entail greater health risks than abortion. Yet, most states guarantee a teenager no such confidentiality when she is seeking an abortion.
In some states, doctors have the legal option of informing parents that their son or daughter has received or is seeking medical attention. However--in complete contrast to statutes mandating parental involvement for abortion--these laws leave the decision of whether or not to inform the parents entirely to the discretion of the physician. If a doctor believes that for medical reasons, it would be in the minor's best interests to inform the parents, he or she may do so. If, on the other hand, the doctor believes no such interests are served by getting in touch with a young patient's parents, treatment may continue in total confidentiality.
Particularly striking is the degree to which states allow a young woman to make her own decisions about all possible outcomes of pregnancy except abortion. A majority of states have laws that authorize a pregnant teenager to consent to prenatal care and labor and delivery services, and no state requires a minor to have parental consent to continue a pregnancy to term. Once a teenager has borne a child, she can decide whether to raise the child herself or put it up for adoption. Yet, in more than one-third of the states, unless she first consults her parents or goes to court to gain permission, a young woman cannot decide on her own that it would be best not to have a child, and then seek medical care to terminate a pregnancy.
The AGI review has shown that states restrict a young teenager's access to abortion, but authorize an adolescent to obtain other sensitive health services and make other important decisions. This discrepancy raises the question of whether laws mandating parental consent or notification for abortion are justified on public policy grounds. Are such laws necessary to safeguard a young woman's health? Are they needed to protect a teenager from making a decision that could lead to long-term psychological problems? Do they improve communication between a teenager and her parents?
Do Parental Involvement Laws Protect a Pregnant Teenager's Health?
Proponents of parental involvement laws contend that abortion can entail such serious health risks as infection, hemorrhage, perforation of the uterus and complications from use of anesthesia, and that a teenager needs her parents' help in assessing these risks. They also assert that a teenager who undergoes an abortion is much more likely than an older woman to suffer such complications as endometriosis (the growth of uterine tissue in other parts of the body) and injury to the cervix, as well as to experience complications in future pregnancies. (41)
The facts, however, do not substantiate these claims. Abortion is one of the safest common surgical procedures, particularly when it is performed in the first 12 weeks of pregnancy. (42) Fewer than one percent of abortion patients suffer a uterine perforation or experience a serious infection. (43) Furthermore, there is no evidence that women who have a single early abortion are at any greater risk of subsequent infertility or ectopic pregnancy than women who carry their first pregnancy to term. (44)
Moreover, strong evidence suggests that for women of all ages, childbirth is considerably more dangerous than abortion: Women giving birth are 100 times more likely than women having abortions to need major abdominal surgery for complications, (45) and they are 11 times more likely to die. (46)
These statistics, and the overall safety of early abortion, undercut the argument that parental involvement is needed to protect a minor's health. In fact, it appears that state laws mandating parental involvement might actually serve to increase the health risks for teenage women. Laws requiring parental consent or notification can cause a minor to carry her pregnancy to term, and thus to face the potential increased hazards of childbirth; they can also cause an adolescent to delay getting an abortion. (47) A pregnant teenager might decide to travel out of state for the procedure but need time to make travel arrangements. She might decide to use the judicial bypass, but keep postponing the day she has to talk to the judge. She might also postpone telling her parents about the pregnancy. All these delays can increase the risks of the procedure, particularly if the abortion is delayed beyond the first trimester. (48)
Evidently, in fact, some parental consent and notification laws have caused minors to postpone having abortions until the second trimester: In Minnesota, the proportion of second-trimester abortions among minors terminating their pregnancies increased by 18 percent following enactment of a parental notification law. (49) And since Missouri's parental consent law went into effect in 1985, the proportion of abortions among minors that occur in the second trimester has increased, from 19 percent in 1985 to 23 percent in 1988. (50)
There is always some risk--albeit a very small one--that a teenager will develop a complication following an abortion. But the same possibility exists for many of the confidential services that states authorize a minor to obtain on his or her own consent, such as surgery and the use of prescription medications. In all cases involving the risk of complications, health professionals have a special responsibility to make sure that their young patients recognize the signs of possible problems and know what to do in the event they occur.
Do Parental Involvement Laws Help a Teenager Avoid a Decision She Might Later Regret?
Advocates of mandatory parental involvement contend that many minors are too young and immature to appreciate the long-term implications of the decision to terminate a pregnancy, and that they therefore need the benefit of their parents' perspective and maturity to help them avoid making a choice that could cause serious long-term emotional distress. (51) Some women do experience short-term feelings of sadness, regret, guilt or anger after an abortion, but for the vast majority of women who terminate their pregnancies, there is no evidence that abortion results in serious psychological problems. Indeed, after a yearlong evaluation, former U.S. Surgeon General C. Everett Koop, who is an outspoken critic of legal abortion, concluded that the negative impact of abortion on women's mental health is "minuscule from a public health perspective." (52)
Furthermore, only four states mandate that parents play a role in a teenage daughter's decision to place her child for adoption, and two-thirds of the states explicitly recognize a minor's authority to make that decision by herself. It is hard to reconcile these facts with the argument that parental involvement in the abortion decision is necessary to help young women avoid possible mental anguish. The decision to relinquish motherhood after giving birth would seem to have at least as great a potential to cause long-lasting sadness and regret as the decision not to bear a child in the first place.
Some advocates might claim that the common practice of requiring parental consent before a minor may marry is comparable to state laws mandating parental involvement in the abortion decision. However, the decision to marry and the decision to terminate a pregnancy differ in one significant respect: If a young person's parents will not give their consent to a teenage marriage, the marriage can be postponed until the minor has reached the age of majority, with no ill effect. But, as the Supreme Court has observed, "a pregnant adolescent...cannot preserve for long the possibility of aborting, which effectively expires in a matter of weeks from the onset of pregnancy." (53) If a pregnant teenager does not act in a timely manner, the point at which she can obtain a legal abortion will pass, and by default, she will be forced to make a quite different and highly significant decision--the decision to become a teenage parent.
Do Parental Involvement Laws Improve Communication Between Parents and Their Adolescent Daughter?
Supporters of laws mandating parental involvement for abortion often justify those statutes as an effective way of improving communication between adolescents and their parents. They argue, for example, that a teenager who fears her parents' reaction to the news of a pregnancy often gets a far more supportive response than she had anticipated. (54)
Some minors undoubtedly do misjudge how their parents will react. However, experts in family counseling and family communication say that while family relationships generally benefit from voluntary and open communication, forced communication can be disastrous, particularly if a parent is abusive. (55) And court officials who are experienced in dealing with minors say that teenagers usually assess their family circumstances quite accurately. (56)
Furthermore, laws that require involvement of both parents can actually inhibit a minor from discussing her situation with one parent, since she knows she must still go to court to get authorization from a judge if she is not willing to consult with the other parent. The situation is exacerbated for a young woman whose parents are separated or divorced and who has little or no relationship with the noncustodial parent. (57) Under these circumstances, it is hard to believe that compulsory communication about a minor's pregnancy will improve parent-child communication.
Even where no law mandates parental involvement, teenagers generally do consult with their parents. A majority of the roughly 180,000 young women under 18 who have abortions each year (58) say that at least one parent knows of their decision, usually because the minor has told that parent voluntarily. The younger the teenager, the more likely her parents are to know. (59)
(41.) A. Philburn, 1991, op. cit. (see reference 31).
(42.) S. K. Henshaw, calculations from special tabulations of data from CDC; and S. K. Henshaw and J. Van Vort, Abortion Services in the United States, Each State and Metropolitan Area, 1984-1985, AGI, New York, 1988.
(43.) National Abortion Federation, Summary of Annual Complication Statistics, Washington, D.C., 1990.
(44.) C. J. R. Hogue, W Cates, Jr., and C. Tietze, "The Effects of Induced Abortion on Subsequent Reproduction," Epidemiologic Review, 4:66, 1982.
(45.) W. Cates, Jr., "Legal Abortion: The Public Health Record," Science, 215:1, 586, 1982.
(46.) H.W Lawson et al., "Abortion Surveillance, United States, 1984-1985," Morbidity and Mortality Weekly Report, Vol. 38, No. SS-2, Sept. 1989, p. 11; National Center for Health Statistics, Vital Statistics of the United States, 1981: Vol. II-Mortality, Part A, GPO, Washington, D.C., 1986; --, Vital Statistics of the United States, 1983: Vol. II--Mortality, GPO, Washington, D.C., 1987; --, Vital Statistics of the United States, 1984: Vol. II--Mortality, Part A, GPO, Washington, D.C., 1987; And--, Vital Statistics of the United States, 1985: Vol. II--Mortality, GPO, Washington, D.C., 1988.
(47.) J. Benshoof et al., 1989, op. cit. (see reference 32), pp. 9-16.
(48.) C. Tietze and S. K. Henshaw, Induced Abortion; A World Review, 1986, sixth ed., AGI, New York, 1986.
(49.) AGI calculations based on unpublished data from the Center for Health Statistics, Minnesota Department of Health, for 1978-1980, before the law was enforced, and 1982-1985, when the law was in effect.
(50.) Missouri Department of Health, Missouri Monthly Vital Statistics, Jefferson City, 1990, p.2.
(51.) A. Philburn, 1991, op. cit. (see reference 29); E.L. Worthington, Jr., et al., 1989, op. cit. (see reference 2); and D. Andrusko, "Supreme Court Upholds Parental Notification Laws," National Right to Life News, June 25, 1990, p.14.
(52.) Hearings before the Human Resources and Intergovernmental Subcommittee of the Committee on Government Operations, U.S. House of Representatives, Mar. 16, 1989, p. 241.
(53.) Bellotti v. Baird, 1979, op. cit. (see reference 17).
(54.) A. Philburn, 1991, op. cit. (see reference 29).
(55.) J. Benshoof et al., 1989, op. cit. (see reference 32), pp. 19-20.
(56.) Ibid., p. 19.
(57.) Ibid., pp. 19-23.
(58.) S. K. Henshaw, L. M. Koonin and J. C. Smith, "Characteristics of U. S. Women Having Abortions, 1987," Family Planning Perspectives, 23:75, 1991.
(59.) A. Torres, J. D. Forrest and S. Eisman, "Telling Parents: Clinic Policies and Adolescents' Use of Family Planning and Abortion Services," Family Planning Perspectives, 12:284, 1980.