Many parents of teenagers think parental involvement laws will increase risks.

Parents of adolescents in Minnesota and Wisconsin are divided in their support of laws requiring parental involvement in minors' reproductive health care, but they are nearly unanimous in expecting that such laws will breed negative consequences. (1) Fifty-five percent of parents participating in a 2002 survey said that overall, proposed laws requiring that parents be notified before their minor children obtain prescription contraceptives are a good idea. Nevertheless, 96% would expect such requirements to have some negative outcome, such as decreased use of effective contraceptives and increases in unprotected intercourse, pregnancies and STDs among teenagers. Parents' likelihood of supporting parental notification laws fell as the number of negative consequences they expected rose.

A total of 1,069 parents of 13-17-year-olds completed the population-based telephone survey, which elicited respondents' views on three key issues: the right of minors younger than 18 to receive contraceptive services at a clinic without parental consent; a specific requirement for written parental notification that would entail several days' delay before the minor could receive the requested service; and the overall idea of parental notification. The survey also asked parents which of 11 consequences (four positive and seven negative) they thought would follow from implementation of a parental notification law, and which of six possible exceptions such a law should allow.

The majority of respondents were female (68%), in their 40s (66%), white (89%), and either Catholic or Protestant (86%). Three-quarters had some postsecondary education, and half had an annual household income of $41,000-80,000. Forty-one percent of parents characterized themselves as politically conservative, 38% as middle-of-the-road and 19% as liberal. Respondents were about equally divided between parents of male and female 13-17-year-olds.

Forty-nine percent of respondents believed that minors should be permitted to obtain contraceptives without their parents' consent, and 33% considered this a bad idea. Written parental notification was supported by 42% of parents and opposed by 32%. In general, 55% of parents favored parental notification, and 28% considered it a bad idea. The remaining 17-26% of respondents said that these were neither good nor bad ideas.

Overall, 53% of parents thought that a parental notification requirement would have at least one positive consequence--mainly, that it would encourage minors to more carefully weigh the decision to have sex (42%) or to talk to their parents (33%). Fifteen percent believed that teenagers would have less sex if their parents were notified about their seeking contraceptive services, and 4% thought that they would stop having sex. The proportion anticipating that three or all four of these outcomes would occur was low (10%).

By contrast, 96% of parents would expect at least one negative consequence to result from a parental notification requirement, and 48% would expect five or more. The most common concerns were that teenagers would use nonprescription contraceptives (76%) and that they would increasingly have unprotected sex (67%). Three in five respondents thought that pregnancies or STDs would occur with growing frequency among teenagers, or that teenagers would stop or delay getting contraceptives. Nearly half believed that minors would not go to clinics or would travel out of state for contraceptive services if their parents had to be informed of a clinic visit.

When presented with a list of possible circumstances in which parental notification requirements might be waived, 86% of respondents favored at least one. Support was highest for situations involving abuse or incest (68%). Other circumstances in which at least half of parents approved of waiving parental notification were when a judge granted permission for the youth to obtain services (60%), the minor was in danger of being harmed by a parent (57%) and the teenager had a poor relationship with her parent (51%). One-third of parents would favor exceptions for 16-17-year-olds and for teenagers who had discussed their contraceptive decision with some adult.

In logistic regression analyses controlling for parents' characteristics and attitudes toward parental notification laws, the odds of support for parental notification in general more than doubled for every positive consequence a parent expected (odds ratio, 2.3). The odds declined with the number of negative consequences anticipated (0.9) and with the number of exceptions that parents favored (0.7). In addition, the more liberal respondents considered themselves, the less likely they were to support parental notification (0.6). No other factors were significantly associated with support.

In this sample, parents' support for parental notification laws were closely tied to their expectations of the outcomes. Therefore, the researchers suggest that it may be worthwhile for health care providers to educate parents about the "likelihood of adverse consequences (e.g., increased rates of teen pregnancy and sexually transmitted infections) and the improbability of positive consequences (e.g., youth choosing abstinence)" of restrictions on adolescents' access to confidential reproductive health services.

REFERENCE

(1.) Eisenberg ME et al., Parental notification laws for minors' access to contraception: what do parents say? Archives of Pediatrics and Adolescent Medicine, 2005, 159(2):120-125.