EXECUTIVE SUMMARY

Access to contraceptives for reproductive-age minors varies across the United States but should be accessible to all, according to the authors of a recent paper.

  • State laws often prevent minors from consenting to contraception by themselves or only allow access without parental permission if the minor is married.
  • A federal policy might be necessary to make contraceptives available to adolescents across the United States and to allow adolescents without the means or parental support to access contraception.
  • Adolescents especially need postpartum contraception options, since a rapid repeat pregnancy could pose negative effects to their socioeconomic status and education.

States are not equal in permitting access to contraceptives for minors. This creates inequities and unintended pregnancy risks for adolescents in nearly half of states.

“New York is great, with very flexible reproductive health laws when it comes to minors. However, a lot of states do not have the same laws,” says Savannah Kaszubinski, MD, resident, post-graduate year one at the University of Rochester (NY).

Some states are so restrictive that minors have to be married to obtain birth control without parental permission. “There’s a law where they can get married at ages 14 to 16, but they can’t consent to their own birth control,” Kaszubinski adds.

Even adolescents who have given birth are restricted from receiving birth control, such as long-acting reversible contraceptives (LARC), in some states. These restrictions create problems for reproductive health providers who are willing to place the contraceptive for the patient but cannot because of state restrictions and guidelines.1

In a recent paper, Kaszubinski argues that adolescent mothers should be allowed to consent to the placement of LARC because they can legally consent to healthcare for their child, starting in the prenatal period.1

“LARC use has increased in the adolescent population, and for women overall,” Kaszubinski says. “People who have LARC placement after they give birth are not very likely to take the device out. The overall favorability of LARC has increased quite a bit for almost all populations.”

Reproductive health practitioners should know their state laws and offer contraceptive counseling and services to adolescents wherever it is permissible.

“However, with state law restrictions, my hope would be that there is eventually some federal policy where the state law is overridden,” Kaszubinski says. “Adolescent mothers are able to consent for all of their prenatal care and pediatric care after giving birth. Using that framework, we can justify that if an adolescent is able to consent for their fetus and potential child, their right to contraception and reproductive rights should not be forbidden.”

LARC placement is very safe, Kaszubinski notes. “Of course, there has to be a conversation with the provider in terms of going over the risks and benefits,” she explains. “There is no greater harm to LARC placement in the adolescent population than there is in the non-adolescent population.”

These disparities call for a federal policy making contraceptives available to adolescents. State laws should not prevent them from making reproductive choices, Kaszubinski says.

For instance, minors who are uninsured, have non-involved parents, or are in the foster care system might not be able to obtain parental consent for contraception. Many of these patients could come from low socioeconomic status, so it is a major issue for them, she says.

There also are adolescents whose parents have insurance and could consent to contraceptives but refuse to do so, even though the adolescents are sexually active. “Having a federal policy would provide equal opportunity in every state,” Kaszubinski argues. “This would allow adolescents without the opportunity or without parental support to have the option of birth control.”

Reproductive health providers should counsel all patients about their contraceptive options and help them understand the risks and benefits so they can make an informed decision. “I don’t think that LARC placement should be the only option, but it is important to have a wide range of knowledge and options available to them,” Kaszubinski says.

Adolescent mothers especially need contraceptive options and counseling because a second pregnancy at a young age could affect their socioeconomic status and education. “Having a contraceptive plan and avoiding a rapid repeat pregnancy is really important, especially in that population,” Kaszubinski adds. “Regardless of age, they should be able to choose their reproductive plan.”

Clinicians should ensure they are not pressuring adolescents into selecting a certain type of contraception, and should be respectful and unbiased regarding the choice the adolescent makes.

“I think it’s important to have a conversation about every option,” Kaszubinski notes. “Make sure you’ve given them every choice to make an informed decision — not only offering LARC.”

REFERENCE

  1. Kaszubinski S. Placement of long-acting reversible contraception for minors who are mothers should not require parental consent. J Med Ethics 2021 Jul 14;medethics-2020-106225. doi: 10.1136/medethics-2020-106225. [Online ahead of print].