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The Point of Parental Notification

Yesterday, I responded to Adam Lee’s post answering questions about abortion with some answers of my own. Adam then responded in the comments:

Just polling the crowd here. There was only one question on this list that I thought posed a difficult dilemma, which was whether there should be parental notification for a teenager seeking an abortion.

Unlike most of the questions, this is one case where I think there are genuine interests that collide. I think that parents should have a role in medical decisions for their minor children, but I also think that if a teenage girl needs an abortion but doesn’t want to tell her parents, there’s probably a good reason for that. What does everyone else think about this?

I hadn’t considered this a particularly difficult question myself. I don’t see a compelling need to uniformly notify parents about abortions, but it took some thinking to work out why.

I started by taking a step back to reproductive decisions in general. Do I support a parental notification requirement for the use of birth control? Absolutely not, and for easily articulated reasons.

Human beings (physcially) mature sexually far sooner than we mature emotionally and as decision-makers, as a general rule. In our society, we’ve decided that managing sexual maturity is an individual responsibility, but we don’t have any agreed-upon standards for how that should be done. We also don’t have social systems in place to support young people who make decisions at this point that they may later regret or who take risks that end in unintended consequences.

Then there is the fact that nearly half of all sexual assault victims in the U.S. are assaulted before they reach the age of majority.

Basically, we have a compelling social case for making the use of birth control within this age group as ubiquitous as the use of seatbelts. Medically, economically, in terms of neonatal health and the quality of infant care, as a reduction of harm to the victims of crime–it is better for us if people this age do not reproduce. We have a stake in this. It doesn’t automatically override a parent’s interest, but it sets the framework in which we should consider that interest. The parent’s interest doesn’t stand alone here any more than it does in the case of vaccination.

When we move from birth control to abortion, we aren’t changing much. Our societal interest still stands. We add, however, an immediate medical interest on the part of the pregnant person. This was always there in the abstract in a discussion of birth control. It becomes even more important now.

Simply put, a pregnancy carried to term is always going to be more medically risky and morely likely to carry long-term, negative medical consequences than an abortion, particularly an early abortion. This is even more true for those who are just pubertal or post-pubertal. Pregnant teens–and pre-teens–have very good medical reasons not to carry a pregnancy to term.

Additionally, they have a medical interest in safe terminations. Putting barriers in the way of young people terminating pregnancies in sterile environments using best medical practices does not stop them from trying to terminate those pregancies. It means that many of them will try less safe methods without medical supervision. It means, in extreme cases, that abortion becomes infanticide.

In other words, if we base our decision on the outcome to the patient, early medical abortion is the standard of care for most teen and almost all preteen pregnancies. So says science. So says societal interest. So say the teenagers who want to end their pregnancies.

That’s where we need to start before we even consider any parental interest. That tells us what we’re suggesting when we say that parents have to be notified and approve before an abortion can be performed on a minor.

So what are we suggesting? That parents be allowed to object to and obstruct standard medical care that their children have requested and that is in their children’s best medical and other interests.

We aren’t saying parents have the right to keep their children from avoiding pregnancy as a consequence of sexual activity. We’ve already decided the minor’s interest prevails here. We allow them to buy condoms without parental permission. We allow them to buy condoms without parental notification.

We aren’t saying parents should be the ones to negotiate medical risks for their child. The data on gestational risk versus abortion risk is extremely one-sided. There is no evidence-based debate on which is riskier. There is no gray area on which is indicated medically.

What we are doing is saying that parents should get to veto the interests of both society and their children when it comes to matters of abortion. Thus some parents will make their children live with this wholly preventable consequence of having sex as well as the additional risks and long-term consequences it imposes on them. Essentially, if we require parental notification and approval, we’re giving parents an opportunity to punish their children by denying them medical care or to decide that their religious beliefs about embryos and fetuses are more important than both their child’s wishes and health.

Nobody is proposing that parents be allowed to force their children to have abortions, just that parents be allowed to stop them. The only justification for creating laws that allow this veto is that some parents will object to the abortion. That is the point of requiring parental notification and approval, to stop abortions. 

Without these laws, minors and their doctors will make these health decisions together. Given the state of medical consensus, that will result in abortions for the children who want them. Parents will still be told, when a child thinks it is appropriate. Doctors will still urge children to talk these things over with their parents when it’s safe to do so, because social support for good reproductive decision-making makes it more likely that good decisions will be made. Child social services will still be alerted if there is a suggestion that the child involved is being abused.

That is the state of things if we do not require parental approval. Children will continue to make decisions about their own reproduction no matter what we do. People whose vocation it is to care for these children will continue to do so and do it as well as they can. Parents who make it clear to their children that they share that mission will continue to be included in their children’s lives and decisions. Parents who do not have their children’s best interests at heart will continue to be safely circumvented. That’s how it already works when no one is interfering.

Adding laws that require parental notification and approval doesn’t support children better. All it does is give a parent a chance to make a decision that everyone else has to pay for. I can’t support that.

Comments

  1. says

    I think your most important argument is in the statement of the opposite situation.

    I’ve never heard anyone suggest that parents have the legal right to force a teen to have an abortion. If a teen says “I’m having the baby,” then I can’t imagine any court in the land saying otherwise. Even if the minor is mentally disabled and/or has a physical disability that makes carrying a pregnancy to term risky. Only in cases where there is a medical emergency that acutely endangers the teen’s life can the parents intervene and get a court-ordered abortion without her consent.

    Therefore, we agree that the right to the decision is the teen’s to make.

    If it’s her right to decide to keep the baby, then it’s also her right to decide to terminate it.

    I wish all decisions were that simple.

  2. smhll says

    Additionally, they have a medical interest in safe terminations. Putting barriers in the way of young people terminating pregnancies in sterile environments using best medical practices does not stop them from trying to terminate those pregancies. It means that many of them will try less safe methods without medical supervision. It means, in extreme cases, that abortion becomes infanticide.

    I think you raise some excellent points.

  3. says

    On Respectful Insolence I have occasionally opined that letting parents have uncontested control over their childrens’ medical decisions is a recipe for violating their childrens’ rights.

    That opinion has usually been issued on the subject of immunizations, where given the current state of the evidence it is (at least IMO) obviously in children’s best interests to be protected from infectious diseases, parents’ beliefs notwithstanding.

    If anything, it appears my opinion fits even better in the case of contraception/abortion, where allowing a “parent’s veto”, again IMO, very clearly violates pre-teen or teenaged women’s rights to person.

    It seems to me that as a society we tend to under-emphasize the superior rights/interests claims of children over and against their parents’ rights/interests as parents. Parents have an obligation, in my opinion, to discern, defend, and advance the best interests of their children. This obligation stands in contrast with the kind of rhetoric I see from, say, anti-vax parents, or anti-gay parents, where they appear to suggest that they are entitled to engage in whimsical (in the sense of being based on their whims or desires) childrearing practice, even when such practice contravenes their childrens’ interests.

    (I may have used some apostrophes erroneously in the above, for which I apologize.)

  4. Sercee says

    Extremely well written, and very good points.

    In particular, that you point out that we’re talking about CHILDREN being in this situation it should be perfectly clear what the answer is. Having a period does not mean that the body is capable of carrying a pregnancy to term, and most certainly does not mean the mind is capable of providing care to the resulting infant. Forcing a child to carry a pregnancy, in my firm opinion, results in the neglect and abuse of both children.

  5. says

    I read of one case in the U.S. where a girl was killed by her father after she was forced to notify him that she needed an abortion.

    Parental consent and parental notification laws seem to prevent young women from getting abortions: consent laws are followed by a 13% increase in homicides of children under five years old and notification laws by an 8% increase. Mandatory delays were associated with a 13% rise as well. See “The Relationship Between state abortion-restrictions and homicide deaths among children under 5 years of age: a longitudinal study” by Sen B, Wingate MS, Kirby R. (Soc Sci Med. 2012 Jul;75(1):156-64. Epub 2012 Mar 13.) “…we speculate that state restrictions on abortion may result in a disproportionate increase in children born into relatively high-risk environments.”

    Trust women when they say they can’t handle having a baby!

  6. smrnda says

    I think another issue is that many parents would punish a daughter for being sexually active, even if they would agree to an abortion. For me, I don’t think that parents ought to have that right (children are not your property) but it’s quite likely that a minor seeking an abortion would be subjected to abuse. Many issues about ‘parental notification’ are really just built around keeping parents in control of children, regardless of if they actually have their best interest in mind.

  7. Tsu Dho Nimh says

    Nobody is proposing that parents be allowed to force their children to have abortions.

    In the only instance I can remember, a mother who was determined that her 17-year old daughter was not going to be an unwed mother dragged that poor child to half the abortion clinics on the East Coast trying to find one that would override the patient’s refusals. I’m not sure what she expected us to do? Slap a chloroform-soaked rag over her face until she was unconscious, then do the abortion?

    But she had come a couple hundred miles because she had heard we were “easy” (it was a free clinic of the hippie sort).

    Unfortunately, our protocol was to do a private interview with the patient, and the first word out of her mouth was “No”, so that was the end of the pre-abortion counseling and we went into the pre-natal counseling and referral protocol. It’s that straightforward. No means no.

  8. shari says

    there’s a point that isn’t raised in this post – as a post advocating for the rights of minors, i like it (Caveat – i haven’t had time to read any of the links.)

    I am curious about the issue of follow-up medical care. Girls may need follow up medical care after an abortion (risk of infection, bleeding). Some kids are very private, some are very dramatic (my son routinely thinks his teacher ‘will kill him’, and his teacher is a mild mannered pacifist!!) Children in an abusive home situation are high candidates for unwanted pregnancy, from what I recall, and I do think they need protection. A LOT of protection. But I think there should still be some vector of notification so that parents don’t have to find out via high fever that a major medical procedure has been performed on their child. Especially since follow-up care may require the child’s insurance to cover it.

    A parent doesn’t ‘own’ their child, but they are legally responsible for their child’s well-being – including medical care, as well as financial obligations. It would be great to think that I will know when my child is sexually active. And that they will talk to me about everything. Hopefully, I raise them to be slightly risk-averse, and to treat their bodies respectfully. But stuff happens. Pregnancy happens. And as a caring parent (who a child may be afraid to ‘let down’) i would like to see some provision in place that would notify the parent, when the risk of abusive (mental or physical) response isn’t present. I can’t think of what that mechanism would look like, but it has to be considered. And it has to protect the child from going from the proverbial frying pan, into the fire.

  9. Didaktylos says

    For practical purposes it would seem to be that those most likely to prevent their daughter having an abortion are the ones who should be denied that power.

  10. doubtthat says

    The only possible situation where a parental notification law could actually benefit the child would require parents that would immediately leap into action to provide any necessary counseling or further intervention to help the child.

    Based on numbers, there must necessarily be a subset of children and young adults in that situation: they made a mistake, wanted to hide it from their supportive parents, and upon learning, the parents intervene in appropriate, necessary ways, but I would imagine (not having anything empirical to back this up) that the number of women who would deeply suffer by being forced to notify a parent is significantly larger.

    If we agree that the pregnant child/young adult is the principle, and that their rights and needs must be met, there doesn’t appear to be much benefit from these laws. Notification only makes sense if we consider the parents to be the relevant party, and that makes little sense.

  11. says

    It seems to me that as a society we tend to under-emphasize the superior rights/interests claims of children over and against their parents’ rights/interests as parents.

    Can we just agree to skip the idea of parental rights alltogether? Let’s call it parental privileges and treat it accordingly. As a parent I am a steward of my children’s rights, using them in their interest and raising them to the point they can use them themselves.

    +++
    Generally I would like there to be a “mandatory” counselling that makes sure the kid has all she needs and support, because if she’s in for an abortion, all alone, not wanting to tell her parents, she will most likely be terrified. Maybe she was the victim of a crime or an abusive relationship. And I want to make sure that a competent and supportive adult takes a look. If it was an “oops my boyfriend and I just didn’t take care, but don’t tell my parents because they’ll send me to a christian boarding school”, give her contraception and all the best. If not, give her help.

  12. geocatherder says

    “oops my boyfriend and I just didn’t take care, but don’t tell my parents because they’ll send me to a christian boarding school”, give her contraception and all the best. If not, give her help.”

    HUH!

    From what I’ve heard of Christian boarding schools, some of them can be a fate worse than death. And even if the young lady has made some careless decisions, why does that remove her from the category of those needing help? The ability to use birth control carefully and wisely is a mark of maturity. Are you arguing that young women, not yet that mature and pregnant, should be forced to have the baby? Because if you are, you’re an asshat.

  13. D. C. Sessions says

    Giliell brings up the point that a child pregnancy (let’s skip the more problematic late-teen ones, where the increasing autonomy of the young woman complicates matters) is prima facie evidence that something is wrong: abusive relationship, lack of adequate sex education, etc.

    When a 14yo shows up looking for an abortion, it’s an alarm that a lot has already gone wrong, and the pregnancy is just the latest in the chain. So, yes, there’s more required than pregnancy termination — not least being, from both published research and personal examples, teaching her enough about her own body so that she recognizes that she is pregnant soon enough to minimize the adverse consequences. Which a remarkable number of 14yo girls don’t.

    And, no, telling her “don’t do that any more” is not an effective method of preventing future pregnancies. Duh.

  14. Ysanne says

    geocatherder,
    you obviously never heard of contraception other than the pill or condoms. There are low-maintenance options suitable for teens, called frameless IUDs, that work just great for years without requiring the woman to do anything once they’re fitted (which, btw, can happen in the same session as the abortion, and also works as emergency contraception). This is routine for teen pregnancies in the UK.

  15. says

    Copied over from the earlier thread because it is more relevant here:

    @Adam Lee, on the topic of parental notification: you are trying to legislate for good family relationships, which is impossible.

    Consider the likely edge cases – a missing parent like a deadbeat dad; an abusive parent or foster parent who is possibly even the father by rape. If a girl has a decent loving relationship with her parents, she will seek their help. If not, she has her reason not to, and your laws won’t change that. Say hello to back alleys and coathangers.

  16. geocatherder says

    @Ysanne, I’m not that stupid, even though I do live in the US. Here, even if a young woman is covered for an IUD under her parents’ insurance, if they’re the kind to send her to Christian boarding school if she gets pregnant, they’re certainly not going to approve of the IUD (which insurance will require). Her realistic choices are the pill (if she can find a low-cost clinic to dispense them) or condoms, the two least reliable choices for teens.

  17. bobo says

    I read a really depressing comments thread and a bunch of rape victims basically said that when they were raped ( and ended up pregnant) their parents beat the shit out of them for it.

    I think this is a good reason why parents should NOT have the power to deny their children medical are in the form of abortion.

  18. Ysanne says

    geocatherder,
    then I’m a bit confused about why Giliell’s “give her contraception and all the best” didn’t count as help in your previous comment… As far as I understand it, “giving” in this instance means “enable access to contraception she’s able to use correctly, without telling the parents”.

  19. says

    This is an area where I always come up short. In general, I agree with everything you said. No matter what, a pregnant girl gets to make the first and last choice about the pregnancy. Not even a parent can stand in the way of that.

    Here’s where I have a my problem:

    I am the mother of four daughters. I would do anything for them. I will never stop loving them. They are all well past the stage of childhood now, but when they were young, I would have been horrified if one had an abortion and I wasn’t allowed to be Mom for her. I would want to be with my daughter through every step, holding her hand and taking care of her afterwards.

    My daughters knew my opinions on things, but any teenager may feel they can’t “tell” mom or dad about something. Teenagers are so full of angst – my daughters would never have been punished by me or their father for sexual activity, but they still didn’t always feel comfortable coming to us about it. As a loving and supportive mother, if I did not know my daughter had an abortion, and she was suffering post-abortion problems, how could I help her? As her parent, I am completely responsible for her, yet I don’t know she had a major medical procedure?

    It’s true that the girl always has the choice to tell her parents and bring them into the decision process. As a parent, you can only hope the child truly understands that you will be on her side and will take care of her. I really wonder – are the majority of parents the kind who will punish the girl? Or are more of them like me – non-judgmental, loving, and supportive? Or at least, parents who will come through for their daughter, even if they are unhappy with the situation?

    In the end, I know we need to allow minors to have this freedom. It’s the only way to protect those that need protection from parents. Those of us who are supportive parents just have to make sure our kids know they can depend on us.

  20. says

    geocatherder

    And even if the young lady has made some careless decisions, why does that remove her from the category of those needing help?

    Hold your horses.
    The help I was talking about was some larger intervention, counselling, maybe legal advice and so on. Now I happen to believe that teens can have sex and make that decision. I don’t get upset about the idea of a 16 yo (maybe 14 is different) having sex as such. I also know that teens are by definition a bit careless (their risk-calculation is actually skewed) and that even with the most careful people “Ooops” happens.
    So, what that girl needs is a quick abortion and access to reliable contraception. Without notifying the parents. Obviously handing contraception without providing an abortion would make no sense so I don’t know how you get to “force her to carry the pegnancy to term”.
    I hope you would agree that the problems of that girl are very different from those of a girl who needs an abortion because of sexual abuse.

    Ysanne
    Well, I guess that that’s a problem us mums have to come to term with. I would like my daughter to talk to me about this, I’m trying to make sure that she really, really knows that I have her back. But the decision is hers.
    I will trust them to make the right decision. Authorities must trust them to make the right decision in telling their parents or not, because I’m not willing to let the girl with the shitty parents pay the price.

  21. jeroenmetselaar says

    I am a bit shockled by this whole question. Isn’t it obvious that a teenager has a certain right to their own body and privacy?

    Especially when it comes to medical issues of a sexual nature a child may discuss things with a doctor or a nurse that it will never, ever want to mention to a parent.

    Here in The Netherlands a child of 12 or older can visit a medical professional without informing their parents. Parents also do not have the right to see medical dossiers of their child if that child objects. There is even a way to have the medical costs payed by a shared insurance without a parent knowing.

    I can see how a parent would prefer a child with chlamydia would tell them first. Reality is that the child very likely won’t. Isn’t the next best thing that there are other responsible and knowledgable adults around that your child can talk to to get a dose of azithromycin?

    How much more is this true for pregnancies or birth control?

  22. says

    jeroenmetselaar
    Exactly. The fact that we don’t let children make their own medical decisions alone for a good reason doesn’t mean that the person who is involved in making them had to be the parent. That idea stems from the very toxic idea of children being somehow the property of their parents.

    Ysanne
    To elaborate a bit on your point.
    Many years ago my sister had a miscarriage followed by a D&C. She was already legally an adult so the question of parental notification didn’t arise.
    But when she told us (actually she flung it at our mother in a big fight)she said she was all alone back then with nobody to care for her. Now, you could say that it was her own fault because she chose not to say anything, but the fact is that she was alone.
    She had been pregnant from the guy our mother had sworn to drive out of her life and I was still half a child (I must have been between 13 and 14).
    Had our mother been informed, I’m pretty sure everybody would have been amazed by the fact that the poor girl has such a supportive mother. I remember well her “support” after my miscarriage and especially during my following pregnancy.
    My sister made the right decision. Sometimes being desperate and alone is better than being with somebody who will subtly abuse you a littel more and who will use the power you just handed them.
    It took me many more years to find that out. When dealing with a narcistic parent there’s often a “golden child” which was me (subsequnetly she treats my oldest daughter as her golden child).
    So, back then my sister made the right decision because she knew what would happen and how it would hurt even more when everybody else would think that everything is perfect (now people look at me in disgust of the ungrateful brat that I am given that my mother did everything for me.)
    Of course you say that you’re not my mum, you’re really loving and accepting and supportive and I well believe you, but fact is that a stranger can’t make that call and then decide over the head of somenody with more insight into the situation who says “no”.

  23. jeroenmetselaar says

    “The fact that we don’t let children make their own medical decisions alone for a good reason”

    You really did not understand me then. A medical professional should only ever advice and counsel, not tell, not even when the patient is a child.

    Teenagers are not insane and they do have the right to their own body, especially when it comes to pregnancies. Abortions should never be withheld or forced: it should always be the pregnant person to decide.

  24. says

    Great post, Stephanie. Thanks.

    A couple of people who have responded here have said they don’t like the idea of their child having a “major medical procedure” without their knowledge, and I do understand that it comes from a place of care.

    Simply put, however, abortion is *not* a major medical procedure by any stretch of the imagination. Getting my leg pieced back together in 6 hours of surgery after a severe break was a major medical procedure. Abortion is a very safe, very minor medical procedure somewhat on the order of getting stitches for a cut. It has a low risk of complication. The child or teen who gets an abortion could very easily be told what problems to look out for and come back or phone for followup if necessary.

  25. says

    jeroenmetselaar

    You really did not understand me then. A medical professional should only ever advice and counsel, not tell, not even when the patient is a child.

    So, to stay in this topic, if the pregnant child is 11 years old and as a medical profesional I know she won’t survive it I’m supposed to let her die if she doesn’t want an abortion? Or if it’s an ectopic pregnancy and she refuses because she has heard about some miracle cases where it turns out fine? If my kid needs an IV fluid and screams and yells no, am I supposed to let her die because she refuses the treatment? Or not vaccinate them before they could make an informed decision?
    Fuck no.
    They are kids, they are not adults. They cannot judge the risks and consequences of their actions correctly, so we put that responsibility on adults who have to hand it back piece by piece, depending on their maturity and the severity of the question. We have to weigh the consequences of our decisions if they oppose the expressed will of the child.
    In the case of an abortion this is clear: Since there is no “cost” with getting one, but a high price if she is denied one, so she gets one.
    It can be the other way round if she wants to carry to term: there might be a very high cost with forcing her to have an abortion, but the price of inaction would be her life.

  26. geocatherder says

    Apologies to all who engaged with me, I think I managed to confuse myself about what other people were saying. (It doesn’t pay to get on the Internet without enough sleep the night before.) In the very imperfect world of the U.S., we fight to oppose parental consent laws because they’re constructed for the express purpose of preventing abortions regardless of the need of the individuals involved. Even without parental consent laws, abortions are horribly difficult to get in some parts of the country. Equally vexing, the only practical birth control options for teens are those most easily badly used by those who lack maturity. This all frustrates me terribly.

    But many of you are saying what _should_ be. Access to do-once-and-forget birth control, like an IUD. Counseling, to help teens understand their own values about such things. And of course, when all else fails, abortion. You are all correct in that these things should be. And I’m glad to know that other places in the world are doing some or all of these things. You inspire me to keep fighting here.

  27. says

    Thanks for the replies, everyone. This thread has done a lot to help me make up my mind.

    If it wasn’t clear, I unquestionably agree that parents shouldn’t be allowed to force a minor to carry a pregnancy to term. But there are cases where I do think parents (or legal guardians) should have a legal role in their children’s medical care in other cases, and it’s hard deciding where to draw that line. If it was, say, a 13-year-old Jehovah’s Witness with leukemia and an atheist parent who wanted her to get blood transfusions against her will, I don’t have any trouble saying that the parent’s will should override, and I bet most people here would agree. Maybe the criterion we should be using is reversibility: giving up your life is a decision that can’t be undone, whereas it’s always possible to have children later in life.

    Markita Lynda’s comment at #5 about homicide rates increasing after parental notification laws is horrifying, and that more than anything else makes me think these laws are an awful idea. But I also agree with D.C. Sessions in #13 that when a 14-year-old shows up needing an abortion, it’s prima facie evidence that something has gone wrong.

    Rather than mandatory notification laws, I’m coming to think the best solution would be for family-planning clinics to have a counselor or case worker on staff. That way, if an unaccompanied minor comes in, they can have a discussion about whether to inform her parents, and if she doesn’t want to, they can look into the reasons why that is.

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