The legal underpinnings of minor consent in the United States emerged during the 1970s and 1980s, with Supreme Court rulings affirming the rights of mature minors to make some medical decisions and the right to privacy in consenting to contraception and abortion.1,2 Minors’ ability to consent to contraception varies from state to state, with 22 states and the District of Columbia having no restrictions.3

However, right to consent does not necessarily mean access to contraception. Twenty-one states have allowed insurance companies to opt out of the contraceptive mandate in the Affordable Care Act,4 and a recent Supreme Court decision allows religious institutions in every state to opt out of providing this service.5 Coinciding with these opt-outs, the percentage of hospitals and health systems run by religious organizations that do not provide contraception has increased, particularly in the South and Midwest.6

Recent federal executive decisions raise concerns about whether low income teens can continue to rely on confidential and affordable access to contraception through clinics funded by Title X,7 which has provided longstanding family planning funding for low income individuals8 whether or not their state allowed contraceptive consent and/or funding for minors. The impact of these changes on contraceptive access is unknown, but past research shows that access to effective contraception, including LARC, is a primary factor contributing to the decline of teen pregnancy.9

References

  1. Schlam L, Wood JP. Informed consent to the medical treatment of minors: law and practice. Health Matrix Clevel. 2000;10(2):141-174.
  2. Schapiro NA, Mejia J. Adolescent confidentiality and women’s health: history, rationale, and current threats. Nurs Clin North Am. 2018;53(2):145-156.
  3. Guttmacher Institute. State legislation tracker. Major developments in sexual and reproductive health. https://www.guttmacher.org/state-policy/explore/insurance-coverage-contraceptives. Accessed August 29, 2020.
  4. American College of Obstetricians & Gynecologists. ACOG Committee Opinion No. 803: confidentiality in adolescent health care. Obstet Gynecol. 2020;135(4):e171-e177.
  5. Keith K. Supreme court upholds broad exemptions to contraceptive mandate — for now. Health Affairs Blog. July 9, 2020.
  6. Takahashi J, Cher A, Sheeder J, Teal S, Guiahi M. Disclosure of religious identity and health care practices on Catholic hospital websites. JAMA. 2019;321(11):1103-1104.
  7. Schapiro NA. Title X Regulatory Changes and Their Impact on Adolescent Health. J Pediatr Health Care. 2020;34(2):171-176.
  8. Napili A. Title X (Public Health Service Act) Family Planning Program. Washington DC: Congressional Research Service; August 31,2017. RL33644.
  9. Lindberg L, Santelli J, Desai S. Understanding the decline in adolescent fertility in the United States, 2007-2012. J Adolesc Health. 2016;59(5):577-583.