Opinion: A major problem for minors: post-Roe access to abortion

Now that the Supreme Court has overturned constitutional protection to abortion access, more than two dozen states will ban or severely restrict abortion access. Young people, especially those under age 18, will be disproportionally affected by this decision.

The existing barriers to legal access to abortion, already insurmountable for many people, serve as a preview of what to expect and the inequities that will further be exacerbated. In Indiana, for example, consent for a minor to have an abortion requires a notarized parental consent form to be completed; in-person, state-directed counseling; an ultrasound; and an 18-hour waiting period.

Given teens also face greater barriers to preventing pregnancy in the first place, including barriers to accessing contraception and limited access to comprehensive sexual health education, the door is closed for them at every turn.

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Teens under age 20 make up 12% of individuals who have abortions nationally; minors, age 17 or younger, account for about 4% of all abortions in the U.S. This means at least 50,000 adolescents need abortion care each year in the United States. Further, teen pregnancies are more likely to be unintended and end in abortion than pregnancies among older individuals. This means teens will be disproportionately impacted by this legal decision.

Teens’ rights to access safe and confidential abortions has been affirmed by the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, and the North American Society of Pediatric and Adolescent Gynecology. Yet, abortion access for teens is more legally regulated than adults’ access. Currently, minors lack access to confidential abortion care in 38 states, as parental notification or consent is required before obtaining an abortion. While judicial bypass is a legal option to obtain an abortion without parental involvement, the process is complicated, onerous, and time consuming.

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Even when young people can overcome legal obstacles, they face barriers related to economics, information, and access. The cost of an abortion, which is likely to rise in a post-Roe world, makes it inaccessible for many teens. Teens and their guardians are rarely familiar with existing federal and state legal restrictions on abortion care coverage through insurance until an abortion is needed. There are federal restrictions to Medicaid plans, and various state restrictions on both public and private insurance plans.

The teen “abortion road trip” is already part of American cultural discourse in books and movies. These fictionalized versions will pale against the harsh realities of increasingly far distances to travel to obtain an abortion if the constitutional precedent of Roe is overturned. Illinois, New York and other states where abortion remains legal will become a “safe haven state” for people across the country seeking abortions, but many youths will not be able to travel hundreds of miles to get to a clinic.

Minors face restrictions in independently buying interstate bus, rail, or airline tickets. Covering the cost of travel is particularly difficult for youths who are not financially independent. Supportive adults may fear legal consequences if they assist with transporting a minor across state lines to seek abortion care. Existing laws that require waiting periods and multiple appointments make these trips more time consuming, costly, and challenging.

When combined with delays in recognizing that a pregnancy has begun and presenting for medical care, which are more common among teens, abortion regulations based on weeks of pregnancy will have a larger impact on teens’ ability to access abortion care. Although telehealth can serve as an option for those desiring medication abortion, these services are almost entirely restricted to those 18 years and older in states that permit telehealth, leaving younger teens without this medically safe option.

The existing laws and barriers have outsized harm for teens as they contribute to unnecessary medical complications due to delays in care.

These barriers are compounded by poverty, race, and other social statuses. Teen pregnancy rates are higher among youths who are poor, people of color, LGBTQ+, and those in foster care or in the criminal justice system. They are also least likely to have resources and social networks to support them as they navigate barriers to abortion access — or as new parents. When young people give birth to children in the absence of a real choice about whether to become a parent, existing inequities grow.

As the right to make decisions about pregnancy and parenthood becomes more restricted, teens’ rights to bodily autonomy and reproductive freedom must be protected so they can determine their own futures.

Immediate efforts must focus on supporting abortion funds that provide people with financial and logistical support and helping legal groups assist minors with obtaining judicial bypass and other legal. Policymakers in states with protected abortion access need to repeal forced parental involvement laws, as Illinois recently did. Access to medication abortion via telehealth should be expanded to minors in these states as well. And policymakers must be held accountable to ensure access to comprehensive sex education and the full range of contraceptive options for everyone in all states.

Teens deserve to have autonomy over their bodies. It is time to fight for this fundamental right.

Tracey Wilkinson is a pediatrician and an assistant professor of pediatrics at Indiana University School of Medicine. Julie Maslowsky is an associate professor of community health sciences at the University of Illinois Chicago School of Public Health. Laura Lindberg is a professor of urban-global health at Rutgers School of Public Health.

Source: STAT