Should doctors have to notify parents before a minor receives an abortion?

Today's question: In California, minors need parental consent before undergoing almost any medical procedure. Why is reproductive medicine treated differently? Miriam Gerace and Katie Short debate Proposition 4, which would require a parent to be notified before a minor undergoes an abortion.

What a doctor says about adolescent healthcare
Point: Miriam Gerace

I work in a healthcare setting, so when considering this question I checked with the doctors, nurses and counselors I know who counsel and treat teens every day. I know that they would do everything in their power to keep teens safe.

I asked L.A. pediatrician Curren Warf to share his thoughts on Proposition 4 with me; what I write here is largely what he told me. Warf, who specializes in adolescent care at Childrens Hospital Los Angeles, says he does everything he can to encourage communication between parents and their teenage children. He opposes Proposition 4, the ballot initiative that would require doctors to notify a parent if their daughter wants to terminate a pregnancy. Why do the American Academy of Pediatrics, the Society for Adolescent Medicine, the American Academy of Family Physicians, the California Medical Assn. and the American College of Obstetricians and Gynecologists all agree with him?

The answer, he says, is that most teens already talk to their parents when they face an unplanned pregnancy. He points to studies showing that more than 60% of teens (and more than 90% of teens 14 and under) already talk to parents when they consider this difficult decision. Among those adolescents who did not talk to their parents, about one-third had already experienced violence in the family and feared it would occur again. Almost all teens who don't involve a parent do involve another trusted adult, such as an aunt or grandmother. Forced parental notification will not improve family communication -- but it will put teenagers at risk.

Yet despite research from the American Academy of Pediatrics, the New England Journal of Medicine and other top-tier health journals that shows there is a significant risk of violence, abuse and rejection in families when parents are informed of a pregnancy, proponents of Proposition 4 insist there's no risk of harm to teens. But consider the young woman in Michigan, where there is a parental involvement law, who tried to self-induce an abortion by asking her teen boyfriend to hit her in the stomach with a baseball bat. We can't let those tragic stories happen in California.

Worse yet, under Proposition 4, if a teenager cannot talk to her parents -- for whatever reason -- she is forced to go to law enforcement. Imagine a scared, pregnant teen having to make that decision and then waiting at home for the authorities to come to the door -- the same door she has to return through when it's all over.

Warf said we shouldn't forget the negative medical outcomes that Proposition 4 would bring about. Teens are twice as likely as adults to delay pregnancy-related care. Experience from some states with notification laws shows us that teens will avoid doctors and delay getting an abortion later into a pregnancy -- sometimes as late as the second trimester, when abortion is a more complicated procedure. Some teens will panic, others will travel alone or out of state, others may take desperate measures to end the pregnancy themselves -- and some will die. Warf says that as a doctor, he knows that before the days of safe and legal abortion care, self-induced abortion was the leading cause of hospitalization for women. It remains a leading cause of death for women of child-bearing age in countries where abortion remains illegal.

California has had great success in reducing teen pregnancy rates by 40% over the last 10 years. We know that there is still work to be done. Warf said the best answer to curtailing teen pregnancy and reducing abortions starts with caring families. We should try to foster an atmosphere that assures our daughters that they can come to their parents. But no matter what, as a medical professional and parent, Warf said, he knows that the most important thing is for his daughter to get medical care and counseling without delay. The two sides of this issue may not agree on everything, but we can agree that we want our teenagers to be safe.

Miriam Gerace is a spokesperson for the No on 4 Campaign for Teen Safety and director of communications for Planned Parenthood Los Angeles.

Planned Parenthood plays loose with research
Counterpoint: Katie Short

First, I feel compelled to point out that what Warf "told" you closely tracks various Planned Parenthood opinion pieces. Who are you trying to kid? What you are doing here is putting Planned Parenthood's words into the mouth of a pediatrician and pretending those words are his. Why? Because you are trying to make people think this is about "caring doctors" who have long-standing relationships with their teen patients and their families, rather than the reality of girls going to free-standing abortion clinics for serous medical procedures by doctors they have never seen before -- without anyone in their families even knowing.

Yes, we can agree that we want our teenagers to be safe. Healthcare professionals know that young teens are safest when a parent is involved in their medical care. That's why, getting back to the original question, we don't just "encourage communication" between young teens and parents about other medical care; we require parental consent. Proposition 4 simply requires that a doctor notify a parent or, in case of parental abuse, another adult family member before performing a serious medical procedure on a minor. That's just common sense.

But you write, Miriam, that most teens already tell a parent. The "studies" about how many teens tell a parent before an abortion is actually one 16-year-old study, which opponents of parental notification have been misrepresenting for years. The study showed that only 43% of minor girls told a parent themselves before seeking an abortion. Only 55% of those 14 and under did so. The author of the study, Stanley Henshaw, testified at a trial that the use of the study to claim that 60% of teens involve a parent before having an abortion is "entirely incorrect." Since the Yes on Proposition 4 campaign began pointing this out, Planned Parenthood now randomly claims that 70%, 80% or even 90% of teens already talk to a parent. It can't seem to settle on a figure.

Warf also told you that almost all teens who don't involve a parent involve another adult. Wrong again. The study said only 52% of those who didn't involve a parent involved another adult, including their adult boyfriend, which doesn't inspire a lot of confidence that these girls are getting disinterested advice.

As for why teens don't tell, few teens say that they fear abuse. Dr. Bruce Lucero, who has performed more than 45,000 abortions, wrote in 1998, "In almost all cases, the only reason that a teen-age girl doesn't want to tell her parents about her pregnancy is that she feels ashamed and doesn't want to let her parents down."

You claim that research from the American Academy of Pediatrics and the New England Journal of Medicine shows that there is a significant risk of violence. But instead of identifying any of this research, you rely on one anecdote from Michigan. The problem is, by those on the scene and aware of the circumstances, the girl and her boyfriend were not seen as "victims" of a law that they never even tried to work within any more than the teen in New Jersey (which has no parental involvement law) who gave birth at her prom and left the baby to die in a restroom was seen as a victim. Even the vice president of Planned Parenthood Mid-Michigan said there were options available that these teens simply ignored.

Miriam, I look forward to taking up the "delay" issue when we talk tomorrow about the experience in states with parental involvement laws.

Katie Short, coauthor of Proposition 4, is the legal director of the Life Legal Defense Foundation.