The printed sign propped on the reception desk at Valley Community Clinic in North Hollywood is aimed at the nervous teenagers who often populate the waiting room.
It reminds all clients to complete their paperwork before seeing a doctor or nurse practitioner, but with the young in mind concludes: ". . . Remember--we keep our mouths shut."
Although publicly funded family planning clinics must, by law, urge minors to consult their parents about health matters, it is the guarantee of confidentiality, say clinic directors, that enables millions of American teenagers to seek reproductive health services.
According to one study, an estimated 256,000 unintended teenage pregnancies are prevented each year by teens' use of contraceptives--usually obtained without their parents' knowledge or consent. Thus, 110,000 births, 112,000 abortions and several maternal deaths are avoided, researchers say.
But what is being hailed as a successful system by family planning organizations is being portrayed as a failed social program by some conservative and religious groups. And the battle is being played out in state legislatures across the country, where the two sides are at odds over the burgeoning "parental rights" movement.
In essence, parental rights legislation would require such things as written permission for a minor to seek any education, counseling or health care deemed sensitive to family relationships or values.
Even though few laws have been changed, this has been a banner year for parental rights proponents. Bills that give parents more control have been introduced in 28 states, up from 12 such proposals in 1995, according to Of the People Foundation, a Virginia-based group founded four years ago to advance parental rights legislation.
In California, a bill that would have required mandatory, written parental consent before minors could participate in school sex education classes sailed through the Assembly before being halted by protests in a Senate subcommittee.
In the nation's capital, the Parental Rights and Responsibilities Act, which would give parents a free hand to legally challenge virtually any services for children--including education and health care--is still under consideration. The proposed act is sponsored by Sen. Charles Grassley (R-Iowa) and Rep. Steve Largent (R-Okla.).
And, in Colorado, a group called the Coalition for Parental Responsibility says it is optimistic it will have enough signatures by the Aug. 5 deadline to put the first-ever parental rights initiative--an amendment to the state's constitution--on the November ballot. The wording of the amendment, similar to the proposed federal law, would bar practices that "usurp the right of a parent to direct the upbringing of the child."
"Fifty-five thousand signatures are needed. We intend to go way above that and have close to 80,000 signatures," says Greg Erken, Of the People's executive director.
"A victory in Colorado would be electrifying," says Of the People founder Jeffrey Bell. "We have laid a foundation in a lot of other states. We have legal sponsors in 28 states, so there is going to be a lot of knowledge about this."
Bell calls the parental rights movement a "wake-up call" to Americans. High rates of juvenile crime, violence, substance abuse and pregnancy demand that parents become reengaged in their children's lives in a more authoritarian manner, he says.
"I think this [movement] is a healthy thing," Bell says. "There would seem to be, on the surface, a conflict between parents' rights and parental responsibility. But I think if you get one, you'll get more of the other."
But all the nation will get under this scenario is a whole lot of trouble, say the legions of opponents of the movement. They predict a host of lawsuits will arise as parents feel free to challenge almost any service provided to their children without their explicit written permission. This could alter textbook selection in schools; school-based assessments, vision and hearing tests and counseling; minors' access to health services; even safety regulations requiring the use of car seats and bicycle helmets, critics charge.
Health, education and child welfare leaders are aghast that the trend has picked up steam under the noses of an unknowing public and overworked legislators.
Organizations such as the American Academy of Pediatrics, American Academy of Family Physicians, National Education Assn., American Psychological Assn., American Civil Liberties Union and the Child Welfare League of America have protested the legislation.
Opponents also say they are worried that the movement will succeed because it sounds reasonable on its face.
"Everyone says, 'What's wrong with parental rights?' " says Peter Kostmayer, executive director of Zero Population Growth. "The danger here is that it sounds fine on the surface, but there is a hidden agenda."
Critics say the movement originated as one of 10 planks in the Christian Coalition's 1995 document called "Contract With the American Family."
"What it would do is fulfill a bunch of pieces of the agenda of the religious right," charges Rebecca Isaacs, director of public policy for People for the American Way, a liberal watchdog group concerned with constitutional rights and civil liberties. She cites ensuring conservative curricula in public schools and additional support for home schooling. "And there is a whole host of programs they'd like to do away with, such as family planning."
Bell of Of the People, however, says the movement is not about religion. It's about the erosion of strong families and what can be done about it.
"A lot of people say parenting has fallen on hard times, and I would not dispute that. There are big barriers to parenting that are economic in nature. But we would argue that the way to make parents focus more on their parental responsibility is to empower them," he says.
Parents, Bell says, have given up and relinquished too much responsibility for their kids to public institutions.
"I think a lot of the reasons that parents have withdrawn from parenting is that they are demoralized," he says. "But what has been the result with regard to promiscuity, illegitimacy, teen pregnancy? I'm not saying everything is attributable to parents withdrawing, but you can't say things have gone well with schools and communities taking over a lot of this."
Parents are no longer providing adequate protection for their children, Bell adds. He cites a case in eastern Pennsylvania in which a group of parents allege that their daughters were given invasive pelvic exams as part of health examinations without their permission, even though the girls asked to have their parents notified first.
"These students were told they could not call their parents," Bell says. "It was a rather flagrant case. But it's the type of thing that seems to be happening more often."
Isaacs says proponents of parental rights laws "pick local anecdotes and play them up. They say, 'This is why we need this overarching federal scheme.' "
To be sure, there is much hand-wringing over the state of affairs among children today, notes Kostmayer. And there are situations when parents need to be assertive about what kinds of services their children are offered or receive, whether in education or health. But those disputes should not require federal legislation that would supersede existing state statutes on such matters, he says.
"There are going to be instances where there is a problem. Generally, however, it's better not to get the federal government involved. Generally, it's better to work with consensus and consultation, not lawyers and federal bureaucrats ironing out local disputes across the country. To do otherwise is a formula for disaster," Kostmayer says.
The debate also pits parents' rights against the rights of adolescents, who, in recent history, have been given fairly wide latitude by courts to look out for their own best interests. All but one state, South Carolina, extends confidential testing and treatment of sexually transmitted diseases to minors, and 23 states give minors the right to consent to contraceptive services.
The right to confidential abortions for minors has been the exception, however. The U.S. Supreme Court has ruled, in a line of decisions beginning in 1976, that states can require parental consent or notification when a minor seeks an abortion as long is it also gives the youth a confidential alternative, such as authorization from a judge.
In April, the California Supreme Court upheld a similar ruling, although the law is not being enforced currently because of legal challenges. Eventual enforcement of this requirement could make it easier for parental rights advocates to push for more laws on consent, says Margie Fites Seigle, chief executive officer of the Los Angeles Regional Family Planning Council.
"The door becomes open with this issue of abortion," Seigle says. "Once it has become less accessible for teens in one area of medical services, it's easier to expand that into other areas."
And, in an era when 12% of females ages 15 to 19 become pregnant in the United States each year (about 1 million girls), family planning experts are appalled by anything that would put more barriers between adolescents and contraceptives services.
"The consequences of [parental rights laws] would be phenomenal," says Ramona Rule, a nurse practitioner who works with teens at the Valley Community Clinic in North Hollywood. "Teens are so ambivalent about birth control anyway. Already, we have such a limited opportunity to get through to these kids."
The parental rights trend threatens to clash with an equally powerful teen pregnancy prevention movement underway in California and elsewhere. The California Wellness Foundation recently launched a $60-million, 10-year campaign to reduce teen pregnancies while the new state budget contains one of the strongest commitments to family planning in recent memory.
But many adolescents would rather risk pregnancy or a sexually transmitted disease, even HIV infection, than tell Mom or Dad that they are sexually active, says Jennie Haynes, 18, a peer counselor at Valley Community Clinic.
"One of the biggest factors in their coming here is confidentiality," she says. "They say, 'Oh, you're not going to call my house, are you?' "
Lisa Grigoryan, 20, has worked as a peer counselor at the clinic for five years. When she encourages teens to consult their parents about their sexual relationships, "they laugh at me," she says.
Most teens, she adds, are afraid they'll disappoint their parents or invoke their anger if they confide in them.
"They are trying to be responsible, and these proposed laws would take that away," Grigoryan says. "It takes courage to come into the clinic."
Very few teens seek reproductive health services with a parent's knowledge or permission, Rule says. A 1993 study in the journal Pediatrics found that if confidential treatment for sexually transmitted diseases were available, 50% of adolescents would seek treatment but only 15% would do so if parental consent or notification were required.
But one 17-year-old seeking a physical examination at the Valley Community Clinic on a recent summer morning had her mother's blessing. Heather, who asked not to have her real name used, has been sexually active since she was 14. She says she is glad she can tell her mother, a highly educated professional, "because you need that support."
Her mom had asked Heather to call her at work after the exam to tell her what happened.
"She gave me gas money to get here," Heather says. "My mom is very open about these things. But I know a lot of kids who can't talk to their parents."
Studies show that adolescents wish they could talk to their parents about sensitive issues such as sex and substance abuse. But if an authority stepped in and said they had to talk to their parents, would they? Or would they simply not seek any treatment, information, counseling or guidance?
That is the unknown repercussion of parental rights laws, critics say.
"Teens have their own minds, and they are going to do what they are going to do," says Rosie Munguia, 19, a Valley Community Clinic peer counselor. Still, she adds, "Adults should work with teens, not against them."