Confidentiality's role in supporting adolescent health

The Minnesota legislature is pushing a bill, SF 1017, to remove a minors right to obtain medical care. There is an exception for incest, rape and abuse but only when the abuse comes at the hand of a parent or a legal guardian - the victim would be forced to go in front of a judge to prove that abuse occurred. This bill would not only force rape and many incest victims to confront their assailants to obtain permission for an abortion, they would have to obtain their permission for STI testing, pregnancy testing, alcohol/drug counseling, mental health counseling and all other medical care.

In Minnesota, STI's disproportionally affect teens. According to the American Medical Association, parental consent and notification laws prevent teens from seeking health care. Removing the right to privacy will not only prevent teens from accessing health care but will prevent teens from obtaining the counseling medical professionals provide. Counseling that includes teaching teens about safe sex practices and guidance for talking to parents about sex. Confidential access to medical care has been a cornerstone to improving the health of American teens.

Guttmacher

Research from as far back as the late 1970s has highlighted the importance of confidentiality to teens' willingness to seek care. Recent research confirms these original findings. For example, a study appearing in 1999 in the Journal of the American Medical Association (JAMA) found that a significant percentage of teenagers had decided not to seek health care that they thought they needed due to confidentiality concerns. With respect to reproductive health care, specifically, a 2002 JAMA study found that almost half of sexually active teens (47%) visiting a family planning clinic would stop using clinic services if their parents were notified that they were seeking birth control, and another 11% reported that they would delay testing or treatment for sexually transmitted diseases (STDs) or HIV; virtually all (99%), however, reported that they would continue having sex.

The American Academy of Pediatrics states that parental consent legislation does not increase family communication, but does increase the risk of harm to the adolescent by delaying access to medical care. Physicians agree that minors should be encouraged to discuss their health with their parents/guardians, but should not be forced in order to obtain care. Parental notification/consent laws have been shown to decrease adolescents’ likelihood of seeking health care and use of contraceptives by almost 50% - thus completing the circle - and increasing the rates of teen pregnancy.

MNCASA provides some linkes to take action.

HIV Prevention and Title X

More than 56,000 new cases of HIV are diagnosed every year; the number of new HIV infections in Minnesota rose 25 percent in 2009. This increase brings the number of new HIV cases back to levels seen in the 90's.

According to the Minnesota AIDS project, this dramatic increase in HIV infections can be linked to the decline of comprehensive sex ed in public schools, a general sense that the risk of contracting HIV is low and the perception that HIV is a manageable disease. These and other social factors have contributed to men ages 15 to 24 seeing the largest increase in HIV cases in Minnesota.

Prevention is the key to saving lives and money. Prevention begins with comprehensive sex education. Young people need to know behaviors that put a person at risk for HIV/STIs and the methods to best prevent exposure. Through Title X funding, Planned Parenthood provided counseling, education and conducted 10,000 HIV tests in Minnesota last year. Unfortunately, Title X funding and other preventative care funding is at risk of being eliminated by the GOP majority in the U.S. House of Representatives. While the U.S. Senate rejected the budget bill removing funding from Planned Parenthood, we still do not have a finalized budget.

Removing funding from preventative health programs is negligent and short-sighted. Public health programs have helped prevent 340,000 babies from being born with HIV. Cutting funding for these programs would have a devastating effect for a generation of children being born with HIV especially when mother to child transmission is easily preventable. Cost to treat one HIV infection is over $25,000 per year, but programs to help cover the costs of these treatments may also be cut pushing the burden onto states. Public Health programs need to be above petty partisan politics, preventing disease and promoting health benefits all.

The importance of Title X

Planned Parenthood has served Minnesotans for over 80 years, helping men and women access comprehensive, medically accurate information and basic health care. 64,000 men and women in Minnesota utilize Planned Parenthood's services every year; 54% of those patients are at or below the federal poverty level and 83% of patients are eligible for health care services at little or no cost. Health care services provided by Planned Parenthood are especially critical in rural communities, where people are more likely to live in poverty and have extreme barriers to accessing health care. Only 3% of Planned Parenthood patients can afford the full cost of their care and, for many, Planned Parenthood functions as their primary care provider.


Recently, the House of Representatives voted to strip Planned Parenthood of all federal funding by zeroing out the title X budget. This move was based solely on politics and ignored 40 years of effective public policy. Every dollar spent on family planning services saves taxpayers four dollars in Medicaid spending, this is an excellent return on investment that is matched by few other federal programs. Title X funding, contrary to the speeches give by many on the house floor, does not fund abortion services.  Title X funds cancer screenings, STI/HIV testing, medically accurate sex education and contraception. The majority of title X patients are low-income women who are uninsured but ineligible for medicaid, making title X one of their few options to access health care services.

Title X grants provide Planned Parenthood of Minnesota with approximately 20% of their funding and eliminating this funding will disproportionately hurt rural Minnesota communities. Rural clinics serve fewer patients and those patients have an even greater need for federal aid. The map to the left depicts the percentage of births per county to mothers under 18.  Teen pregnancy already accounts for a large percentage of births in rural communities. Low maternal age negatively impacts infant health. Infants born to mothers under the age of 20 have a mortality rate 1.5 times higher than infants born to older mothers.

All women should have the knowledge and resources to prevent unintended pregnancies. Contraception services at Title X centers (like Planned Parenthood) prevented 973,000 unintended pregnancies. Without Title X this would have resulted in 406,000 more abortions. Removing funding for Planned Parenthood, one of the few sources for medically accurate sex education and contraception, will result in more unintended pregnancies and will disproportionately impact women in rural communities.


Cross posted from Planned Parenthood Advocate

Obama administration: Birth control is too politically risky

When did birth control become such a political football? I'm not talking about abortion. I'm talking birth control pills; that medicine most women take at some point in their lives to prevent pregnancy. The political fight over birth control access ramped up significantly with the health care reform debate and is back as the committee appointed by members of congress now debate what should or should not be covered as preventative medicine.

If birth control is specified as a preventative, insurance companies will cover the total cost of the prescription (meaning no copay for women).  For many, a copay may not be a big issue. They may not see the importance or impact of providing free birth control to low income women. To those who are barely getting by, a $10-$50 expense per month is significant. A college student making 12K per year (my sister made less than this as a student) per year as a waitress and has a $50/month prescription has to spend 5% of her income. 5% of her income just for birth control. And people wonder why there are so many unplanned pregnancies.

Sadly, the Obama administration seems content to sit back and let the chips fall as they may.
The Nation

Douglas Laube, a veteran ob-gyn and chair of the board of Physicians for Reproductive Choice and Health, who attended a fall meeting with White House staff to discuss the issue, described members of the administration as appreciative of the importance of birth control – but also worried. “Nobody in that room disagreed,” said Laube. “It all had to do with the potential political fallout.”

If the GOP, who fights access to family planning at every turn, REALLY cared about reducing the numbers of abortions, they would fight FOR expanded coverage of birth control. We need a leader to stand up and protect women's access to comprehensive health care. Prevention works. Prevention saves money. Prevention saves lives.