States Must Act Now to Protect Teenagers’ Reproductive Healthcare

Laws requiring parental consent for minors requiring abortion care do not help teenagers—they only delay much needed healthcare for vulnerable youth.

Pro-choice demonstrators rally on Mother’s Day Rally in Boston on May 8, 2022. (Photo by Joseph Prezioso / AFP via Getty Images)

As has been reported in an unprecedented leak of a draft opinion in Dobbs v. Jackson Women’s Health Organization, the Supreme Court appears to have the votes to overrule 50 years of precedent upholding the constitutional right to abortion. In the leaked draft opinion, Justice Alito proclaims that Roe v. Wade and Planned Parenthood v. Casey must be reversed—leaving legislatures free to ban abortion in almost all circumstances.

As many as 28 states will ban or severely restrict abortion services when Roe is overturned. It is not far-fetched to imagine anti-abortion states criminalizing the out-of-state abortions that will be a necessary part of a post-Roe legal landscape. A Missouri legislator already introduced such a proposal.

In reaction, abortion-supportive states are proposing and passing legislation protecting clinicians and advocates who help to provide lawful in-state care to out-of-state patients. More needs to be done to protect abortion access for pregnant people traveling across state lines, especially teenagers.

Roe’s Reversal Will Harm Marginalized Groups, Including Adolescents

We know that bans on abortion will disproportionately impact the most vulnerable groups who already lack access to healthcare, including low-income people and pregnant women of color. Research shows that 75 percent abortion patients live at or near the federal poverty line, and more than half are people of color. Teenagers will also be especially impacted by Roe’s reversal.

Teenagers already face additional hurdles to accessing abortion care. In addition to coping with practical difficulties such as finding transportation to an abortion provider, paying for the services and obtaining time off from school, adolescents must also navigate laws mandating parental involvement with abortion care. States with parental notice or consent mandates, which are the vast majority of states, require teenagers facing an unplanned pregnancy to obtain permission from a parent or alternatively from a judge to receive abortion care.

Even in jurisdictions sympathetic to abortion rights, the notion of parental involvement with abortion for teenagers remains quite popular because the law generally requires parental consent for a minor’s medical care. However, this general rule is misleading because states typically exempt other similarly sensitive medical care from parental involvement.

Failure to protect physician-patient confidentiality in this sensitive area will only hurt the teenagers we all seek to help.

Abortion opponents confuse and trivialize the issue by comparing laws requiring parental consent for abortion to laws requiring parental consent for ear piercing, visiting a tanning salon or obtaining aspirin from a school nurse. Although we do mandate parental consent for many services provided to minors, the law does not generally require parental consent for teenagers who seek time-sensitive medical care related to sexuality and reproduction.

States generally exempt sexual and reproductive healthcare from mandated parental involvement precisely because we recognize that failure to protect physician-patient confidentiality in this sensitive area will only hurt the teenagers we all seek to help. All states allow minors to obtain treatment for sexually transmitted infection without notifying their parents and many states allow minors to receive contraceptive services without involving a parent. States overwhelmingly allow a teenager to independently consent to pregnancy care and medical treatment for her child, and even to give up her child for adoption, without notice to her parents, yet require parental notice or consent for abortion. In other words, it is actually abortion that is exceptionalized in the context of teenagers’ access to healthcare.

Mandated Parental Involvement With Abortion Endangers Teen Health

Parental involvement laws and the judicial bypass process do not help scared teenagers. Instead, these laws delay much needed healthcare for our most vulnerable youth.

Decades of public health research on the efficacy of parental involvement laws and the judicial bypass process demonstrate that these laws threaten adolescent health. In particular, research shows most teens do involve parents or other trusted adults in abortion decisions—but minors who feel they cannot safely inform their parents about a pregnancy end up delaying abortion care (often to travel out of state for care) and face greater medical risks as a result. Parental involvement laws most heavily punish the most vulnerable and marginalized minors—those who lack supportive parents or the resources to readily access the court system.

In addition, teenagers are more likely to be late in discovering their pregnancy and delayed access to care may prevent them from obtaining abortion care entirely. The Turnaway Study provided evidence about the harms that result when pregnant people are denied wanted abortion care. The Turnaway Study found that a significant number of women seeking second-trimester abortions were already in their second trimester when they first realized they were pregnant. Young women who have never been pregnant and women who conceived the pregnancy despite using a hormonal method of contraception are more likely than other women to be late in discovering their pregnancy.

Even if abortion parental consent laws appear well-intentioned, public health research shows that these laws drive teens away from care in ways that increase risks to their health and harm the most marginalized groups of adolescents. State legislatures can prevent these health harms by ensuring that teenagers have the ability to consent to the full spectrum of reproductive healthcare without parental involvement.

States Must Enact Legislation Permitting Teenagers to Consent to Reproductive Healthcare

Abortion-supportive state legislatures should act immediately to protect adolescents who will need to travel across state borders to obtain abortion care. State governments can repeal their parental involvement laws and explicitly permit adolescents to consent to medical care for contraception and abortion just as they allow adolescents to consent to treatment for sexually transmitted infections and pregnancy care.

Massachusetts recently passed a ground-breaking law repealing its parental involvement law for 16- and 17-year-olds. For adolescents younger than 16, states could adopt creative strategies such as involving an adult family member other than a parent or another trusted third party in a minor’s abortion care rather than forcing teenagers to endure the ordeal of a judicial bypass. In many cases, other adults in the community will be better situated than judges to help a pregnant minor secure a sound decision-making process.

A few states have expanded options for pregnant teens seeking abortion care, by permitting adolescents to consult with extended family members such as grandparents or other adult relatives in lieu of a parent or a judge. Connecticut takes a different approach, eschewing parental consent entirely and instead mandating counseling prior to a minor receiving an abortion. These statutes recognize that a judge, who has no prior relationship with the minor and must conduct an interrogation in the context of a formal judicial proceeding, can offer pregnant teenagers little help or counseling. 

Parental involvement laws are most likely motivated by a desire to thwart access to abortion and shame pregnant teenagers. These laws should be repealed or at a minimum reformed to truly provide teenagers with adult counsel as opposed to mere judicial scrutiny. Enlisting other trusted members of the community to assist pregnant teenagers should assuage those who want to guarantee that teenagers consult with an adult in a time of crisis, while also giving leeway to the well-documented concern that some teenagers reasonably fear discussing pregnancy with their parents.

Turning to State Legislatures to Protect Access to Abortion Care

The fight for reproductive autonomy will now be largely waged at the ballot box rather than in the federal courts. There is much that can be accomplished through the state legislatures. Along with creative strategies at the federal and state level to protect access to abortion care, reproductive justice advocates must fight to remove the additional obstacles faced by teens seeking reproductive health care in a post-Roe world.

Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.

Up next:


Maya Manian, J.D., is a professor of law and faculty director of the Health Law and Policy Program at American University Washington College of Law. Manian's research investigates the relationship between constitutional law, family law and healthcare law, with a particular focus on access to reproductive healthcare. She previously served as a Blackmun fellowship attorney at the Center for Reproductive Rights. Manian received her undergraduate degree from the University of Michigan and her law degree magna cum laude from Harvard Law School.