Forum: Teenagers Educating Teenagers About Reproductive Health and Their Rights to Confidential Care
Teenagers are more likely to use health services when they are guaranteed confidentiality.1 But what rights do minors have to confidential care, including reproductive health care? To what services can minors give informed consent without their parents' knowledge or permission? Using foundation funding and private donations, the Reproductive Rights Project of the New York Civil Liberties Union (NYCLU) created the Teen Health Initiative (THI) to fill the need for an accurate understanding of teenagers' rights to health care in New York.
New York broadly protects minors' rights to obtain and consent to confidential health care. Still, health care professionals—who cannot provide appropriate and comprehensive care unless they know exactly what the law specifies—are often confused about those rights.2 THI makes the state's laws understandable and explains minors' legal rights to health care.
THI not only provides extensive training for professionals who work with adolescents, but also runs a peer education program. The program involves teenagers in discussions about their rights to confidential health care and gives them the tools to present that information to other adolescents around the state. In 1998, THI produced Teenagers, Healthcare and the Law, a booklet outlining minors' health care rights in New York. This booklet presents clear explanations, for both teenagers and professionals, of the state and federal laws that apply to minors' health care, specifically those related to confidentiality, informed consent and the health services to which minors are legally entitled.
Many teenagers will seek reproductive health care only if they know that it is available to them and that they can obtain it confidentially. According to Wilson, one peer educator, "The problem with laws is that teenagers aren't aware of the rights they have concerning their sexual health, and therefore do not receive the help they would like."
Sixteen peer educators, aged 14-19, make up the core of the program. Their weekly meetings in the offices of the NYCLU are a jumping off point for activities throughout New York. In a given month, members of the group may give workshops for other adolescents, identify "teenager-friendly" health centers in talks at schools and youth groups, participate in health fairs, attend rallies and demonstrations, call on state legislators and write letters to the editor. Currently, the peer educators are conducting interviews with adolescents throughout New York City about the barriers and problems they face in obtaining health care. This information will be incorporated into a Youth Summit that THI will hold in December for New York City peer educators who are working on health issues. THI is also producing a video on minors' legal rights to health care and the peer education program.
As peer educators organize and carry out these activities, they come to understand how reproductive health laws affect them. They are engaged in active learning and teaching; they are involved in their communities and become activists. "One of the things I like best about THI is its emphasis on teenagers' responsibilities," says Sophie, a peer educator and intern. "Although we discuss safe sex, contraceptive methods, HIV testing and AIDS, we also discuss teenagers' rights. We teach teenagers the power over their health care that the law gives them, and we emphasize the wide range of choices that a teenager has about his or her own health."
THI's work with the peer educators provides much of its energy, ideas and inspiration. In creating a two-tiered program—working with both teenagers and professionals—the program gains information and knowledge from each group. The peer educators become "advisors," experts on being adolescents in New York. By giving advice and asking questions, they provide information about their concerns and what they feel is important to include in the workshops. This process helps shape the direction of the advocacy, the production of materials and the professional training sessions offered by the program. Working directly with teenagers adds valuable depth to THI's training sessions for professionals. The THI program staff running these sessions can truthfully say, "Teenagers in New York are concerned about confidentiality in health care" or "Many adolescents don't know they can receive emergency contraception."
In turn, the peer educators benefit from being part of a professional organization that works on legal aspects of health care. Each teenager goes through an intensive training program at the beginning of the year that introduces or reinforces knowledge about issues related to reproductive health, civil liberties, youth rights and sexuality. The peer educators create a workshop called "Know Your Rights! Minors' Legal Rights to Health Care in New York." According to Wilson, "One of the most important aspects of the THI program is that it focuses on teenagers educating teenagers. The workshop feels more like a sharing of information than the lectures that some sex education classes present." The workshop covers the areas of health care to which minors can give informed consent and that they can receive confidentially. In New York State, in addition to mental health care and drug and alcohol counseling, these areas include reproductive health care—birth control (including emergency contraception), pregnancy testing, prenatal care and counseling, testing and treatment for sexually transmitted diseases (STDs), HIV and AIDS testing and treatment, and abortion.
The peer educators often open up the workshops by using a question as an ice-breaker. One of the most telling is: "Can you talk to your parents about sex?" The majority of the adolescents attending say no. When asked what they consider the most crucial health problems teenagers are facing right now, they cite pregnancy, HIV infection and depression—all problems requiring services that teenagers can obtain confidentially in New York. The THI workshop shows teenagers that they have the right to receive these services and gives them a forum for asking questions. "Do I really have the right to an abortion without my parents knowing?" "Can I go for treatment of an STD by myself?" "Where can I get emergency contraception?" "Where can I obtain confidential counseling?" The questions raised in the workshops provide evidence of a great need for comprehensive sex education programs that include accurate information on teenagers' legal rights.
The creation of a peer education program around the legal rights of teenagers to health care expands the concept of sex education. The content of the workshop helps the peer educators and their audience to understand why they do and do not have access to different services, and encourages them to delve into the legal framework of access to health care. It discusses reproductive health, but also gives them the tools to understand the history and the current status of their rights to reproductive health care. This, in turn, leads them to question how health care is provided, and to learn what they can do if they feel they do not have access to the services they need. Wilson notes: "Another thing that draws me to THI is that instead of presenting ideas or opinions on sex, it presents nonnegotiable facts about the rights teenagers have." Teresa, also a peer educator and intern, says, "The information that THI provides for teenagers is vital and unique in that it really empowers youth. It is helpful for teenagers to know that they have choices; our group reinforces this knowledge by letting youth know what their options and legal rights are when dealing with their health care."
The key is to make teenagers understand that they have a right to confidential health care and lead them to believe that they can assert and defend those rights and should tell their peers about them. THI involves adolescents in the legal processes of health care by explaining their rights and helping them to become advocates for their own health. Teenagers who understand and value their rights are a powerful voice in their defense when policymakers seek to put politics before public health. As Sophie comments, "We believe that when fully educated and treated respectfully, most teenagers are willing and able to make responsible choices about their health and their lives."
1. English A and Simmons P, Legal issues in reproductive health care for adolescents, Adolescent Medicine, 1999, 10(2):181-194; and Ford C et al., Foregone health care among adolescents, Journal of the American Medical Association, 1999, 282(23):2227-2234.
2. Lieberman D and Feierman J, Legal issues in the reproductive health care of adolescents, Journal of the American Medical Women's Association, 1999, 54(3):109-114.