In two-thirds of states, at least some categories of minors are legally entitled to consent to contraceptive services; throughout the country, most minors can consent to testing and treatment for sexually transmitted diseases. However, proposals in some states and in Congress would limit these rights, instead requiring minors to involve their parents in their reproductive health care. Most of these efforts seek to make public funding of services conditional on a parental involvement requirement, and as a result, teenagers who obtain services at publicly funded family planning clinics stand to bear the brunt of any new restrictions. In this issue of Perspectives on Sexual and Reproductive Health (see article), Rachel K. Jones and Heather Boonstra examine two decades' worth of literature to assess how young people who use these clinics would likely react to a legal requirement that they involve their parents and the extent to which parents already participate in their minor children's reproductive health decisions.
As Jones and Boonstra report, the research is admittedly sketchy, but it yields a number of consistent outcomes. Contrary to the expectations of backers of mandatory parental involvement, such a requirement would deter few teenagers from having sex, and would not necessarily result in either broader parent-child communication about sexual matters or more consistent contraceptive use. A substantial proportion of teenagers would likely use prescription contraceptives even if their parents were informed, but others would use ineffective methods or none at all; moreover, those who decided to forgo clinic visits for contraception would miss the opportunity to get other reproductive health services.
A uniform parental involvement requirement for teenagers using clinic services, the researchers conclude, "would benefit only a small proportion of families and could have substantial negative consequences." A better alternative, in their view, is to work toward improving parent-child communication in general and on sexuality-related issues.
Also in This Issue
•Pregnancy intendedness—what it means and how best to measure it—is the subject of the next two contributions. Denise V. D'Angelo and colleagues (see article) use a population-based sample, from the 1998 Pregnancy Risk Assessment Monitoring System, to compare women who said that their recent live birth resulted from a mistimed pregnancy with those who said that the pregnancy had been unwanted. The researchers studied a greater number of variables than has been possible in earlier efforts and found differences on nearly all of them. Risky behaviors and adverse experiences—smoking late in pregnancy, being physically abused while pregnant, and receiving delayed or no prenatal care, among others—were significantly more common among women with a mistimed pregnancy than among those whose pregnancy was intended. They were more prevalent still among those who had not wanted to become pregnant at all. The authors note that their findings demonstrate the need for research to distinguish mistimed from unwanted pregnancies; more immediately, the results can help service providers target interventions at women who could most benefit from counseling about the effects of unhealthy behaviors during pregnancy.
An analysis by Ilene S. Speizer and coinvestigators suggests that a single factor—pregnancy desirability—underlies a wide variety of intendedness measures (see article). Employing factor analysis to examine data on inner-city low-income women attending a public prenatal clinic or a public family planning clinic in New Orleans, the researchers found that similar sets of variables best captured that factor for both women reporting on a first pregnancy and those reporting on a second or higher order one. Results differed only for teenagers reporting on a first pregnancy. The authors conclude that to "help standardize...public health surveillance systems and thus permit better assessments of trends in pregnancy desirability over time," future surveys should reduce the number of questions they use to capture pregnancy desirability.
•On the face of it, the U.S. network of publicly funded family planning clinics seems fairly stable: The number of sites rose by 8% between 1994 and 2001, and the number of clients by 2%. But beneath the surface, Jennifer J. Frost and coauthors report (see article), marked changes are evident in the types of providers offering care and the clinic network's ability to meet the demand for services. Health departments and Planned Parenthood affiliates now serve more clients at fewer sites than they did in the early 1990s, while community health centers serve fewer clients at more sites. In one-third of states, clinics' capacity to meet contraceptive need has increased, sometimes considerably; but in another third, it has declined, also sometimes considerably. In states that have broadened their Medicaid programs and extended eligibility on the basis of low income, clinics are providing care to increasing proportions of those in need; in others, they are unable to do so. Clinic closings pose obvious problems for women in need of services, and the authors stress the importance of ensuring access to services for low-income women across the nation.
Notice to Readers
Beginning in 2005, Perspectives on Sexual and Reproductive Health will be published quarterly—in March, June, September and December.