5/16/2022
 
A leaked draft opinion of the Supreme Court of the United States regarding Mississippi v. Jackson Women’s Health Organization raises concern that federal protections for abortion access may be at risk1. In the interest of the health and well-being of adolescents and young adults in the United States, the Society for Adolescent Health and Medicine (SAHM) and the North American Society for Pediatric and Adolescent Gynecology (NASPAG) object to any restrictions placed on the reproductive rights and care of adolescents and young adults, including access to safe abortion. 
 
Abortion is a safe and essential component of comprehensive sexual and reproductive health care and a basic human right2.  Comprehensive sexual and reproductive health for adolescents and young adults (AYA) involves multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. AYA have the demonstrated ability to make responsible and informed decisions about their own reproductive and sexual health, which includes decisions about pregnancy and abortion care3.  As such, healthcare laws have evolved to allow adolescents less than 18 years of age to make these decisions by protecting their autonomy, confidentiality, and right to consent in these areas.  States have obligations to respect, protect and fulfill rights related to adolescent sexual and reproductive health including access to safe abortions. Barriers to abortion access threatens the lives, health, and human rights of AYA4.
 
Adolescents and young adults experience multiple barriers to sexual and reproductive health and justice
 
Access to effective contraception is essential to preventing unintended pregnancies and reducing the need for the discussion/consideration of pregnancy termination, yet AYA face significant barriers to confidential, culturally appropriate, comprehensive sexual and reproductive education and healthcare,5. Furthermore, young people are particularly vulnerable to coercive sexual encounters and unintended pregnancy6,7. This vulnerability may be compounded by disability, immigration status, involvement in the foster care system, incarceration, or experiences of sexism, racism, and other systems of oppression8-11.  Minor adolescents in particular can encounter substantial challenges in preventing pregnancy when there are laws and policies that restrict the provision of contraception and limit a minor’s autonomy to make reproductive healthcare decisions.  Access to contraception may also be limited by financial resources and healthcare providers’ own bias, coercion, or lack of willingness to acknowledge AYA’s sexual and reproductive health needs2,12. AYA need reproductive justice-informed, comprehensive sexual and reproductive health education and care that includes access to abortion13.
 
Adolescents and young adults experience specific barriers to abortion access
 
In 2019 (most recent available data) the distribution of reported abortions across ages was 2% for those <15 years, 8.6% for 15-19 years, 27.6% for 20-24 years, and 29.3% for 25-29 years14. Reducing barriers to comprehensive sexual and reproductive education and healthcare is an essential component for AYA to obtain the highest attainable standard of physical and mental health as stated in the Universal Declaration of Human Rights16, as unintended pregnancy and childbearing for AYA is both a cause and a consequence of adverse health, education, and economic circumstances. Ensuring reproductive rights and access to abortion is one critical piece of improving the life circumstances of families and communities.
 
AYA face significant barriers to confidential abortion due to financial constraints, travel challenges, and limited access to medication abortion by telehealth17-27.  All leading medical associations explicitly support parental involvement in adolescent health care; however, adolescent confidentiality must be protected in the case of sexual and reproductive healthcare, including abortions. Mandating communication about abortion can have detrimental consequences in delaying access to medical care and placing the minor at risk of violence or abuse. Parental notification and consent requirements place additional and undue burdens for this particularly vulnerable population. AYA will be disproportionately impacted if Roe v. Wade is overturned and by further state-based restrictions on abortion access 17,19,27.
 
Health professionals who serve adolescents and young adults must:
 
1. Contribute to health system, research, and advocacy efforts to ensure adolescents and young adults have access to safe abortion. This includes normalizing the topics of abortion and pregnancy options counseling as an essential component of comprehensive sexual and reproductive health care when speaking to colleagues, AYA, parents, guardians, and supportive adults.
 
2. Educate policymakers on AYA’s developmental capacity to make safe and informed reproductive health decisions, apply a rights-based framework to adolescent abortion access, and oppose legislation requiring parental consent or notification for abortion care or imposing age restrictions on telehealth abortion services.
 
3. Catalyze community members to support AYA, by holding elected officials accountable to improve access to contraception and comprehensive sexual health education and by supporting initiatives that promote health, agency, and opportunity among AYA facing reproductive health inequities.
 
About SAHM
The Society for Adolescent Health and Medicine (SAHM), founded in 1968, is a nonprofit multidisciplinary professional society of 1,200 members committed to the promotion of health, well-being and equity for all adolescents and young adults by supporting adolescent health and medicine professionals through the advancement of clinical practice, care delivery, research, advocacy and professional development. Through education, research, clinical services and advocacy activities, SAHM enhances public and professional awareness of adolescent health issues among families, educators, policy makers, youth-serving organizations, students in the field as well as other health professionals around the world.
 
About NASPAG
The North American Society for Pediatric and Adolescent Gynecology (NASPAG), founded in 1986, is dedicated to providing multidisciplinary leadership in education, research, and gynecologic care to improve the reproductive health of youth.  Its focus is to serve and be recognized as the lead provider in PAG education, research, and clinical care, conduct and encourage multidisciplinary and inter-professional programs of medical education and research in the field of PAG, and advocate for the reproductive well-being of children and adolescents and the provision of unrestricted, unbiased and evidence-based practice of PAG. Its official journal, Journal of Pediatric and Adolescent Gynecology, had its first volume published in 1987 and it continues to cover the spectrum of basic science and clinical research in the subspecialty area, addressing gynecological related problems from birth through the early twenties.
 
 
 
 
1.           Gerstein J, Ward A. Supreme Court has voted to overturn abortion rights, draft opinion shows. 2022. May 2, 2022. https://www.politico.com/news/2022/05/02/supreme-court-abortion-draft-opinion-00029473
2.           Burke PJ, Coles MS, Di Meglio G, et al. Sexual and reproductive health care: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health. Apr 2014;54(4):491-6. doi:10.1016/j.jadohealth.2014.01.010
3.           Grootens-Wiegers P, Hein IM, van den Broek JM, de Vries MC. Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatr. 2017;17(1):120. Published 2017 May 8. doi:10.1186/s12887-017-0869-x
4.           World Health Organization. Abortion. 2021. November 25, 2021. https://www.who.int/news-room/fact-sheets/detail/abortion
5.           Breuner CC, Mattson G, ADOLESCENCE CO, et al. Sexuality Education for Children and Adolescents. Pediatrics. 2016;138(2)doi:10.1542/peds.2016-1348
6.           Barral R, Kelley MA, Harrison ME, et al. Dismantling Inequities in Adolescent and Young Adult Health through a Sexual and Reproductive Health Justice Approach. Semin Reprod Med. Jan 20 2022;doi:10.1055/s-0042-1742347
7.           Franchino-Olsen H. Vulnerabilities Relevant for Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking: A Systematic Review of Risk Factors. Trauma, Violence, & Abuse. 2021;22(1):99-111. doi:10.1177/1524838018821956
8.           Rizk R, Alderman E. Issues in gynecologic care for adolescent girls in the juvenile justice system. J Pediatr Adolesc Gynecol. Feb 2012;25(1):2-5. doi:10.1016/j.jpag.2011.01.060
9.           Kaufman M. The sexual abuse of young people with a disability or chronic health condition. Paediatr Child Health. Jun 2011;16(6):365. doi:10.1093/pch/16.6.365
10.         Mailhot Amborski A, Bussières EL, Vaillancourt-Morel MP, Joyal CC. Sexual Violence Against Persons With Disabilities: A Meta-Analysis. Trauma Violence Abuse. Mar 4 2021:1524838021995975. doi:10.1177/1524838021995975
11.         PettyJohn ME, Reid TA, Miller E, Bogen KW, McCauley HL. Reproductive coercion, intimate partner violence, and pregnancy risk among adolescent women with a history of foster care involvement. Child Youth Serv Rev. Jan 2021;120doi:10.1016/j.childyouth.2020.105731
12.         Gomez AM, Wapman M. Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care. Contraception. Oct 2017;96(4):221-226. doi:10.1016/j.contraception.2017.07.007
13.         Ross L, Solinger R. Reproductive Justice: An Introduction. University of California Press; 2017.
14.         Kortsmit K, Mandel MG, Reeves JA, et al. Abortion Surveillance — United States, 2019. MMWR Surveill Summ 2021;70(No. SS-9):1–29. DOI:  http://dx.doi.org/10.15585/mmwr.ss7009a1
15.         Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep 2021;70:1–51.
16.         The Universal Declaration of Human Rights, 1948-1998. New York: United Nations Dept. of Public Information, 1998. Print. Turabian (6th ed.) United Nations.
17.         ADOLESCENCE CO, Braverman PK, Adelman WP, et al. The Adolescent’s Right to Confidential Care When Considering Abortion. Pediatrics. 2017;139(2)doi:10.1542/peds.2016-3861
18.         Davis AR, Beasley AD. Abortion in adolescents: epidemiology, confidentiality, and methods. Curr Opin Obstet Gynecol. Oct 2009;21(5):390-5. doi:10.1097/GCO.0b013e3283307b84
19.         Bryson AE, Hassan A, Goldberg J, Moayedi G, Koyama A. Call to Action: Healthcare Providers Must Speak Up for Adolescent Abortion Access. J Adolesc Health. Feb 2022;70(2):189-191. doi:10.1016/j.jadohealth.2021.11.010
20.         Committee on Health Care for Underserved Women. Increasing Access to Abortion. ACOG Committee Opinion. American College of Obstetricians and Gynecologists; 2020;136(6). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-access-to-abortion
21.         Coleman-Minahan K, Stevenson AJ, Obront E, Hays S. Young Women's Experiences Obtaining Judicial Bypass for Abortion in Texas. J Adolesc Health. Jan 2019;64(1):20-25. doi:10.1016/j.jadohealth.2018.07.017
22.         Ely GE, Hales TW, Jackson DL, Kotting J, Agbemenu K. Access to choice: Examining differences between adolescent and adult abortion fund service recipients. Health Soc Care Community. Apr 23 2018;doi:10.1111/hsc.12582
23.         Leyser-Whalen O, Torres L, Gonzales B. Revealing Economic and Racial Injustices: Demographics of Abortion Fund Callers on the U.S.-Mexico Border. Womens Reprod Health (Phila). 2021;8(3):188-202. doi:10.1080/23293691.2021.1973845
24.         HeyJane. https://www.heyjane.co/how-it-works#:~:text=Hey%20Jane%20provides%20medication%20abortion,Medically%20eligible
25.         Abortion Care. Choix, Inc. https://www.mychoix.co/abortion-care
26.         GREYHOUND LINES INC. PASSENGER FARE TARIFF AND SALES MANUAL. https://extranet.greyhound.com/revsup/pfsm/pdf/sec07dsc.pdf
27.         Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion because of provider gestational age limits in the United States. Am J Public Health. Sep 2014;104(9):1687-94. doi:10.2105/ajph.2013.301378
 
 

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