Editor’s Note: The opinions expressed in this blog post are solely those of the author.

“Being a parent is so often about waiting. Waiting for the due date, for the first smile, the first steps, the first time wings take flight. The years pass, the clock ticks, the heart beats faster. And we wait.”

This episode dealt with teenage pregnancy, preeclampsia and adoption; concerns for baby Elaine reveal a PKU diagnosis; budding feelings emerge between Trixie and Mr. Elwood; Timothy gets into a top medical school in Edenborough; and, the students continue to get work and life education.

This episode really got me thinking of several things; however, the storyline of Janette Owen’s teen pregnancy and her lack of rights and autonomy got me searching, exploring and reflecting. I found myself siding with the pupil midwife Nancy. A couple areas that I did some research on were ethical and legal boundaries for minors surrounding their autonomy within the health care system. I am aware that as a Modern Day Midwife this situation would have been dealt with much differently. There are vast differences from the late 1960s to 2021—from the perspective of stigma to many other areas within reproductive health care. This blog is about some of these issues and I have included some links for readers to explore the polices of their own state.

The legal definition of a minor is generally someone younger than 18 years of age. Over the last several decades, the ability of minors to consent to a range of health care services has expanded. Some of these sensitive areas include sexual and reproductive health care, mental health services, and alcohol and drug abuse treatment. Obviously, involving parents is always desirable; however, many young people will not obtain vital services that involve their health if forced to involve their parents. The Guttmacher Institute (2021) is a great site to see individual State Law information along with having a State Policy tracker for major developments in sexual or reproductive health issues.

The site states that in regard to sexual and reproductive health care, many states explicitly permit all or some people younger than 18 to obtain contraceptive, prenatal and STI services without parental involvement. Nearly every state permits parents younger than 18 to make important decisions regarding their children. However, the majority of states require parental involvement before a legal minor can obtain an abortion. While exploring the information I found out that 33 states and DC explicitly allow all individuals younger than 18 to consent to prenatal care. While 14 of these states allow, but do not require, a practitioner to inform parents that their child is seeking or receiving prenatal care when the doctor deems it in the young person’s best interest to do so. North Dakota allows young people to consent to prenatal care during the first trimester yet during the second and third trimesters requires parental consent for most care. And interestingly, 13 states have no explicit policy or relevant case law. If you live in the United States I have put a link below to explore your own location and laws and regulations.

The Center for Disease Control (CDC) is always a good site to explore. They share information about US teen birth rates, disparities in the US teen birth rate with varying racial groups, geographic differences, social determinants of health (example: low education and low income levels of a teen’s family may contribute to high teen birth rates), and certain settings (example: teens in foster care are twice as likely to become pregnant). Since 1991 the US teen birth rate has been declining. The birth rate is given as births per 1,000 females aged 15-19 years old. The most up to date National Vital Statistics Report (2019) record the US teen birth rate as 16.7 per 1,000 females. This was a record low for US teens and a decrease of 4% from 2018. As well, the birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years. Research in this area suggests possible reasons are more teens abstaining from sexual activity, and more teens that are sexually active using birth control.

The U.S. Department of Health and Human Services sponsored an independent systematic review of the teen pregnancy prevention literature to identify programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors. This was carried out from 2009 until 2019. I have put a link below to the article which summarizes some of these effective programs. I enjoyed reading about their creativity and outcomes.

Of most importance when taking care of a teen that shows up at your clinic is that you are teen friendly for their reproductive visit. Areas that need to be addressed would include confidentiality, privacy, consent, cultural and linguistic appropriateness, comprehensive services, and attention to your State’s Laws and Regulations regarding parent/ guardian involvement.

This storyline exemplified the need for communication, listening to each other, and shared decision making. Miss Higgins was so sensitive with Janette and Glen and I felt a true fondness for her words and actions. I do agree with Shelagh that at times you must put your emotions to one side and sometimes it’s about as much reading a situation with sensitivity and common sense as you can muster. She is right you can’t get the best results for the mother if you are putting what you feel center stage.

“Sometimes we wait not for change but for the grace to accept the status quo. We must embrace the way things are and let life frame the love we have to share. We wait for meaning to be made apparent. We wait for the things we are promised or will choose. We wait as things unfold and take the shape they will—not knowing what the future holds or quite where we are flying or what we have begun.”

RESOURCES

CDC, Reproductive Health: Teen Pregnancy.

CDC: Teens visiting a Health Clinic

Guttmacher Institute. An Overview of Consent to Reproductive Health Services by Young People. 

Guttmacher Institute: State Policy Tracker

US Health and Human Services: Updated findings from the HHS Teen Pregnancy Prevention Evidence
Review (August 2015 through October 2016)