42 It is inconsistent, then, to presume that the minor is not legally competent to make decisions regarding pregnancy termination. No state laws require the minor’s parent to consent to the minor’s decision to continue the pregnancy when the parent believes that terminating the pregnancy is in the minor’s best interest, nor do any state laws require a minor’s parent to consent to medical decisions for the infant’s health care or, with few exceptions, to place the infant for adoption. Once pregnant, an adolescent, by many state laws, is held responsible for and competent to consent to her own medical treatment during the pregnancy and to the medical decisions regarding her fetus or newborn infant (eg, amniocentesis, genetic testing, life-saving treatment, and circumcision). States enacted more restrictions on abortions in the years 2011–2013 than in the entire previous decade, 27 reinforcing the need for health care professionals to be fully aware of their state laws to provide the best care for adolescents. The laws generally take 2 forms: some require a clinic or physician to obtain the consent of 1 or both parents before the teenager’s abortion, and others require the parent(s) to be notified before the procedure.
These court decisions led to the passage of additional state laws requiring parental involvement for minors. 5, 6, 25, 26 In Planned Parenthood v Casey (1992), the Supreme Court upheld several state abortion-related restrictions, including a parental involvement restriction, ruling that the requirements did not impose an “undue burden” on women. Subsequent Supreme Court decisions affirmed a state’s right to pass laws requiring parental involvement in a minor’s decision to have an abortion, but only if they were accompanied by judicial bypass procedures that also allow a minor to receive court approval for an abortion without her parents’ knowledge or consent. 24 This right could be overcome by state interests in regulating abortions and preserving life after the fetus was viable outside the womb. In the landmark case Roe v Wade in 1973, the US Supreme Court ruled 7 to 2 that a right to privacy extended to a woman’s decision to have an abortion. Postulated explanations for the decline include a shift in attitudes toward abortion among adolescents increased legal and financial barriers to abortion, particularly for low-income adolescents and increasing social acceptance of childbearing among unmarried adolescents. The percentage of pregnancies terminated by induced abortion in minors increased in the 1970s, reached a plateau in the early 1980s, and has decreased since 1985. 15 The absolute number of teen pregnancies may actually be higher if pregnant teenagers undergo illegal or self-induced terminations or experience a miscarriage or a home delivery and never seek pregnancy-related health care. In this same year, adolescents (15–19 years of age) accounted for 13.5% of all abortions. 14 In 2011, the National Campaign to Prevent Teen and Unplanned Pregnancy reported 553 000 teen pregnancies.
14 Of those pregnancies, 25% (176 000) were terminated by elective abortion. In 2009, 705 000 teenagers 15 to 19 years of age became pregnant. The AAP is foremost an advocate of strong family relationships and holds that parents are generally supportive and act in the best interests of their children. This statement affirms the value of parental involvement in decision-making by adolescents and the importance of productive family communication in general. The AAP acknowledges and respects the diversity of beliefs about abortion. Beliefs about abortion are deeply personal and are shaped by class, culture, religion, and personal history as well as the current social and political climate.
This statement does not discuss the philosophical or religious issues related to abortion.
8 This statement does not duplicate the extensive analysis in that report but presents a summary of pertinent current information related to the benefits and risks of legislation requiring mandatory parental involvement in an adolescent’s decision to obtain an abortion. The AAP supports the recommendations presented by the Council on Ethical and Judicial Affairs of the American Medical Association in its report on mandatory parental consent to abortion. In this statement, the AAP reaffirms its position on the protection of the rights of adolescents to confidential care when considering abortion.