Abortion: When Denial is Not the Best Choice

Putting aside any values, religious beliefs and thoughts about what is "right," it is important that teens understand their medical choices if they do become, or get someone pregnant.

I know that denial works in some situations and teens who are afraid of their parents knowing that they had sexual intercourse may try very hard to hope that the missed periods do not mean they are pregnant, but there are some very important time considerations to take into account.

If a medical or surgical abortion is an option for a woman, she needs to understand that a non-surgical, or medical abortion can be done within seven weeks from the first day of the woman's last menstrual period, or within three weeks of missing one period. A medical abortion is done with medicine (mifepristone or RU486) that end the pregnancy and a second medicine (misoprostol) causes the uterus to empty. It may take up to a few days for a woman to abort, and it is not uncommon to bleed for up to four weeks.

A surgical or aspiration abortion is usually done between six and sixteen weeks of pregnancy and uses a vacuum to remove the fetus. The longer the woman is pregnant, the more complicated the abortion and the higher the risks, so making a decision quickly is important. After 16 weeks after the last period, and D & E - dilation (of the cervix) and evacuation (of the uterus) will be done. After 24 weeks, abortions are only performed for serious health concerns. All surgical abortions will include antibiotics to prevent infection.

If you are pregnant, please go to your doctor or a local Planned Parenthood Clinic to discuss your options. The longer you wait, the fewer options you have.

Photo credit: Brittany G

Labels: Abortion, Healthline, Teen Health

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Unwanted and Teen Pregnancy in the Media

Have you seen the movie "Juno?" It is a great movie about teenage pregnancy, but I have to admit, it pretty much normalizes teen pregnancy, continues the myth that it is "the girl's problem," and presents a year of Juno's life as just a blip - the result of one sexual act - and at the end everything pretty much goes back to the way it was and everyone moves on,which is not quite accurate, but I guess realism is not why we go to the movies.

I loved the character of Juno. She is bright, self-assured, sarcastic, and definitely dances to the beat of her own drum. The movie allows us to "peek" into her thoughts about what to do when she realizes she is pregnant, her decision, and the consequences of that decision in her rural town. She has to make difficult decisions with the support of her best friend, dad and step mom. I will not ruin the movie for you, but it is a good one to see with your teens - lots of opportunity for conversation will follow, trust me.

Another very interesting, but more mature movie about another type of unwanted pregnancy is "Waitress," which may be a little too mature for some teens. The heroine in this story also is young, lives in a rural place, makes amazing pies, is stuck in a very emotional abusive and unhappy marriage, finds herself pregnant, has an affair with her doctor during the very unwelcome pregnancy, and then ... there is a surprise ending! Sorry, but you should see it yourself, I promise.

Our reality is that one million teenagers in the United States become pregnant each year, 40% abort the pregnancy, and only 3% give the baby up for adoption, although much of the young adult literature focuses on keeping the baby and adoption. Abortion is not much fun to write about I guess, in spite of it being the decision made by half of the teenagers who find themselves pregnant.

Photo credit: numberstumper

Labels: Abortion, Media, Pregnancy, Teen Health

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Supreme Court Restricts Women's Reproductive Freedom

I cannot believe that our nation's highest court has permitted itself to be a tool of the anti-choice movement instead of preserving a woman's constitutionally protected right to make childbearing choices in consultation with medical care providers.

On April 18 in a 5-4 decision the Supreme Court upheld a federal abortion ban enacted by Congress and signed by President GW Bush in 2003. The law, titled the "Partial Birth Abortion Act," criminalizes abortions in the second trimester of pregnancy, even if the abortion would be safe and protect a woman's health.

The decision reverses every federal court that has reviewed the law up to date, all of which had struck down the law because of its failure to protect the woman's health. The decision April 18, 2007 represents a serious erosion of the precedent supporting a woman's right to bodily autonomy and choice articulated by the court in 1973 in Woe v. Wade. The Justices in the majority opinion were Anthony Kennedy, Clarence Thomas, Antonin Scalia, and both new Bush conservative appointees, Samuel Alito and John Roberts.

Photo Credit: alexandralee

Labels: Abortion

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Confidential Reproductive Health Care and Teens

One reason that adolescents forgo medical care is that they may be concerned about confidentiality. Their parent(s) may have always gone to the doctor with them and they are concerned that he or she will tell the parent about any behavior they report to the doctor. This is why at about age 12 (in California) some doctors will tell youth that anything said to them is confidential and start asking the parent to step out of the room for a minute during a physical or ask the child if they would rather meet with the doctor alone.

As health care professionals, we want the adolescents to trust us and disclose any risk behavior so that referrals or appropriate care can be provided. To encourage this, there are confidentiality laws in most states, although I dare say most parents and even some doctors are not clear what they mean.

I will summarize the laws (for minors) related to reproductive health care in California. A minor of any age may consent for care for pregnancy, contraception, abortion, emergency medical services, or sexual assault and rape services. The health care provider may not inform the parent if a minor seeks care for pregnancy, contraception, or abortion. The health care provider must contact the parent for emergency medical services and sexual assault (unless the parent is responsible for the assault, or the minor is over 12 and treated for rape).

A minor over the age of 12 can request testing or treatment for sexually transmitted disease, including HIV, as well as rape, and the health care provider may not tell the parent without the minor’s (signed) consent. That means that parents cannot see the medical records relating to reproductive services of teens.

Reporting the sexual activity of minors to children’s protective service or police
If a minor is being coerced or exploited into sexual activity, it is reportable. In addition, if a minor is having consensual sexual intercourse with an older partner, it is reportable if the child is 11 – 13 and the partner is 14 or older; and if the teen is 14 – 15 and the partner is 21 years or older.

A note to doctors: Even though the laws are in place to encourage teens to seek and receive care, the “system” may provide leaks and physicians must protect teens by understanding how billing and Explanation of Benefits, satisfaction surveys, appointment reminders and lab results are handled. If there is a chance that a parent will find out the teen was seen for a confidential reproductive service, it would be better to refer them to a local Planned Parenthood, or work with your institution to eliminate the barriers to providing care.

A note to parents: I know that the fact that your teen can receive health care for pregnancy, contraception, abortion, testing or treatment for sexually transmitted disease, including HIV, as well as rape without your knowledge or consent may surprise, and maybe outrage you, but please take a deep breath and think about this: if your child is involved in sexual behavior, and you do not know, wouldn’t it better for the doctor to know, provide information and protection to avoid unwanted pregnancy and sexually transmitted infection? The way to avoid this situation is to be an approachable parent. Start early and talk to your kids about everything - sex, alcohol, smoking, drugs, rape, and every other difficult subject –include your values and expectations - you will be glad you did, and it will increase the chances that you will know when your teens become sexually active.

Sources
National Center for Youth Law
Understanding Confidentiality and Minor Consent in California: An Adolescent Provider Toolkit, Adolescent Health Working Group

Labels: Abortion, Parenting

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