The Colorado Department of Public Health and Environment reported last week that the state's teen pregnancy rate was cut in half from 2009 to 2014 thanks to a program called the Colorado Family Planning Initiative. The results of this program - which gives teens and young women unrestricted access to effective birth control - are unequivocal. There have already been calls to increase funding for the program and expand it to other states. But many of the places that need it most have state laws that make providing confidential contraception to teens illegal.
As a women's health physician in Los Angeles, I can provide birth control directly to teens in my practice only because the state of California allows it. States get to decide whether or not teens can independently access contraception, resulting in three scenarios: unconditional access to birth control for teens, access in some special cases only, or mandated parental notification. This variation in policies creates disparities in teen contraceptive access from state to state.
To date, 21 states and the District of Columbia have laws specifying that all minors may receive confidential contraceptive services. Teens in the rest of the country are subject to their own state's specific regulations regarding parental notification. For example, a teen must be legally married to get birth control without parental notification in Mississippi, Texas, Louisiana, Oklahoma, Nevada, and South Carolina. Unsurprisingly, all six of these states were among the top ten for teen pregnancy in 2010.
The lack of federal legislation on this issue reflects a collective refusal to acknowledge that American teens are having sex, even while the U.S. ranks among the highest among developed nations in teen births. According to the Centers for Disease Control and Prevention, 30 percent of girls and 34 percent of boys have experience intercourse at least once by age 17. While almost half of U.S. pregnancies are unintended, this proportion balloons to almost eighty percent among teens, who lack unfettered access to birth control. A pregnancy during adolescence can have serious health consequences: infants of teen mothers are more likely to be born premature, and to die in the first year of life. Teen mothers are only half as likely to graduate from high school as their non-parent counterparts, leading to higher rates of subsequent unemployment and poverty that affect young families, and society as a whole.
There is strong evidence that giving a teen unrestricted access to contraceptives is safe and effective. Results of multiple large prospective studies have shown that when all options are available, teens choose the most effective contraceptive methods - such as intrauterine devices and implants - and continue to use them reliably. These same studies have also disproven the myth that birth control increases sexual risk-taking behaviors among teens. Easy access to contraception among teens simply decreases the number of teen pregnancies, largely without any identifiable drawbacks.
We also know that enforced parental notification doesn't work as intended. Such legislation has not resulted in open and frank discussions about reproductive health between parents and their teens. Studies dating back several decades have shown that this practice does not discourage or delay intercourse. Instead, teens are pushed to choose less effective forms of birth control - including condoms and the withdrawal method - that can be accessed without consulting a health care provider.
From a medical perspective, it would be best for teens and their parents to talk honestly about sex and contraception. As we wait for society to move forward on acknowledging the reproductive health needs of minors, we need federal legislation that protects their health. Based on the best scientific evidence we have, this means it must protect the legal rights of all American teens to receive confidential contraceptive services.