PARENTAL NOTIFICATION FOR FAMILY PLANNING SERVICES:
TITLE X REGULATIONS
MINI BRIEF NUMBER MB83214
AUTHOR:
Susan Bailey
Education and Public Welfare Division
THE LIBRARY OF CONGRESS
CONGRESSIONAL RESEARCH SERVICE
MAJOR ISSUES SYSTEM
D A T E ORIGINATED 02/18/83
DATE UPDATED 05y18/83
FOR ADDITIONAL INFORMATION CALL 287-5700
0518
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ISSUE DEFINITION
The Omnibus Budget Reconcilia.tion Act of 1 9 8 1 , P.L. 97-35, amended title X
of the Public Health Service Act
to encourage, if practical, parental
involvement when family planning services a r e provided to minor children.
To
implement this provision the Department of Health and Human Services
(DHHS),
in February 1 9 8 2 , proposed regulations to require title X projects to notify
the parents of unemancipated minors when prescription drugs or devices a r e
provided to these adolescents by family planning clinics.
Final regulations
were issued on Jan. 2 6 , 1983. They were scheduled to go into effect Feb. 2 8 ,
1983.
On Mar. 2 , 1 9 8 3 , a U.S.
Dist'rict C o u r t
judge in the District of
Columbia issued a permanent
injunction forbidding the government from
implementing this rule.
DHHS i s appealing this ruling.
Concern has been
expressed about the possible effect these regulations w i l l . h a v e on the
provision of family planning services to minors.
Some a r e also concerned
that D H H S may
have exceeded
i t s authority by. requiring rather
than
encouraging parental notification.
BACKGROUND
Background
the
The Voluntary Family Planning Program authorized under
title X of
Public Health Service Act currently provides support for (1) family planning
clinics, (2) training of family planning personnel, and (3) development and
dissemination of family planning and population
growth information to a l l
persons desiring such information.
Title X activities were first established
when Congress enacted P.L. 91-572, the Family Planning ~ e i v i c e s and and
Population Research Act of 1970, to expand and improve t h e availability of
family planning
services to a l l persons desiring
them,
particularly
low-income women.
Since 1970, the program has been reauthorized and amended
several times, most recently by the Omnibus Budget Reconciliation Act of
1 9 8 1 , P.L. 9 7 - 3 5 , which extended the authority through 1984.
clinics.
These
M o s t - o f the title X funds a r e awarded to family planning
clinics offer a broad
range of
family planning methods
and
services,
including natural family planning methods, infertility services, and services
for adolescents.
In 1 9 7 8 , in response to concern over
increased
teenage
sexuai activity and pregnancy, Congress included provisions
i n title X
requiring that family planning c l i n i c s provide services f o r adolescents.
At
this t i m e , Congress also increased title X authorization levels to a l l o w the
program to place greater emphasis o n reaching teenagers and making
family
planning services available to them before a n unwanted
pregnancy
occurs.
Persons aged 1 9 and u n d e r , currently represent about 34% o f clients served by
P.L. 97-35 amended title X to require family planning
title X clinics.
projects to encourage families to participate when services were provided
to
them by projects, if at a l l possible.
In February 1 9 8 2 , D H H S - issued its proposed
parental
notification
regulations.
These regulations stipulated that parents o r guardians must be
notified within 1 0 working days following the provision
of prescription
child.
T h e clinic must
contraceptives by a title X clinic to their minor
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UPDATE-05/18/83
v e r i f y by c e r t i f i e d mail,
o r oth'er
similar documentation,
that
the
A c l i n i c may n o t c o m p l y w i t h t h i s r e g u l a t i o n
n o t i f i c a t i o n h a s been r e c e i v e d .
if i t s d i r e c t o r d e t e r m i n e s n o t i f i c a t i o n w i l l r e s u l t i n p h y s i c i a l .harm t o
the
minor by p a r e n t o r
guardian.
The D e p a r t m e n t
received
60,000
indiv'idual
comments a n d 1 , 2 0 0 l e t t e r s f r o m v a r i o u s o r g a n i z a t i o n s as w e l l as form l e t t e r s
and p e t i t i o n s concerning these regulations.
However,
it
did
not
provide
s t a t i s t i c s on t h e number o f p e r s o n s f o r
or against the
regulation.
DHHS
26,
1983.
These
i s s u e d f i n a l r e g u l a t i o n s w i t h o n l y m i n o r c h a n g e s on J a n .
r e g u l a t i o n s w e r e s c h e d u l e d t o g o i n t o e f f e c t Feb. 2 8 , 1 9 8 3 , b u t on F e b . 1 4 , a
U.S, D i s t r i c t , C o u r t j u d g e , i n New
York
granted a preliminary injunction
against the rule.
According t o t h e
judge,
the requirement appeared t o
c o n t r a d i c t COngreSSiOnal i n t e n t t o
s i m p . 1 ~ encourage
r a t h e r . t h a n mandate
parental involvement.
On F e b . 1 8 ,
at
U.S.
D i s t r i c t Court
judge
in
the
D i s t r i c t of Columbia. a l s o t e m p o r a r i l y s t a y e d t h e Government's proposed r u l e .
On Mar. 2 , t h e j u d g e g r a n t e d a p e r m a n e n t i n j u n c t i o n a g a i n s t t h e
rule.
DHHS
is appealing t h i s ruling.
Analysis
is
S u p p o r t e r s o f t h i s r e g u l a t i o n c o n t e n d t h a t some k i n d
of
notification
necessary t o give parents t h e opportunity t o participate i n family planning
decisions their
t e e n a g e r s make.
They b e l i e v e
family planning
clinics
currently take the position t h a t families are not necessary t o t h i s process.
A s a r e s u l t , supporter's claim t h a t t h e s e c l i n i c s have n o t
been
demonstrably
e f f e c t i v e i n reducing t h e r a t e of
teenage pregnancies.
Between
1973 and
1 9 7 8 , t h e p r e g n a n c y r a t e h a s i n c r e a s e d from 50 p r e g n a n c i e s p e r
1 , 0 0 0 t o 59
f o r women a g e d 1 0 - 1 9 .
s u p p o r t e r s of
the
regulation
believe notification
c o u l d encourage p a r e n t s and t e e n s t o communicate b e t t e r a b o u t t h e a p p r o p r i a t e
use of c o n t r a c e p t i v e s .
Others p r e d i c t g r e a t e r communication could encourage
t e e n a g e r s t o a b s t a i n from s e x u a l a c t i v i t y .
In a d d i t i o n , s u p p o r t e r s emphasize
t h e regulation does not i n t e r f e r e with services because n o t i f i c a t i o n does not
take place u n t i l a f t e r t h e s e r v i c e h a s been rendered.,
Advocates of t h e r u l e a l s o believe p a r e n t a l r i g h t s
and responsibilities
to
confidential
family planning
s e r v i c e s mainly
outweigh minors' r i g h t s
because contraceptive use can pose hazards t o
teenager's
health.
Although
t h e p i l l a n d i n t r a u t e r i n e d e v i c e ( I U D ) h a v e b e e n Shown t o b e s a f e f o r m o s t
women, s t u d i e s i n d i c a t e a w i d e a r r a y o f s i d e e f f e c t s t h a t c a n o c c u r a s a
r e s u l t of t h e i r use.
I n c r e a s e d r i s k s of e c t o p i c p r e g n a n c y , i n f e c t i o n of
the
o v a r i e s and f a l l o p i a n t u b e s , and i n f e r t i l i t y a f t e r d i s c o n t i n u a n c e have been
c i t e d a s . s i d e e f f e c t s of I U D u s e .
Blood-clotting and s t r o k e s can occur
in
connection with o r a l contraceptive use.
parental
permission
Some b e l i e v e t h e r e g u l a t i o n i s t o o w e a k a n d t h a t
for persons
under
18
to
receive
prescription
s h o u l d be r e q u i r e d
contr'aceptives.
C r i t i c s m a i n t a i n t h a t t h e r u l e e x c e e d s c o n g r e s s i o n a l i n t e n t by m a n d a t i n g ,
r a t h e r than simply encourging, parental involvement.
They c i t e s t u d i e s which
show t h a t t e e n a g e r s a t t e n d f a m i l y p l a n n i n g c l i n i c s b e c a u s e t h e y a r e a s s u r e d
of c o n f i d e n t i a l i t y .
Some c l a i m t h a t t h e p r o p o s a l w i l l
not' d e t e r
teenagers
from s e x u a l a c t i v i t y b u t w i l l
d i s c o u r a g e many who w o u l d o t h e r w i s e s e e k
c o n t r a c e p t i v e s from a t t e n d i n g c l i n i c s .
As a result,
critics believe,
more
unwanted p r e g n a n c i e s and a b o r t i o n s would o c c u r .
A
1979-1980
survey,
which
sought t o determine t h e e f f e c t s of-a
parental no.tification regulation
for
p r e s c r i p t i o n c o n t r a c e p t i v e s o n t e e n a g e r s u n d e r 18 e n r o l l e d i n f a m i l y p l a n n i n g
c l i n i c s , f o u n d t h a t 1 i n 4 young p e o p l e c u r r e n t l y u s i n g c l i n i c s e r v i c e s would
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UPDATE-0.5/18/83
became effective. T h e g r e a t majority of those
s t o p i f . s u c h a proposal
surveyed w o u l d u s e l e s s efficient methods
or would abandon contraception.
Only 2 in 100 said they would stop s e x u a l activity.
O p p o n e n t s f e a r notification would d a m a g e family relationships.
Parents,
h u r t o r a n g r y because their child did n o t confide i n t h e m , might punish t h e
child physically o r turn her o u t of their house.
In a d d i t i o n , s o m e charge
t h a t t h e r e g u l a t i o n discriminates a g a i n s t women, s i n c e only
females use
p r e s c r i p t i o n contraception.
O t h e r s q u e s t i o n t h e justification o f t h e regulation f o r health
reasons.
They c o n t e n d t h e r i s k s involved with pregnancy and childbirth exceed
those
a,ssociated with using contraceptives, citing evidence which
s h o w s that t h e
mortality r a t e from pregnancy, birth a n d delivery complications i s 6 0 % higher
than n o r m a l for w o m e n w h o become pregnant before they a r e 15.
Other
studies
i n d i c a t e t h e most c o m m o n medical problems associated with
the u s e of o r a l
c o n t r a c e p t i v e s o c c u r a m o n g women w h o a r e over 30.
Opponents also cite
certain h e a l t h b e n e f i t s which occur a s a result of o r a l contraceptive u s e ,
i n c l u d i n g t h e reduced likelihood of developing benign
breast
disease o r
o v a r i a n cysts.
S o m e f a m i l y p l a n n i n g clinics have complained t h a t t h e a d d i t i o n a l c o s t s t o
i m p l e m e n t t h e s e r e g u l a t i o n s will
c a u s e financial hardships
for
them,
especially a f t e r r e c e n t funding reductions.