Parental Notification for Family Planning Services: Title X Regulations

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 CRS- 1 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 CRS- 2 MB83214 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 CRS- 3 MB83214 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.