by Seema Menon, M.D.
Adolescents have the right to confidential care when seeking abortion
services, according to a position reaffirmed by the Academy in an updated policy statement.
The stance is in line with other professional
medical societies such as the American Medical
Association, the Society for Adolescent Health and
Medicine, the American Public Health Association
and the American College of Obstetricians and Gynecologists.
The Adolescent’s Right to Confidential Care When
Considering Abortion, from the Committee on Adolescence, is available at http://dx.doi.org/10.1542/
peds.2016-3861 and is published in the February
issue of Pediatrics.
Effects of state policies
Since 2011, states have been enacting more restrictive policies on abortion services than seen in
previous decades. In 2015, 38 states required parental involvement in a minor’s decision to have an
abortion. The Supreme Court has declared it to be
constitutional for states to develop their own mandatory parental notification laws for minors seeking
abortion services provided a judicial bypass process
is in place.
The mandatory parental notification law is rooted
in preservation of family communication and in the
physical and emotional well-being of adolescents.
However, research has shown that these laws have
the opposite effect. Minors, particularly younger ad-
olescents, are likely to involve a trusted adult when
seeking abortion services regardless of whether a state
law mandating parental notification is in place. Ad-
olescents choosing not to involve parents do so be-
cause of their ability to accurately predict a family
crisis stemming from severe anger and rejection.
It also has been found that the proportion of
adolescents seeking abortion services in the sec-
ond trimester has increased in several states where
mandatory parental notification laws are in place.
Rather than having a beneficial health impact, these
laws may delay care, leading to a second trimester
procedure that not only is more medically complex,
but also associated more with psychological sequelae
compared to abortion services in the first trimester.
While the judicial bypass process may seem to be a
reasonable compromise, adolescents find this process
to be an obstacle in accessing health care. This pro-
cess has been described as burdensome, humiliating
and stressful. Importantly, it has been found that
adolescents often are not made aware of this process
in states requiring mandatory parental notification.
Concerns related to adolescent decision-making
ability often are questioned when considering the
need for mandatory parental involvement. Cur-
rently, laws allow adolescents to make independent
medical decisions during pregnancy and for their
children. The policy statement points out, therefore,
that it is consistent to protect the right of adoles-
cents to seek abortion services confidentially, with-
out mandatory parental notification.
The Academy advocates a strong family relation-
ship and holds the belief that parents generally act
in the best interest of their children.
• Adolescents have the right to confidential care
when considering abortion services.
• Health care professionals are in a position to
facilitate family communication and should
strongly encourage a pregnant adolescent to
seek guidance from a trusted adult when considering all pregnancy options.
• Concern for incest or abuse should be raised
when a younger adolescent resists parental in-
volvement when seeking abortion services.
• It ultimately is the pregnant adolescent’s right
to decide who should be involved in the deci-
sion-making process and what the outcome of
the pregnancy will be.
Dr. Menon, lead author of the policy,
is the liaison from the North American
Society for Pediatric and Adolescent
Gynecology to the AAP Committee on
AAP reaffirms adolescents’ rights to
confidential care when seeking abortion
by Richard Lander, M.D., FAAP
One aspect of AAP private payer advocacy is to
review insurance carrier policies to ensure they cover
recommended pediatric services and provide payment to primary care and subspecialty pediatricians.
Such review is not an endorsement of a carrier’s policy but an opportunity to advise the carrier on the
policy’s impact on pediatrics and pediatricians.
The policy is shared with the appropriate AAP
council, committee or section for review, and feedback then is forwarded to the carrier. When a carrier’s policy is not in alignment with AAP recommendations, the reviewing group recommends a response
from the Academy.
The Academy has facilitated review of the nation’s
largest private carriers’ clinical policies to incorpo-
rate pediatric perspective. Recent successes on sub-
specialty pediatric issues include the following:
• The AAP Committee on Fetus and Newborn
and Section on Neonatal-Perinatal Medicine
developed comments on the UnitedHealthcare
(UHC) policy on inhaled nitric oxide (INO)
and had a follow-up conference call with its
authors. As a result of that discussion, UHC
revised its policy regarding non-coverage for
INO in neonates born at less than 34 weeks.
• Based on input from the AAP Section on Cardiology and Cardiac Surgery, Anthem revised its
policy on implantable cardioverter defibrillators
to expand the pediatric indications for implantation to include all adult indications considered medically necessary when criteria are met.
• Members of the AAP Section on Otolaryngology–Head and Neck Surgery provided clarification and peer-reviewed published reports
supporting digital sound processing for certain
types of hearing loss and urged Anthem and the
Blue Cross Blue Shield Association to provide
appropriate benefits coverage. In light of the
information provided, clarifications on medical
necessity for bone conducted hearing loss were
included in policy templates.
• The AAP Section on Urology worked with the
AAP Private Payer Advocacy Advisory Committee (PPAAC) to develop appeal letter templates for its members to advocate for benefits
coverage for biofeedback therapy for lower urinary tract dysfunction, testicular prostheses and
treatment with Deflux for children
with vesicoureteral reflux. The templates are available at http://www2.
Dr. Lander is chair of the AAP Private
Payer Advocacy Advisory Committee.
Subspecialists benefit from AAP private payer advocacy
• PPAAC is available to work with chapters, councils,
committees and sections on private payer coverage
and payment issues. For more information, contact Lou
Terranova, in the AAP Division of Health Care Finance,
at 847-434-7633 or email@example.com.
• To assist in private payer advocacy, AAP members are
urged to report any carrier concerns using the Hassle
Factor Form at http://bit.ly/2iEbnPT.
Pediatricians should strongly encourage a pregnant
adolescent to seek guidance from a trusted adult
when considering all pregnancy options.