Adolescent Access is a Congressional Priority

Since its inception in 1970, Title X funding has provided family planning services to adolescents. In 1978, Congress amended Title X to place “a special emphasis on preventing unwanted pregnancies among sexually active adolescents,” adding services specifically for teenagers.² Congress recognized that teen pregnancies “are often unwanted, and are likely to have adverse health, social, and economic consequences for the individuals involved.”³ Providing adolescents with access to contraceptives can significantly reduce the risk of pregnancy and sexually transmitted infections.

Teens Need Title X Services More than half of U.S. women have intercourse before their 17th birthday. A sexually active teenager using no contraception over the course of a year has a 90% chance of becoming pregnant. Publicly funded family planning services help approximately 386,000 teenagers avoid pregnancy each year, averting 183,000 abortions. In a single act of unprotected intercourse with an infected partner, a woman has a 1% risk of acquiring HIV; a 30% risk of getting genital herpes; and, a 50% risk of contracting gonorrhea. Sources: The Alan Guttmacher Institute, Teen Sex and Pregnancy (September 1999); The Alan Guttmacher Institute, Facts in Brief: Title X and the U.S. Family Planning Effort (1997).

Title X Guarantees Confidentiality

Regulations governing the Title X program mandate health care providers to enforce patient-physician confidentiality, which is crucial for providing timely, appropriate services.⁴ Guidelines promulgated by DHHS in January 2001 prohibit Title X projects from requiring parental consent prior to the provision of services. In addition, they forbid grantees from notifying parents or guardians of a minor’s request for, or receipt of, Title X family planning services. While confidentiality is required, Congress amended Title X in 1981 to require grantees to “encourage” family participation in all cases — a statutory provision that remains in effect to this day.⁵

As a further safeguard to ensure minors’ access to Title X services, the January 2001 guidelines state that eligibility for discounts for minors who receive confidential services will be evaluated based solely on the income of the minor. Title X projects may not deny minors discounted services based on their parents’ income. Therefore, minors will not be forced to choose between disclosing their personal reproductive health choices to their parents or forgo Title X services.

Only once in the history of the Title X program has adolescent access to confidential care been called into question. In 1981, DHHS issued regulations calling for parental notification when adolescents receive family planning services. They based these regulations on a misinterpretation of an amendment to Title X. In 1983, two federal courts of appeals — the Second and District of Columbia Circuits — found that parental notification contravened the goal of the Title X program. As a result, DHHS never implemented the invalid regulations.⁶

Attempts to Undermine Title X Family Planning Have Been Rebuffed

Family planning opponents attempt to use the annual appropriations process to restrict young women’s access to Title X services. In 1996, an amendment was proposed requiring parental notification and consent, and emancipation or judicial bypass, for young women seeking Title X services. In 1997 and 1998, amendments targeted Title X contraceptive services.⁷

To date, Congress has opposed adoption of these amendments. And when Congressional members were given an opportunity to vote for alternative proposals in 1996 and 1997, they supported amendments that encouraged, rather than mandated, parental involvement in teens’ decisions to seek Title X services.⁸

Forced Parental Involvement Harms Public Health

The U.S. Court of Appeals for the Second Circuit noted that the failure to guarantee confidentiality for adolescents seeking family planning “will cause increased adolescent pregnancies . . . [which are] fraught with dangers to the health of both the young mother and her child.” The court also noted the lower court’s finding that it will “place great socio-economic burdens on the young mother, her family and society at large.”⁹

The Medical Community Opposes Forced Parental Involvement

The medical and public health organizations opposing forced parental involvement include the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women’s Association, and the Society of Adolescent Medicine. When DHHS erroneously promulgated regulations requiring parental notification in 1981, more than 120,000 individuals and organizations contributed to the public comment process. Almost all of the major medical associations, including the American Medical Association and the American Psychiatric Association, opposed parental notification and, by overwhelming numbers, supported confidentiality for adolescents seeking family planning services.

Forced Parental Involvement Conflicts with Title X Goals

The U.S. Court of Appeals for the District of Columbia noted that “confidentiality [is] essential to attract adolescents to the Title X clinics; without such assurances, one of the primary purposes of Title X — to make family planning services readily available to teenagers — would be severely undermined.”¹⁰

Forced Parental Involvement Conflicts with State Laws

States recognize that ensuring confidentiality for sensitive health services is critical to maintaining young people’s health and well-being. Requiring parental notification or consent for family planning services would conflict with current law in the majority of states.