Update: The House referred the bill to the Judiciary committee, where it will be heard on Thursday morning. The committee will examine more than 30 amendments to the bill and consider sending their version to the House again. If referred back to the House, it may be heard tomorrow afternoon.
Advocates on many issues - sexual health, mental health, abuse prevention, etc. - have been scrambling to help legislators understand the devastating impact of HB693, which would repeal a minor's ability to consent to certain medical services.
Since the 1970's, any person in North Carolina has had the ability to consent to the diagnosis, prevention, and treatment of pregnancy, STDs, mental illness, or substance abuse. The law excludes abortion, sterilization, and admission to a 24-hour facility, all of which require parental consent.
If HB693 is enacted, a minor would need a notarized signature from a parent to get diagnosis, counseling or treatment for pregnancy, STDs, mental illness or substance abuse, as well as for abortion. (A NOTARIZED signature!) The bill also extends the law to pharmacists. Here are some scenarios that would exist under the law if this bill passes:
A doctor would need notarized permission to ask a teen boy routine depression screening questions (Do you feel sad? Have you lost interest in activities? Have you considered suicide?)
A pharmacist would need notarized permission each month to dispense a refill for birth control pills or Prozac.
If a sexually active 17 year old went to Walgreens, and that store kept condoms under lock and key to prevent theft, the teen could get condoms if the cashier unlocked the case but would need notarized permission if the pharmacist kept the key.
A doctor could see a female patient with a bulging belly who complains about missed periods, but would need notarized permission to ask "Are you pregnant?" or "Have you had unprotected sex?" or administer a pee test - because those things constitute diagnosis.
Here's what we know as pregnancy prevention experts: Teens rarely seek medical care - and almost never seek preventative care. That means that screening for health risks at sick visits is usually the only opportunity to get preventative care. For example, when a teen goes in for strep throat, it presents the only opportunity for a doctor to ask if he or she is sexually active. If this law passes, that screening and preventative care stops. Contraceptive use stops for teens who got care confidentially, and for those whose parents can't go for every appointment or prescription refill. Teen pregnancy and abortion rates go up.
You can make a difference by calling members of the House. Here's our fact sheet so you can see many of the reasons why we so strongly oppose this bill.
What’s the most important law for preventing teen pregnancy? You might think it’s our (important) sex education law. Or maybe our (also important) budget that allocates funding for prevention programs.
In reality, the most important law is a quiet little 1971 law called Minor's Consent for Health Services. Unfortunately, a bill introduced in the NC Senate would undo the law.
According to the current law, anyone – regardless of age – can seek medical care for the treatment, diagnosis, or prevention of pregnancy, STIs/HIV, mental health, or substance abuse. The law excludes abortion or admission to an overnight facility, which still require a parent’s permission.
New state-by-state rankings give North Carolina* the 16th highest teen pregnancy rate in the nation. The ranking illustrates an improvement over past years. North Carolina ranked 14th in 2005, and 9th in 2000.
The rankings are compiled by the Guttmacher Institute, and use 2008 data. The Guttmacher Institute relies on 2008 data because it takes many states years to collect sufficient numbers on pregnancies, fetal deaths, and abortions.
States with higher teen pregnancy rates include (listed in order from 1st to 15th) New Mexico, Mississippi, Texas, Nevada, Arkansas, Arizona, Delaware, Louisiana, Oklahoma, Georgia, South Carolina, Hawaii, Tennessee, Alabama, and Florida. States with the lowest teen pregnancy rates included Minnesota, Vermont, and New Hampshire.
Today’s rankings only illustrate part of North Carolina’s progress: More recent data from the Centers of Disease Control and Prevention (CDC) and the North Carolina State Center for Health Statistics shows that North Carolina has experienced more rapid teen pregnancy rate decreases since 2008. In mid-February, the CDC released preliminary national birth rate** comparisons for 2011 that showed North Carolina's teen birth rate (34.8 per 1,000 15-19-year old girls) is the closest it's ever been to the national teen birth rate (31.3 per 1,000 15-19-year old girls)
*Why does the Guttmacher Institute list a different teen pregnancy rate than our website? In NC, we calculate the number of teen pregnancies using births + abortions + fetal deaths. Guttmacher includes an estimated number of miscarriages, resulting in a higher teen pregnancy number. ** Birth rates aren't the same as pregnancy rates. Birth rates are used most often in national comparisons because a) not every state collects the data needed to produce a pregnancy rate; and b) getting pregnancy estimates is a really slow process - that's why the Guttmacher national rankings are from 2008, even though we have 2011 data in NC.
We just want to take a quick moment to share our sincerest wishes for a happy holiday season!
Helping North Carolina's young people is an incredible task - and it's one we could not do without your support. Please know how grateful we are for you.
No matter what holiday you celebrate or how you celebrate it, please accept our hope that your season is warm, bright, and one that you can treasure.
With our thanks and love,
The APPCNC Team
Kay, Joy, Olivia, Jenny, Sally, Kathy, Elizabeth, Melinda, Debbie, Danielle, Sarah, Patricia, Pat, Kia, Michelle, Amanda, and our amazing crew of interns
We have policies and medical guidance in place now to support major reductions in teen birth rates across the US, and some of those are in jeopardy this election season.
What do children need from their parents? Last weekend, the Huffington Post ran a beautiful piece called The Wholehearted Parenting Manifesto. In it, author Brene Brown urges parents to set aside by-the-book parenting rules and show your children they are loved.
The Wholehearted Parenting Manifesto by Brene Brown
Above all else, I want you to know that you are loved and lovable. You will learn this from my words and actions--the lessons on love are in how I treat you and how I treat myself.
I want you to engage with the world from a place of worthiness. You will learn that you are worthy of love, belonging, and joy every time you see me practice self-compassion and embrace my own imperfections.
We will practice courage in our family by showing up, letting ourselves be seen, and honoring vulnerability. We will share our stories of struggle and strength. There will always be room in our home for both.
We will teach you compassion by practicing compassion with ourselves first; then with each other. We will set and respect boundaries; we will honor hard work, hope, and perseverance. Rest and play will be family values, as well as family practices.
You will learn accountability and respect by watching me make mistakes and make amends, and by watching how I ask for what I need and talk about how I feel.
I want you to know joy, so together we will practice gratitude.
I want you to feel joy, so together we will learn how to be vulnerable.
When uncertainty and scarcity visit, you will be able to draw from the spirit that is a part of our everyday life.
Together we will cry and face fear and grief. I will want to take away your pain, but instead I will sit with you and teach you how to feel it.
We will laugh and sing and dance and create. We will always have permission to be ourselves with each other. No matter what, you will always belong here.
As you begin your Wholehearted journey, the greatest gift that I can give to you is to live and love with my whole heart and to dare greatly.
I will not teach or love or show you anything perfectly, but I will let you see me, and I will always hold sacred the gift of seeing you. Truly, deeply, seeing you.
The Wholehearted Parenting Manifesto touches every moment of parenting, but has some special implications for promoting adolescent sexual health.
Consider that ~70% of North Carolina 12th graders have had sex. Or that teens say their parents are their #1 influence on decisions about sex. Or that the decline in North Carolina’s teen pregnancy rate is directly tied to increases in contraceptive use.
I wonder about what would happen if more parents adopted the Wholehearted Parenting Manifesto:
Would parents and their children be more willing to talk about things like sex, relationships, feelings, values, and dating?
Would those conversations be more open and honest?
Would more young people have access to the things they need to stay healthy, safe, and responsible: guidance, information, support, condoms, and contraception?
A few years ago, we produced Unconditional, a PSA encouraging parental engagement. Watch it, and consider how Wholehearted Parenting can strengthen your relationship with your child.
An article in yesterday’s Washington Post revealed an interesting loophole in how the Affordable Care Act may refuse care for pregnant teens and young adults.
Here’s the scoop:
Employer-based health plans are required to cover maternity services (labor and deliver, etc.) under the Pregnancy Discrimination Act of 1978 BUT they are not required to provide the same coverage for dependent children covered by a parent’s insurance plan. That’s old info. However, while the Affordable Care Act extends parents’ ability to keep coverage for their children up to age 26, it doesn’t change this provision. So, a young person on a parent’s health insurance will not have the most major maternity expenses covered. (Disclaimer: Always check with your insurer about what’s covered and what’s not.)
The Affordable Care Act does include some pregnancy-related services under the Preventative Services for Women provision: prescription prenatal vitamins, gestational diabetes screening, STD tests (state-mandated during pregnancy and very expensive, as I have learned), and breastfeeding supplies and support. This is the same provision that provides contraceptives with no co-pay and it could kick in at any point between August 1st of this year and 2014 depending on the insurance plan. To be clear, these changes will mean great things for teens: fewer pregnancies and healthier pregnancies for girls who are covered.
The very complicated bottom line: If a teen or young adult is up to age 26 and still on a parent’s insurance and gets pregnant and qualifies for the Women’s Preventative Services provision, then many parts of prenatal care are covered but not the most expensive part – actually having the baby.
Today marks one gigantic step forward in teen pregnancy prevention! As of August 1st, the Affordable Care Act (aka “Obamacare”) requires all new insurance plans to include Preventative Services for Women.
What Changes
The Preventative Services for Women provision of the ACA has been hotly contested and often misrepresented in the media. What most people want to know, though, is what it means for them.
Who Qualifies
If you have private insurance from an employer or as an individual (including student health plans) AND your plan is “non-grandfathered” (meaning it started after March 10, 2010) THEN you start receiving the Preventative Services for Women benefit when your plan renews after August 1st.
Here’s an example: We changed to a new health plan as of June 1, 2011 and renewed it this year on June 1. That means we’re “non-grandfathered”. We will start receiving the new benefits when our plan renews next time, which will be on June 1, 2013.
What’s Covered
In all, 22 services are covered for women with no co-pay – from breast cancer screening to STD screening to smoking cessation services. Here are the important ones from a teen health perspective:
Teen pregnancy has dropped by 53% in North Carolina the last 20 years, primarily because of increased contraceptive use. Unfortunately, teens still identify barriers to accessing sexual health care, including contraceptives. We expect that to gradually change under the new provisions and we should all benefit.
Here are five areas where the new provision will make a big difference for teens:
Teens Can Use Better Contraceptives. Long-acting methods like the IUD are ideal for teens – they basically mean no baby until after high school or college. Unfortunately, they can cost $1,000 to insert, even though they save money in the long run. The new provision means teens can access the most effective contraceptives instead of choosing less effective methods to save money.
Teen Parents Will Get Better Care. For a variety of reasons, teen parents are less likely to receive good prenatal care than their adult counterparts – even if they actively pursue it. The new provision covers prenatal vitamins, prenatal care, and expensive prenatal testing for things like gestational diabetes. The new provision also allows insured new moms to purchase a breast pump, giving teen moms more choice in how they’re able to balance work, school, and basic infant care.
Teens Can Get Birth Control’s Other Benefits. Most teens who take oral contraceptives do so for reasons unrelated to sexual health, including severe acne, hormone imbalances, and problematic menstrual cycles. Public health experts have theorized that this normalization of using birth control for other issues has been the primary contributor to contraceptive use and the subsequent drop in pregnancy rates.
Teens Will Be More Protected From STDs. The new provision covers (notoriously expensive) screening for Chlamydia, Gonorrhea, and other STIs. (These services are covered for boys under the Preventative Services for Children provision.) Giving access to testing is the first step in treating and preventing the spread of STIs.
Teens Will Get More Info on Healthy Relationships. The provision covers screening and counseling for interpersonal violence for all women. This is especially important for teens who are just learning how to safely navigate dating relationships. In addition, general increased access to doctors can be a boon for parent-child communications, as doctors can offer great conversation starters to their patients.
"Where do babies come from?" is a question most kids ask. It's a question most parents get. It's also one of the conversational milestones when families talk about sex.
Most of us heard some version of the traditional response: Something about a man and a woman loving each other...and a baby growing in a mommy's tummy... But that answer doesn't work for many families and many children.
Enter the great new book, What Makes A Baby?, by well-known sex educator Cory Silverberg.
What Makes A Baby? is a factually accurate and age-appropriate book about where babies come from that accounts for the many ways children become a part of families. For example, it covers adoptive families, families who use fertility treatments, LGBT families, and families with a network of step-parents and step-siblings.
While my baby (due later this summer) will have entered the world following the traditional narrative, she will notice at some point that not all babies followed the same path. Her uncle was adopted. Other babies she will know - also adopted by family friends - look entirely different from their parents. We know how to tell her where she came from, but she will also need and want to know where other people came from. As Cory notes on the What Makes A Baby? website, the book is especially helpful for families who have children with different origins - say, one is biological and one is adopted.
Talking about sex in a gradual, age-appropriate way is one of the most important things a parent can do to help a child grow up to be a safe, healthy, and responsible adult. What Makes A Baby? is a great new tool to make that process easy, factual, and inclusive of all children.
What Makes a Baby? is available in print and as an e-book.
