Laws that require federally funded clinics to notify parents if a minor wants to obtain prescription contraception (search) may increase risky sexual behavior among teenagers, according to a new study conducted at a national sample of family planning clinics.

Researchers found that one in five adolescent girls would not use contraception, or would rely on withdrawal as a birth control method, if they were required to notify their parents about seeking sexual health services.

Although parents generally have the legal authority to make medical decisions about their children, it’s generally assumed that many teenagers would avoid seeking medical services for prescription birth control or sexually transmitted diseases (STDs) if they were required to notify their parents.

That’s prompted many states to pass laws in the last 30 years that give adolescents under age 18 the right to consent to a variety of sexual health services. Where the law is silent, the decision of whether a minor can consent to services is up to the discretion of the health care provider.

But researchers say that until now it wasn’t clear just how many parents of adolescent girls are aware that their daughter is seeking sexual health services or how the teenagers would react to the possibility of mandated parental consent for prescription birth control.

Consent Laws May Affect Teen Sexual Behavior

In the study, researchers surveyed 1,526 girls under age 18 who sought reproductive health services at a national sample of 79 family planning clinics between May 2003 and Feb. 2004. The results appear in the Jan. 19 issue of The Journal of the American Medical Association.

Nearly two-thirds of the teens (60 percent) said that a parent or guardian knew they were seeking services at the clinic. Adolescents were more likely to have informed their parents if they were under 15 years of age, non-Hispanic black, or had made two or more visits to the clinic.

Girls who lived with their mothers or female guardians and not their fathers were also more likely to have told a parent than others.

Among those teens who hadn’t informed their parents about their use of sexual health services, the main reasons were:

—Not wanting their parents to know they were sexually active

—Taking responsibility for their own health

—Concern that their parent would be disappointed if they were having sex

—Feeling uncomfortable talking about sex with their parents

Most of the girls (59 percent) said they would continue to use the clinic for prescription birth control if parental consent was required, but those responses varied greatly.

Only about 30 percent of the girls who said their parents were unaware of their clinic visits said they would continue to use the clinic for birth control services if parental consent was required. But nearly 80 percent of those girls who parents were aware of their clinic use said they continue to use the clinic under those circumstances.

The second most common response to mandated parental notification was to use an over-the-counter method of birth control, such as condoms, if consent was required. Teens whose parents knew they were visiting the clinic were more likely to indicate that they would use an over-the-counter method.

But the study also showed that 18 percent of teenagers said they would engage in risky sex by not using any birth control if parental notification (search) was mandated. The likelihood of engaging in risky sex was much lower among teens who had informed their parents of clinic use and those whose parents had suggested the clinic.

When asked if a law mandating parental consent for obtaining prescription birth control would prevent them from seeking sexually transmitted disease testing or other STD services, 95 percent of teens said they would use the clinic or a private physician, but only a few (5 percent) said such a law would cause them to forgo these services.

Researchers say the results show that mandated parental notifications laws would likely increase risky or unsafe sexual behavior among teens and may, in turn, increase rates of teen pregnancy and sexually transmitted diseases.

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCE: Jones, R. The Journal of the American Medical Association, Jan. 19, 2005; vol 293: pp 340-348.