Adolescent pregnancy rates in the United States are on a downward trend; the rate for 2020 was 15.4 births per 1,000 adolescent females ages 15 to 19. Of those births, 75% occurred to mothers aged 18 or 19. Pediatricians have a crucial role in supporting comprehensive reproductive care for adolescents, including non-biased counseling, abortion care, and birth control resources. In this post, we cover the resources available for pediatricians to educate, support, and empower adolescents to have a say in their reproductive health.
After the Supreme Court overturned Roe v. Wade in 2022, access to abortions are no longer a Constitutional right, and some states have or are in the process of eliminating access to abortion access (as of August 2022).
A ban on abortions in some states may lead some adolescents to incredibly difficult choices, which their pediatrician can help guide them and their families through with safe and effective counseling and care. Some experts believe that bans on abortion will lead to impacts on women’s health and “back alley” abortions, which are critical events to avoid for all patients. Pediatricians can help prevent impacts to patients’ health by maintaining and creating positive, supportive provider relationships.
In addition, birth rates among adolescents vary widely across demographics, as shown below from data from 2015 through 2020 by the Centers for Disease Control and Prevention’s birth rates among women aged 15 to 19:
Sources: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf ; https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf
Understanding your practice’s demographics can help pediatricians understand the rates of births in adolescents and be prepared to care for them, with the coordination of a pediatric or adult obstetrician-gynecologist.
The AAP on Adolescent Rights & Resources
The policies that support adolescent reproductive healthcare are for the most part unchanged since their implementation by the American Academy of Pediatrics at various times dating back to 1989. The main policies are Options Counseling for the Pregnant Adolescent Patient and The Adolescent’s Right to Confidential Care When Considering Abortion, both of which were reaffirmed by the AAP and republished in the journal Pediatrics in September 2022.
Both policies reaffirm the rights of adolescents to comprehensive care, and Options Counseling for the Pregnant Adolescent Patient states that “It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options.”
The AAP outlines the following options for most pregnancies:
Pediatricians presenting these options to patients should do so in an unbiased, developmentally-appropriate manner, maintaining respect for the patient’s cultural, familial, and personal beliefs. The Options policy emphasizes the importance of documenting such beliefs and conversations to record decisions such as whether to involve or not involve parents in such decisions, both to protect pediatricians and outline proper medical care (learn about your state’s laws in this matter here).
Below are resources that may help your practice to offer the comprehensive care that young patients and their families need to protect their rights to privacy and care while pregnant.
Continuing Pregnancy
Patients who choose to continue the pregnancy have better outcomes with excellent prenatal care for both the mother and her unborn child. Pediatricians may refer pregnant patients to a pediatric or adult ob-gyn and should take care to coordinate carefully during and after pregnancy, to ensure that the infant and new parents have the support they need from a physician with whom they’ve built trust.
Families may elect to deliver the infant and opt for adoption, foster care, or kinship care, where the infant is raised by the patient’s parents or other relatives alongside themselves or separately. Options and resources for families considering foster, kinship, and other options are available here. Pediatricians can help counsel patients through the many emotions of making this weighty decision, including with mental health integration options available at their practice.
Options for patients who decide to parent a child after a successful pregnancy are widespread, and pediatricians can help guide new parents to financial resources such as WIC, Medicaid, and CHIP. Other programs exist, especially for youths in foster care, to provide home visits, community outreach, and more.
Termination of Pregnancy
The overturning of Roe v. Wade means that in several states, abortion access is severely limited, banned altogether, or is available only in certain cases. It’s critical for pediatricians to maintain awareness of current abortion access policies in their state, and to have updated resources for patients under their care who elect to terminate their pregnancy.
Providing abortions is within a pediatrician’s scope of practice – it is important to consider laws and state regulations before choosing to offer this service. In any case, your practice as a patient’s medical home can provide support and guidance for the patient in seeking services and unbiased counseling. Pregnant adolescents face many challenges in receiving support for terminating their pregnancy, including involvement of parents, financial challenges, access to unbiased care, transportation, and stigma, among others. The AAP’s Options policy supports and encourages pediatricians to take facilitative steps to support patients in this care, including making appointments, advocating for care, and following up with the patient.
Many resources for pediatricians are available in the Options policy, including access to abortion funding, finding a verified provider for abortion care, low-cost or free abortion legal aid for adolescents, and more.
Supporting patients through pregnancy may or may not be common in your practice. When pregnancy does occur, your patients deserve and have a right to the same comprehensive care your practice offers them at any other point in their development to adulthood. As in many other cases, the foundation for excellent care is based on the trust and support of physician-patient relationships, and the dedication of pediatricians across the U.S. to support the best care possible for patients, regardless of location, demographics, or social determinants.
Mental and behavioral healthcare is foundational for many patients, and many pregnant patients or teen parents may need additional support in this area. Learn how your practice can integrate behavioral health in ways that support your patients and are accessible for every practice size with PCC’s ebook, Integrating Behavioral Health: A Guide to Expanding Access.