Parental consent for abortion and the judicial bypass option in Arkansas: effects and correlates.

Almost all states in the middle and southern parts of the United States require that before a physician performs an abortion on a minor, he or she must notify or obtain consent from at least one of the minor’s parents (Figure 1).1 In some states—Florida, for example—minors who want to obtain an abortion without parental involvement must travel hundreds of miles to a state that does not have one of these restrictive laws. The implications of this legal environment on the reproductive outcomes of minors are not well understood. Most research on parental involvement laws pertains to an earlier period, when interstate travel by minors to avoid compliance with a law was more common.2 Studies that used data on abortion by state of occurrence often found that implementation of parental involvement laws was associated with substantial decreases in teenage abortion rates.3–6 The few studies that were able to measure abortion by minors’ state of residence generally showed a small, if any, association.7–9 In a series of studies, researchers analyzed a parental involvement law under circumstances consistent with the current distribution of laws: Implementation of the Texas parental notification law in 2000 was associated with a decline in abortion rates, a rise in birthrates and an elevated likelihood of minors’ obtaining an abortion after 12 weeks’ gestation.10–12 FIGURE 1 Parental involvement laws regarding minors’ access to abortion in the United States, 2009 Although the national map of parental involvement laws is unlikely to change appreciably in the near future, since 2003, four states—Arizona, Arkansas, Texas and Virginia—have converted their parental notification statutes to laws that require parental consent.*1,13 Such changes are motivated by a belief that a notice requirement is easier to circumvent than a consent statute, and that a stricter law will lead to fewer abortions. As Texas State Representative Phil King, who sponsored the change in his state, commented, “I think it will do what [parental notification] intended to do by bringing parents into the decision-making process, and when that happens, we’ll see a reduction in abortion and in teenage pregnancy.”14 Despite this belief by some politicians, only three studies have analyzed whether laws that require parental consent have a greater impact on the behavior of minors than laws that require parental notification, and they report widely disparate estimates and have major methodological weaknesses.6,15,16 Tomal analyzed county-level rates of abortions and births among minors and older teenagers in 11 states in 1995, and found that parental notification laws had a stronger negative association with minors’ abortion rate than did parental consent laws.15 Moreover, both types of law were associated with the abortion rates and birthrates of adolescents aged 18–19, which calls into question the association with minors’ rates. Medoff analyzed minors’ abortion rates—which he defined as abortions per 1,000 pregnancies—from 50 states at three points in time (1982, 1992 and 2000).16 Like Tomal, he found that notification laws were associated with a greater decline in abortions for minors than were parental consent laws. However, it is extremely difficult to distinguish ongoing trends in abortion rates from the influence of changes in the law that may have occurred 8–10 years earlier. Finally, New used a pool time-series cross section of state abortion rates from 1985 to 1999 based on the states that reported abortion to the Centers for Disease Control and Prevention.6 He found that parental consent laws were associated with substantially greater declines in minors’ abortion rate than were parental notification requirements. Yet despite the methodological sophistication of his analysis, the results are questionable. Because New examined abortions by state of occurrence, he could not determine whether the negative association represented a real decline in minors’ abortion rate or simply a change in where abortions were performed. Given the inconsistent findings and questionable designs of these studies, whether parental consent laws have a greater influence than notification requirements on the reproductive outcomes of minors remains an open question. Cross-state travel by minors to avoid compliance with a law has become more difficult for those residing in the central and southern parts of the United States. The Texas study, for instance, found little evidence that minors left the state to obtain an abortion in the period after the parental notification law took effect, since most of the surrounding states also enforced a parental involvement law.10 Because of minors’ lack of access to abortion services in states that require parental involvement, the only practical option for those who do not want to involve their parents is to seek a court waiver based on a judge’s assessment of their maturity or whether parental involvement would not be in their best interest. Despite the potential importance of the judicial bypass system, no population-based studies have examined the characteristics of minors who obtain an abortion through a court waiver, or whether minors who use this option terminate later in pregnancy than those whose parents are involved in their abortion decision. Existing data, from surveys at selected abortion clinics or at a referral organization for pregnant minors, describe minors who went to court for a waiver, but three of these four surveys were conducted more than 25 years ago.17–20 This study draws on unique data on induced terminations from Arkansas and addresses three questions. First, was the state’s change from a notification statute to a consent statute in 2005 associated with a decrease in the abortion rate and an increase in the rate of second-trimester abortions among minors relative to rates among older teenagers? Analysis of changes in a law within the same state, as opposed to a comparison of the effect of laws in different states, offers a useful way to control for hard-to-measure differences between legal jurisdictions. Second, do minors who obtain an abortion through a court bypass differ in age, race or ethnicity, or other demographic characteristics from minors who obtain parental consent for abortion? Finally, do minors who use a judicial bypass have the abortion later in pregnancy than minors who have parental consent? This study is possible because the Arkansas law requires that all abortion providers report to the state health department whether the minor obtained parental consent or received a judicial waiver of consent for the abortion. This is the first effort to analyze these data.