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Pediatricians tell peers: Step up to avoid 'destabilized' teen reproductive health services

Pediatricians wrote in a medical journal Monday that they and their peers must take steps to ensure their adolescent and young adult patients have access to needed reproductive healthcare services after federal abortion protections were overturned. File Photo by orzalaga/Pixabay
Pediatricians wrote in a medical journal Monday that they and their peers must take steps to ensure their adolescent and young adult patients have access to needed reproductive healthcare services after federal abortion protections were overturned. File Photo by orzalaga/Pixabay

Aug. 15 (UPI) -- The U.S. Supreme Court's decision overturning Roe vs. Wade -- the landmark 1973 case affirming the federal constitutional right to an abortion -- may "instantly destabilize" reproductive healthcare access for adolescents and young adults, pediatricians wrote in a commentary published Monday in a medical journal.

The authors, led by Dr. Tracey A. Wilkinson, assistant professor of pediatrics at Indiana University's School of Medicine in Indianapolis, offered pointers to their peers about how to help teen and young adult patients in a post-Roe world in a "viewpoint" article in JAMA Pediatrics.

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Wilkinson is a colleague of Dr. Caitlin Bernard, an Indiana ob-gyn who came under public attack after providing an abortion to a 10-year-old girl who reported a rape in Ohio.

The authors said the backdrop of states permitting varying degrees of abortion access will create uncertainty and challenges for young people and their pediatricians.

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An "arbitrary" upper age limit for pediatric care was eliminated by the American Academy of Pediatrics in 2017 because the transition to adult care is seen as an individualized experience.

Previously, the group had listed an upper age limit of 16 to 18 in the 1930s, raising it to age 21 in 1988 and reaffirming age 21 in 2012.

The problem becomes even more complicated because pregnancy rates are higher among youth from racial and ethnic minority groups, those living at or near poverty, and lesbian, gay, bisexual, transgender and queer youth, the authors said.

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And these young people "are less likely to have resources and social networks to support them as they navigate additional barriers to abortion access," they said.

In their article, two pediatricians and a public health researcher said many of the new restrictions are occurring in states where adolescent and young adults' reproductive healthcare access is already restricted -- and where unintended pregnancy rates are higher than average.

Yet abortion access is an essential component of reproductive healthcare for all people, the authors said. And though people younger than 20 account for 12% of abortions nationwide, adolescent pregnancies are more likely to be unintended and end in abortion -- so adolescents will be disproportionately affected by the legal decision.

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Young people already face significant barriers to abortion access, including "financial issues, transportation, state surveillance and laws that mandate parental consent and notification," the pediatricians said.

Add to that poverty, race and other social inequities and the situation worsens, they say.

"Furthermore, when young people are not given a choice about whether to become a parent, we know that all of these inequities increase," the authors said.

To address the situation, they advise pediatricians to routinely provide guidance on topics such as sex, sexuality and relationships, tailoring it to a young person's developmental stage and introducing it "early and often."

The authors also suggest that pediatricians counsel their adolescent and young adult patients about contraceptives -- and provide them -- via telehealth or in-person visits.

Young patients should be supported in choosing the medically safe contraceptive method they feel best meets their needs and get same-day instructions on how to start it, the authors said.

And if they select a short-acting contraceptive, such as pills, patches, a ring or injection, prescriptions should be written with refills for 1 year, they added.

Patients should be educated about non-prescription forms of contraception, such as condoms and emergency contraceptive pills, the authors said.

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And pediatricians should offer screening for sexually transmitted infections, when it's indicated, for patients of all genders -- and fill in gaps in knowledge left by schools' sex education.

Pediatricians also should provide unbiased counseling to pregnant patients on their options -- parenting, adoption or abortion -- and be aware of state laws on abortion access and whether there are parental consent or notification laws.

The authors urged pediatricians to help their young patients avoid crisis pregnancy centers, which they described as "misleading and harmful clinics" that are "often not licensed and intentionally influence vulnerable pregnant people to continue their pregnancies."

They also stressed that confidential care is required, so pediatricians should consider the potential for breaches of their young patients' privacy in electronic health record documentation, billing and insurance claims.

By incorporating these steps into routine practice, pediatricians can help young people "continue to receive the support they need to control if, when, and how to be parents," the authors concluded.

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