Parental consent: factors influencing adolescent disclosure regarding abortion

Adolescence, Spring, 1993 by Mary S. Griffin-Carlson, Kathleen J. Mackin

INTRODUCTION

Little information exists about the decision-making processes of pregnant adolescents. In the present legal climate where some states are mandating parental permission prior to teenage abortions, little is known about the nature and effect of parental participation in that process. This study is an attempt to investigate factors related to an adolescent's choice to involve parents in the decision to terminate a pregnancy.

In 1988 the Centers for Disease Control (CDC Surveillance Surveys, 1990) reported that there were 1,371,285 abortions in the United States, 25% of which were obtained by women under the age of 19. Researchers at the National Center for Health Statistics estimated that of the 1.1 million pregnancies among teenagers in 1981, 40% ended in abortion, 13% in miscarriage, and 47% in live births (Senderowitz & Paxmon, 1985).

Since 1977 numerous pieces of legislation have been introduced at the local, state, and national levels to restrict abortion services. Issues such as informed consent, waiting periods, parental notification, and regulations relating to methods of abortion and abortion facilities have been debated (Hatcher et al., 1982). The need for parental consent and/or notification is now being disputed around the world. In the United States, 44% of all abortion facilities require parental consent or notification for patients aged 15 or under, while 30% have such requirements up to age 18 (Smith & Mumford, 1985). Many states are now in the process of looking at this important issue and changing their regulations. The legal debate centers around such issues as a minor's maturity level in making adequate judgments, violation of parental responsibilities, and the preservation of the family as a social unit (Smith & Mumford, 1985).

A review of recent interdisciplinary literature reveals that the majority of health professionals believe that the mandate of parental consent forces teenagers to delay abortion decisions to a point which might increase health risks (Hayes, 1987; Silber, 1987; Thompson, 1989; Torres & Forrest, 1988; Yates, 1988). Medical experts agree that late abortions are more traumatic because the procedures are more complicated and are associated with higher morbidity (Smith & Mumford, 1985).

There is no conclusive body of evidence that suggests that abortion has negative effects on adolescents, whether they tell their parents or not. There is little disagreement among researchers regarding minimal physiological complications following adolescent abortions (Smith & Mumford, 1985; Hatcher et al., 1982). Although there is greater disagreement regarding psychological sequelae, the research which identifies negative reactions such as depression and disorganization does not entail large numbers (Belensky, 1978; Spaulding & Cavenau, 1978). A larger body of objective data reveals a surprisingly low incidence of psychological complications (Osofsky & Osofsky, 1972). Emotional adjustment prior to the abortion has been found to be most relevant (Martin, 1973; Moseley et al., 1981). A recent review of studies by Adler et al. (1990) concluded that women show little evidence of psychopathology after abortion. It was noted, however, that the majority of these studies were short-term, revealing little about the long-term effects of abortion.

Melton (1987) suggests that parental consent laws cause unnecessary embarrassment and anxiety among teenagers and foment family conflict. Battle and Battle (1987), in a study involving black women, note that these laws encourage conflict between adolescents and their mothers, who may view teenage parenthood as a more appropriate option in dealing with pregnancy. Gruber and Anderson (1990) question whether mandatory parental involvement will improve family communication, and Lewis (1979) states that "the data suggest that mandatory parental consultation probably would not promote more harmonious relations." On the other hand, Worthington, Larson, Brubaker, and Colecchi (1989) support the position that parents have a responsibility and right to contribute to decisions regarding abortion; however, they do not mention the potential cost to the adolescent.

Several investigations have examined the choices made by women concerning the resolution of their pregnancy. These studies have significant bearing on the parental consent issue. Lewis (1979, 1980, 1987) compared adults and minors and noted developmental changes in the decision-making process. According to Lewis (1980), younger adolescents may be more caught up in the fantasy aspects of pregnancy and less likely to consider the financial and emotional commitments of motherhood, as well as a host of other related responsibilities. He found that young adolescents appeared to be externally motivated and were more concerned about the effects of their decisions on parents and other family members. Older subjects were more likely to consult an outside professional for advice and to be more concerned about the economics of their pregnancy and its effect on their own lives (Lewis, 1980).