Jenna is a 15-year-old admitted to the hospital with hypokalemia secondary to bulimia nervosa. She reports sexual activity with males and females, daily cannabis use and inconsistent adherence to birth control. She is ambivalent about pregnancy intention, stating “if it happens, it happens.”
The resident physician notes Jenna hasn’t had a period in four months, and testing reveals she is pregnant. The resident physician assesses Jenna’s safety within her home and relationships. Reassured of low risk of harm with disclosure of this sensitive information, the physician encourages Jenna to share this information with her parents.
Jenna is counseled about the full range of pregnancy options and decides to continue the pregnancy. She is encouraged to discontinue using cannabis and is prescribed a prenatal vitamin. An appointment is scheduled with an obstetrician team experienced with adolescent pregnancies, and the hospital social work team is consulted to assess additional needs Jenna and her family may have during pregnancy and beyond.
Although adolescent pregnancy rates have declined over the last 70 years, pediatricians may diagnose pregnancy in an adolescent patient in a variety of clinical settings, including inpatient, emergency department and urgent care, behavioral health and outpatient clinics.
In two updated policy statements, the AAP reaffirms its support for adolescents to receive comprehensive, evidence-based reproductive health care services as described above, including unbiased pregnancy options counseling and confidential abortion care.
The statements, Options Counseling for the Pregnant Adolescent Patient and The Adolescent’s Right to Confidential Care When Considering Abortion, from the Committee on Adolescence, are available at https://doi.org/10.1542/peds.2022-058781 and https://doi.org/10.1542/peds.2022-058780 and will be published in the September issue of Pediatrics.
Pediatricians’ role, resources
The updated policy statements’ essential recommendations for pregnancy options counseling are unchanged from 1989: All pregnant adolescents should be counseled in a nonjudgmental, developmentally appropriate manner about the full range of pregnancy options. These options include continuing the pregnancy and raising the child; continuing the pregnancy and making an adoption, kinship care or foster care plan; or terminating the pregnancy.
As legal abortion becomes more difficult to access, Options Counseling for the Pregnant Adolescent Patient provides additional guidance for pediatricians on facilitating referrals for abortion care. The statement includes resources for information about state laws, locating an abortion provider, medication abortion and self-managed abortion, judicial bypass and funding.
Both statements, informed by reproductive justice and human rights frameworks, affirm adolescents’ right to bodily autonomy regarding pregnancy and their rights to confidential abortion care, within the context of encouraging parent or guardian involvement when safe and appropriate.
In addition, both statements include language about AAP opposition to laws that interfere with the practice of medicine. Pediatricians must be able to provide their patients with accurate, evidence-based information without interference. Laws or policies that stand in the way of health care providers’ ability to do so — or that punish or criminalize health care providers for doing their jobs — are detrimental to adolescent health.
Conclusions and recommendations
The policy statements reaffirm the following:
- Access to safe and legal abortion is a core component of sexual and reproductive health care, and adolescents’ rights to confidential care when considering abortion should be protected.
- Because of the harms of restrictive abortion laws and the dangers associated with unsafe abortions, adolescents should have access to legal abortion services.
- Inform the pregnant adolescent of all options, which include continuing the pregnancy and raising the child; continuing the pregnancy and making an adoption, kinship care or foster care plan; or terminating the pregnancy.
- Be prepared to provide a pregnant teen with accurate information about each of these options in a developmentally appropriate manner involving a trusted adult, when possible; support the decision-making process; and assist in making connections with community resources that will provide quality services during and after the pregnancy.
- Encourage adolescents, when it is safe and appropriate, to seek adult guidance and support when considering their pregnancy options. Respect the pregnant adolescent’s right to decide whom to involve in the decision to seek abortion care.
- Be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals’ provision of unbiased pregnancy options counseling and referrals for abortion care.
- Oppose efforts by state governments to interfere in the patient-physician relationship or to levy criminal sanctions on physicians for the provision of care.
- Be aware of structural inequities in U.S. society and understand that adolescents from marginalized communities are likely to experience more negative impacts from restrictive abortion laws, including mandatory parental involvement and judicial bypass requirements.
- Examine their own beliefs and values to determine whether they can provide nonjudgmental, factual pregnancy options counseling that includes the full range of pregnancy options. If they cannot fulfill this role, they should facilitate a prompt referral for counseling by another knowledgeable professional who is willing to have such discussions with adolescent patients.
Dr. Berlan is a lead author of both policy statements and a member of the Committee on Adolescence.