Youth Reproductive Equity kicks off a new research agenda today on minor abortion access

ANN ARBOR – Time magazine ran a profile last summer about “Ashley,” a 13-year-old girl who went nearly mute after she was raped outside of her home in Mississippi: For weeks, she didn’t tell anyone what had happened, and with state abortion bans set into motion following the Supreme Court’s Dobbs decision, she had no practical options but to deliver the baby before she started seventh grade. The story was one of many that have surfaced to show the human impacts of Dobbs, the U.S. Supreme Court decision that overturned the nationwide right to abortion– but how many teens are in the position of seeking abortions they can’t obtain? How do minors learn about abortion access or decide whether and how to seek reproductive healthcare? How are they navigating and experiencing the changing landscape of abortion access, and restrictions that accrue to minors in particular?  We don’t know– because those data do not exist. 

Research Gap

Abortion access policy disproportionately affects adolescents, but we know strikingly little about this population. Next month will mark two years since the U.S. Supreme Court’s Dobbs decision, and an ocean of research has investigated the impacts of legislation that is changing every day as states press for new policies to restrict or protect abortion access. More than 14,000 articles on “abortion after Dobbs” can be found today on Google Scholar. But the impact of these changes on minors–teens aged 17 or younger with often different legal rights –  is a critical area of focus that has been largely overlooked, according to Youth Reproductive Equity, a national collaborative of researchers and clinician-scientists that today launched a report aimed to address this gap.

“Minors are a marginalized group who already face additional barriers to abortion access, have fewer protections, and receive differential treatment under the law,” said lead author Julie Maslowsky, an affiliate of the University of Michigan School of Nursing and the Population Studies Center at the Institute for Social Research. “This is a problem of equity because all people, regardless of age, are entitled to the right of bodily autonomy. It is an issue of scientific rigor because we are systematically excluding one part of the population who are impacted by changing abortion laws from our studies.” 

A Research Agenda for Adolescents and Abortion

The new report, “Adolescence Post-Dobbs: A Policy-Driven Research Agenda for Minor Adolescents and Abortion,” presents an overview of today’s policy landscape, principles and questions for future research, and recommendations to overcome challenges that limit research and policy change for minors. The report is derived from the proceedings of an expert consensus panel representing key constituencies: Researchers, reproductive health organization leaders, clinicians, law and policy experts, and a group that is not often at the table– young people themselves.

Minors aged 17 or younger account for about 4 percent of all abortions in the formal healthcare system. We know that some 25,000 minors received abortion care each year, prior to Dobbs– but we don’t know how many were unable to obtain a wanted abortion. We know that more than two-thirds of pregnancies to minors are unintended– more than other groups, and that minors’ pregnancies were more likely to end in abortion than adults’ pregnancies, prior to Dobbs. Post-Dobbs, adolescents living in states with severe abortion restrictions or bans are expected to be less likely to access abortion than adults. Adults are more likely to be able to travel to another state or access care through telehealth or online options. In Texas– one of the first states to enact a 6-week abortion ban– adolescents showed the largest decrease in their abortion rate compared to other age groups. In the rapidly shifting state policy environment, minors are often targeted by restrictive policies – like parental consent requirements or new “abortion trafficking” laws that criminalize helping minors cross state lines for abortion access – and they are often left out of protective ones, Maslowsky said. Further, adolescents also face particular barriers to pregnancy prevention– including access to contraception and to comprehensive sex education that includes information about pregnancy prevention and abortion.  

The Post-Dobbs Landscape

The Guttmacher Institute yesterday identified “attacks on youth reproductive autonomy” as a key trend in its first quarterly report on state reproductive health policy. Its recent study out last month on the characteristics of adolescents obtaining abortions in the US concluded that this population is “more vulnerable” than adults, and that adolescents navigate unique barriers to both information and logistics to access care. Multiple factors delay abortion care for this age group– including mandated counseling and waiting periods, mandated ultrasound viewing, parental involvement laws, financial barriers, transportation challenges, and limited availability of care. Compared to adults, adolescents are more likely to report not knowing they are pregnant– as some may not recognize signs of pregnancy or have more irregular cycles that make a missed period less concerning. Compared to adults, the Guttmacher study found, adolescents were more likely to report not knowing they were pregnant (57% vs. 43%), not knowing where to obtain an abortion (19% vs. 11%), or that they were looking into insurance (12% vs. 5%). The report was based on Guttmacher’s 2021-22 Abortion Patient Survey, with 6,698 respondents – but because they represent only a small percentage of the population, only 156 minors were included. In reporting the study limitations, the authors acknowledged the data were not nationally representative, the sample included too few minors to do a more comprehensive analysis of the population, and the study did not capture people who wanted abortions but were unable to travel to a facility. While important, this report showcases the prevailing challenge– there is not enough data about adolescents and abortion to provide needed information and perspectives. 

Meanwhile, more than half of American adolescents, aged 13 to 19, now live in states with severely restricted or no legal abortion access.

The details of cases involving minors can be found in testimonies provided to lawmakers and in news stories that paint a picture of a policy landscape that may be confusing, hostile, frightening, and dangerous to navigate. Abortion restrictions have impacted women and girls seeking interventions for life-threatening conditions and medications used to make miscarriages safer. In a post-Dobbs case in Florida, a judge denied a 17-year-old a parental consent waiver for an abortion, citing her C-average grades. A highly publicized case just days after the SCOTUS ruling involved a rape victim who fled Ohio to seek an abortion at six-and-a-half weeks in Indianapolis; she was 10 years old.  

But while experiences and anecdotes like these accumulate, researchers face particular barriers to gathering evidence about minors and struggle to gather data at scales that are sufficient for robust insights.

Research Challenges

“Minors are a major blindspot in abortion research that need to be addressed,” said Laura Lindberg of the Rutgers School of Public Health, a co-author of the Youth Reproductive Equity report. “We need research that incorporates minors’ experiences, corrects the misperception that minors aren’t competent to make decisions, and guides funders and Institutional Review Boards about feasibility and best practices to break through challenges we face in efforts to conduct needed research.”

Those challenges include small samples of minors in abortion surveillance efforts, age groupings in national data that combine minors and non-minors, research gaps on the systems and contexts involved in minor abortion information, access, and care, and limited focus on the unique experiences of minors and parents navigating those systems, according to Youth Reproductive Equity. Their report includes recommendations and research questions in four areas of policy: access to abortion, access to abortion information, parental/adult involvement, and privacy and confidentiality, a category that includes electronic record sharing and criminalization of self-managed abortion. 

Implications

Filling these research gaps may help guide practitioners and policymakers in an era of legislative flux. As of February, 14 states have enacted near-total abortion bans, three states have bans under litigation, and seven have lowered their gestational threshold for abortion to 20 weeks or less. The Supreme Court will rule this year on the closely-watched case that would restrict access to the “abortion pill” mifepristone, and the invocation of 19th-century Comstock Laws in that case by conservative justices was concerning to advocates of reproductive rights. Those laws– which were inactionable under Roe– banned the mailing of “lewd” content and materials for abortion or contraception. Several states– including Oklahoma, Tennessee, Idaho, and Alabama– have moved to consider bills banning minors from crossing state lines to seek abortions without parental consent. A TV response ad entitled “The Fugitive,” running in Alabama, includes a scene reminiscent of A Handmaid’s Tale: A highway patrolman pulls over two frightened young women, tapping the driver-side window with a home pregnancy test. Several states will vote on abortion in the upcoming election, and reproductive rights will figure as a top issue. 

“It would be useful to have a larger body of research about adolescents and minors who get abortion care in all different kinds of contexts, and all different kinds of policy environments,” said Rachel Jones, a principal research scientist at Guttmacher who focuses on domestic abortion research. Most young people do involve their parents in making decisions about pregnancy, said Jones, but it would help legislators to understand the circumstances of those who don’t. Jones said the Guttmacher study suggested minors may be less likely to opt for medication abortion, but that further research would be needed to understand the replicability and implications of that finding. Given their vulnerability, it would benefit the field if foundations were more proactive about supporting research on minors who have abortions, and the barriers they face, she said.

“Historically, young people have always been the first people dismissed when it comes to reproductive care, including abortion care,” said Kylee Sunderlin of the reproductive justice organization If/When/How, whose role as a Michigan judicial bypass lawyer is to represent pregnant minors who must ask a judge to grant the right to obtain an abortion without state-mandated parental involvement. We see this reflected in the maze of laws around the country requiring parental involvement or judicial bypass, in state bills seeking to block young people’s access to abortion, as well as in ballot measures that focus on increasing abortion access but have negotiated young people out of the expansions– as we saw in the Michigan Reproductive Health Act, she said.

“As a lawyer who relies on research for amicus briefs and policy change, I have a front row seat to the ways that the absence of impactful research on sexual and reproductive health for young people has resulted in profound harm,” said Sunderlin. “The Youth Reproductive Equity report not only shows why, in stark terms, we cannot continue to ignore young people, but it also creates a clear roadmap for equitable and actionable research to remedy this gap.”

“If we understand parent perspectives, we can better inform policies about parental involvement that are often a barrier to adolescents’ desired pregnancy outcomes and result in delays in care,” said Maslowsky. “With young people’s perspectives, we will be able to counter restrictions that are based on a non-evidence based narrative that minors aren’t mature enough to make decisions. There are many questions that need to be asked to support stakeholders, make timely decisions, and understand the long-term impacts of these new restrictions.”

“The most consequential data for the work I do supporting young people is about the harms of forced parental involvement laws, the judicial bypass process, and ultimately, what it means to force a young person into birth. Because without a supportive parent or a judicial bypass, then the state is forcing young people into the incredible trauma of forced birth,” said Sunderlin. “Restricting young people’s bodily autonomy is affirmatively harmful. I hope that by hearing this—either directly from young people or indirectly through research—that the people making decisions about young people’s lives will actually start caring about them.”

With Maslowsky and Lindberg, Emily Mann of the University of South Carolina co-authored the Youth Reproductive Equity report.

This post was written by Tevah Platt of the University of Michigan Population Studies Center at the Institute for Social Research.