Maryland Law Allows Pre-Teens Confidential Access to Birth Control

Yesterday, I stood in shock of a recent decision by a Portland, Maine school board to allow a middle school to give out birth control pills to girls as young as 11. Apparently, I should have looked in my own back yard, as the Baltimore Sun reports:

While much of the nation debates a Maine school board's vote to let school-based clinics give young teens contraceptives without parental consent, Baltimore girls as young as 12 have had access to birth-control pills from such clinics for more than 20 years.

Advocates say making contraceptives available has played a large role in the city's declining teen birth rate - especially in the past decade, when it has been cut in half for girls younger than 15.

It's not just in Baltimore. A Maryland law that dates to the 1970s allows a minor confidential access to contraception, meaning any adolescent girl can ask her doctor for birth control - knowing that information will not be shared with her mother or father.

Most girls will tell their parents, health officials said, but the girls have a right to privacy here, as in 20 other states and the District of Columbia.

"We promote abstinence as the best choice for teenagers," said Bonnie S. Birkel, director of Maryland's Center for Maternal and Child Health, "but we don't deny services to anyone."

When it comes to reproductive health care, it is apparent that this country as a real problem with hypocrisy.

Under the laws of 20 states and the District of Columbia a pre-teen can walk into a school administered health clinic (not the school nurse apparently, but if there is a clinic staffed by a nurse practitioner) she can ask and receive birth control pills WITHOUT NOTIFYING HER PARENTS OR GUARDIAN!!!!.

This kind of a law, while it may have lead to a reduction in the teen pregnancy rate, completely undermines the role of parents in the healthcare decisions related to their children. In Maine, the rationale for providing the birth control is that some girls will not want to discuss the matter with their parents. In Maryland, officials believe that the most girls will tell their parents. Unless the girls in Maine are of a completely different sub-species of girls than those in Maryland, the chances are that no girl tells their parents because to do so will indicate to the parents that they are sexually active.

There are so many health risks associated with not telling the parents that it is hard to fathom how this was even made law. First, there is the hormonal content of a birth control pill and the effect on younger girls, even those who have reached menses. This is no a simple matter of giving a child a Tylenol, which washes out of the system in relatively short order, but a pill that alters and regulates the hormones in a body, a body that is still growing and changing on practically a daily basis.

Second, the hormones in a birth control pill can interact with other drugs that may need to be prescribed. Unless the young girl informs the health care worker giving out the pill, there is a risk of interaction. If a girl gets another prescription from her regular doctor and the parents don't know of the birth control pills, there is a risk of an interaction. There is a reason why doctors ask questions about whether you are taking any medications before prescribing a new medication--it is to prevent dangerous interactions.

But aside from the medical/physical side of things, there is a conflict with other laws. For example, under most state laws, including Maryland, a doctor may not treat a child for say a broken leg without parental approval. Absent a life-threatening injury, doctors are supposed to wait for parental approval to do much of anything to any minor, even those as old as 17. Yet, girls as young as 11 can get birth control. How are we to reconcile those two policies? A girl with a broken arm can't authorize treatment of her arm because the law has deemed her incapable of making that choice, but she is capable of making a decision to get birth control?

Either she is old to enough to authorize all medical treatment or she is not old enough to authorize any medical treatment. Choose one policy because the conflict is too great.

The argument that a child is "entitled" to a right of privacy is ludicrous. A girl as young as 11 or 12 is not entitled to the same rights as an 18, 19 or 20 year old. There are so many other reductions in her rights that to say she enjoys a full right of privacy on this matter is ridiculous and flies in the face of logic. For example, in the schools in Frederick County, a high school girl or boy for that matter, cannot take a prescription drug for allergies without oversight by the school nurse. So the right to take a doctor prescribed antibiotic is circumscribed, but not the right to OBTAIN birth control. Is there anything else so ludicrous as that particular dichotomy?

One by-product of this debate is that there will be a fair number of state legislatures put on the defensive about this particular law, not that I expect that Democratically controlled Maryland General Assembly to change the law (that would make sense), but at least there will be some questioning.