Autonomy and Reproductive Choices for Teenagers

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Autonomy and Reproductive Choices for Teenagers

Alex Heilbronner


Sex education for children is a provocative and controversial issue. The one thing everyone seems able to agree on is that it should exist, though when to start it and how to go about doing it vary across a huge spectrum. There is currently a bill in Congress proposing a $500 million plan to reduce public sex education from a comprehensive look—enforcing contraception and safety while also discussing general issues of sexuality—to one that strictly discusses the "social, psychological, and health gains" of abstinence for unmarried people (Sternberg, 1). Advocates of such a conservative form of sex education argue that education about safer sex is not going to prevent disease and unplanned pregnancies. These people claim that only through abstinence education will teenagers learn how to protect themselves from STDs and unplanned pregnancy. Yet perhaps they have not heard that 26% of women who claim to practice abstinence get pregnant each year (Singer, 2). This inconsistency between education, public policy, and actual behavior, along with the increasingly strict regulations on abortion and birth control accessibility, is sending young women mixed messages, and then denying them the opportunity to fix their mistakes.

At the root of this issue is the concept of choice. Women must be given full authority over their bodies; a woman's individual autonomy must be the governing factor in her choice to have sex, use protection, or have an abortion. In 1972, a step toward furthering women's autonomy was made with the Supreme Court case Roe v. Wade. Yet since this ruling, further legislature has once again limited a woman's choices when it comes to her body. Now many states require a 24 hour waiting period between the consultation and the abortion. Other states are lobbying to require consent from the father of the fetus before allowing the woman to abort. Why do many people believe that women are not responsible enough to make reproductive choices on their own? And girls under the age of eighteen have even less autonomy— most states require minors to have written consent from their parents before they can receive abortions—when does a female become a "woman" and get to become the boss of her body?

Abstinence-only sex education removes further choices from teenage sex. This conservative education suggests that by not talking with teenagers about sex, teenagers will choose not to have sex. The fact of current American life is that about 2/3 of boys and ½ of girls in the US are sexually active by age 18 (Rescorla). Clearly sex education in public schools is inadequate—currently, public schools in most states can only receive public funding for sex education programs if they only teach abstinence, and the National Coalition Against Censorship estimates that approximately $100 million are spent yearly to that effect. Bush's $500 million plan would only continue in that tradition. The NCAC estimates that fewer than half of the public sex education programs in the US give students information about how and where they can access birth control. Abstinence only sex-ed is not sex education at all, for it does not educate children about sex; rather, it preaches to them about remaining abstinent until marriage, a sermon half of the teenage girls in this country disregard. Rather than educate young girls about various types of birth control and how or where they can access these resources, public sex education courses are ignoring the issue of teenage sex, hoping it will go away. Further, only a third of public sex education programs discuss abortion and sexual orientation (NCAC).

This sends a message to teenage girls—and not the message that they should abstain from sex. Rather, this non-discussion of safe sex and sexuality further stigmatizes sex for girls, which can cause them to be shamed by their desire to know more about aspects of sex. There is a huge difference between the way teenage boys and teenage girls regard sex. This difference is what causes promiscuous boys to be revered by their peers, and promiscuous girls to be called sluts. Boys are encouraged to assert their manliness through sexual experimentation, which is shown by the statistic that more boys than girls are sexually active by the age of eighteen. It is considered acceptable for boys to have sex, and talk quite openly about sex, in a way that is not paralleled for girls. Because of this, girls are not comfortable in an open sexual discussion. Though both parties, male and female, are greatly interested in all facets of sexuality, girls are less likely to ask their parents questions or seek advice from other knowledgeable sources under the pretext that such questions are inappropriate. As Lauren Doucette, RN, says, "some women feel incredibly embarrassed or shy when it comes to seeking help or clarification." She adds that "these tend to be the girls that may not know enough, or anything at all, about birth control." (Gooding). These same girls then engage in sexual activity without being properly educated about ways to protect themselves, and can end up pregnant or infected with an STD.

Margaret Sanger, a pioneer in birth control education, began speaking out for the need to educate women about birth control options in 1918, long before oral contraceptives had been developed. She saw birth control as a way to maintain lifestyles. That is, giving a sexually active couple the choice to have a baby or not helped them to continue on the path they had set for themselves. In the early 1900's, women who had babies out of wedlock were shut away or cast out (which is still the result for some unwed mothers in certain situations these days), and Sanger knew many of these women. She spoke of a pair of sisters, one of whom became pregnant and had the baby. She was then thrown out of her house and forced to work as a servant for families who mistreated her and her child to the point that the infant died. The other sister also became pregnant, but was sent away to have an abortion, which affected her psychologically but allowed her to continue on in her society. Sanger said, "our laws force women into celibacy on the one hand, or abortion on the other," and she felt that neither option was the best option.

In high school, the following experience was shared with me: a sixteen year old boy went to his local grocery store to buy condoms. As he approached the counter, condoms in hand, the clerk asked, "do you have ID?"
"Excuse me?" said the boy, confused.
"Do you have ID—are you eighteen?"
"You're not going to allow me to have safe sex because I'm underage?" the boy retorted. The clerk then sold him the condoms. And it's a good thing that she did too, because it is actually illegal in Virginia (where I attended high school), and in many other states, to refuse to sell condoms to minors (Planned Parenthood). This woman was most likely told by her conservative employer to demand identification of people who looked too young to be married, in order to help that grocery store do their part to keep sex within marriage. In rural Virginia, it wouldn't surprise anyone. However, the clerk knew she could not flat out refuse the boy, so she conceded upon his pushing. Had he not questioned her, he most likely would have left the store without condoms, and who knows if he would have the confidence to go somewhere else and try to buy them after being denied once already. Though there is a law protecting teenage access to condoms in most states, there is not a universal law protecting a teen's access to other forms of birth control, particularly those used by women.

Currently, 21 states allow all minors to get birth control (oral contraceptives, the patch, the Nuva-Ring, among others) without informing their parents. Another 11 states allow "most" minors to do so (Planned Parenthood). I suspect that these eleven states have an age limitation, such as the minor must be at least sixteen. This ensures that teens who seek out protection can receive it without their parents knowing they are sexually active (surely it is not the fear of most young women that their parents know they are using contraceptives, but that they are sexually active in the first place). But teens who choose to use prescription birth control without the knowledge of their parents are faced with the challenge of paying for it without the assistance of their parents. This poses a problem for young girls without access to money, those who don't have jobs or who could not use their parents' money without their parents' knowing.
Yet even if there is an open relationship between parents and their daughters, paying for birth control can be a challenge. The current Anthem insurance policy my family has does not cover oral contraceptives like Ortho-TriCyclen unless they are being used as an acne treatment, which seems to make a statement about how Anthem feels about teenage sex. Interestingly enough, most mature women (meaning women over the age of eighteen) would not need a prescription medication, be it Acutane (a medication designed specifically to treat acne) or Ortho-TriCyclen, to control their acne (one can assume that these women gained control over their complexions during their teenage years). They might, however, seek an oral contraceptive to reduce their risk of unplanned pregnancy. They would then be disturbed to find that their insurance plan does not cover birth control unless you are presumably a teenager seeking an acne treatment. Even more disturbing is that this same insurance plan covers Viagra. So, though women are essentially denied their right to affordably limit the number of babies they have, men are essentially granted the right to affordably maintain an erection. This insurance policy proves to be not so much anti-sex, as anti-choice for women seeking birth control. Even beyond public policy, private programs are not seeking to facilitate the acquisition of birth control by young women.

What would Margaret Sanger say about this? She argues in her paper "Morality and Birth Control," published in 1918, that birth control education and access has been "tenaciously withheld from...working women," who have not been able to share in the "greater happiness, greater freedom, greater prosperity and...harmony" that upper class women using birth control methods had found. Clearly, birth control has not been equally accessible to everyone since the invention of the pessary, the first form of birth control for women.

So with birth control hard to learn about and even harder to gain access to, what's a girl to do? Planned Parenthood estimates that 34% of teenagers in the US become pregnant by the age of twenty. Currently, 34 states require a minor to have the involvement and permission of at least one parent before that minor can receive an abortion. This can dissuade girls from seeking an abortion, or a legal one, due to the fear of what their parents will do when they find out. Legislature like this does nothing to protect teenage girls who may be better off receiving an abortion without their parents' knowledge. In the most extreme case, should a child who was raped by her father then be forced to ask him whether or not she can abort the fetus? A study by Planned Parenthood suggests that, while most teens do in fact involve their parents in the decision, those that don't come from families with histories of violence. These teens fear their parents' violent reactions were they to learn of an unplanned pregnancy. Other teens worry they'll be kicked out of the house. Teenagers choosing not to involve their parents in the process are not, however, forced to make the decision all on their own. Most of them spoke about it with their boyfriends, a trusted adult, or a "professional," assumably a counselor or social worker.

In Missouri, no matter the patient's age, a twenty four hour waiting period is required between a doctor's consultation with the patient and the procedure. This time is supposedly used to ensure that the patient is making an informed consent before going through with the abortion. If the doctor does not follow guidelines set down by the government, he can be fined or even serve jail time. The problem with this is that the guidelines for ensuring informed consent of the patient are so vague that many doctors do not understand them and could break the law without even realizing it. How anxious do you think this law makes doctors who are already performing such a controversial procedure? Missouri approved this piece of legislature using precedence from Planned Parenthood of Southeastern Pennsylvania v. Casey, which approved the 24 hour waiting period for women in Pennsylvania back in 1992. Especially considering the obscure requirements of the doctor during this twenty four hour waiting period, the general level of anxiety for both the doctor and the patient is greatly increased. Oftentimes, this waiting period is used to try to talk the woman out of the procedure. Though it may be just a rumor, accounts of women being shown photographs of aborted fetuses or very developed fetuses still in the womb (to try and show the woman that she is not simply aborting a bundle of cells, even though late term abortions are not legal and what the woman is about to abort is in actuality nothing more than a bundle of cells) are disturbing. A pregnant woman preparing to have an abortion needs support, not a guilt trip. This guilt imposed on the woman could essentially trick her out of going through with the decision she had made, which is in actuality a form of autonomy-limiting. If a woman has two choices, and she is made to believe that one of them is so horrid that she could not possibly go through with it, then really she has no choice at all. Some would argue legislature like this is not a threat to women's autonomy, because it merely delays the abortion by one day. However, the fact that the government can now dictate when a woman can have an abortion is a small step towards many anti-choice lobbyists' goal of illegalizing abortion.

Even more worrisome than the idea of a 24 hour waiting period is the idea that perhaps men should have a say in whether or not their sexual partners can receive abortions. Many websites such as www.menforchoice.com talk of men being unsatisfied with their partner's decision about abortion. Most cases suggest that these men wish they could convince their partners to have an abortion so that the man will not get stuck paying eighteen years of child support on a child they never wanted to begin with. However, a few men wish they could prevent their partners from having an abortion. Such a battle happened in Pennsylvania in 2002, when a father-to-be got an injunction against his girlfriend's abortion. The injunction was lifted days later under the precedence of Planned Parenthood v. Danforth, a 1976 case that led to the invalidation of a Missouri law that required a woman to have written spousal consent before she could have an abortion (Lithwick, 1). Planned Parenthood v. Danforth posed many problems, the first one being that the state assumed that all women seeking abortions were married, though most likely the opposite was true. Also, Planned Parenthood v. Danforth assumed that a woman's husband is in fact always the father of the fetus she is carrying, which in fact could also be false. Finally, this case attempted to equate the amount of say a woman has when making decisions about her body with the amount of say a man should have in that same decision. This is most likely the reason this ruling was overturned. No one is comfortable flat out saying that women cannot make reproductive choices without the help of men (why is it then that a large portion of America has no problem flat out saying that women should simply not have the choice?). Men and other advocates of "choice for men" seem to have forgotten that there is more to being pregnant than just becoming a mother. The nine month gestation period is something that, quite simply, some women do not want to go through just because their partners say so. You cannot "legally force women to bear children against their will (Lithwick, 2)," just as you cannot legally force them to have an abortion because you don't feel like paying child support.

So, there are many difficulties when it comes to sex in the US. It is difficult to find birth control and learn how to use it. It is difficult to receive an abortion, and may become even more so. The one thing that seems not so difficult is getting pregnant when you weren't planning on it. And why all this trouble? Inadequate sex education practices for young people. As Jocelyn Elders, former US Surgeon General, says, "Vows of abstinence break more easily than latex condoms." So why is the Bush administration trying to push through this $500 million plan that will essentially deny teenagers access to information needed to make responsible decisions about sex? Perhaps it is their Puritan concern with the overall level of national morality. But on that note, Margaret Sanger argues, "knowledge of birth control is essentially moral."

Sources Used

Elders, Jocelyn. Interview by Priscilla Pardini in 2002 for Rethinking Schools.

Gooding, Amber. Birth Control: Knowing What You Need to Know—When You Need to Know It. 2005. [internet] accessed 10 November 2005: .

Lithwick, Dahlia. "Dad's Sad, Mad: Too Bad." Slate 7 August 2002: 1-3. Accessed 19 November 2005 .

National Coalition Against Censorship. Abstinence-Only Education: Why First Ammendment Supporters Should Oppose It. 2005. [internet] accessed 12 December 2005: < http://www.ncac.org/issues/abstinenceonly.html>.

New York University. The Margaret Sanger Papers Project. 2005. [internet] accessed 19 November 2005: .

Planned Parenthood. Planned Parenthood Federation of America. 2005 [internet] accessed 19 November 2005: .

Rescorla, Leslie. Introduction to Psychology. Lecture heard November 2005, Bryn Mawr College.

Singer, Alan. "Preaching Ain't Teaching: Sex Education and America's New Puritans."
Rethinking Schools Online 2003: 1-3. Accessed 10 November 2005: .

Sternberg, Steve. "Sex Education Stirs Controversy." USA Today July 10 2002: 1-3. Accessed 10 November 2005 .


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