Docs see costs in limiting teens’ confidentiality

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Legislation recently passed in Texas limits adolescents’ ability to obtain confidential reproductive health care services. Although the goal is to curtail adolescent sexual activity, these laws are likely to backfire, according to the authors of a new study.

They say the law could have serious health and economic consequences, as teens will likely remain sexually active but stop going to clinics.

The state of Texas now requires parental consent for girls younger than age 18 to receive prescription contraceptives, explain Dr. Luisa Franzini and colleagues. The law also requires health care providers to report the identity of patients younger than 17 to law enforcement officials, since sexual contact with persons this young is considered a criminal offense.

Franzini, at the University of Texas School of Public Health in Houston, and her team estimated the price tag of these requirements, based on projected numbers of additional pregnancies, births, abortions, and untreated sexually transmitted infections.

They report their findings in the Archives of Pediatric and Adolescent Medicine.

They estimate that 37 percent of girls would stop using reproductive health care services if parental notification were required, based on past surveys of what girls said they would do if confidentiality were not maintained.

This would result in an additional 11.45 pregnancies, 7.44 births and 2.29 abortions per 100 teenagers, costing approximately $61,000 per 100 girls.

Also, the estimated increase in sexually transmitted diseases would cost $980 per 100 teens.

The projected overall cost is approximately $43.6 million per year, Franzini’s team reports. Even so, that figure underestimates “the true costs to society because they include only direct medical costs,” they add.

In an accompanying editorial, Dr. Claire D. Brindis and Abigail English at the University of California, San Francisco, point out that several other states and the federal government are currently considering similar legislation.

“Will public policy makers seriously consider the potential negative physical, psychological, and cost-related outcomes for adolescents and the health of the public their policies may cause?” they ask. “Perhaps they, and the adolescents and families they are accountable to, would be better served if they followed the edict of medicine, ‘First do no harm.’”

SOURCE: Archives of Pediatric and Adolescent Medicine, December 2004.

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