Pediatricians tell their peers: Step up to avoid ‘unstable’ reproductive health services for adolescents

Pediatricians wrote in a medical journal Monday that they and their peers must take action to ensure their adolescent and young adult patients have access to needed reproductive health services after federal protections against HIV were rolled back. abortion. File photo by orzalaga/Pixabay

August 15 (UPI) — U.S. Supreme Court ruling overturning Roe v. Wade — the landmark 1973 case affirming the federal constitutional right to abortion — could ‘instantly destabilize’ access to reproductive health care for adolescents and young people adults, pediatricians wrote in a comment published Monday in a medical journal. log.

The authors, led by Dr. Tracey A. Wilkinson, assistant professor of pediatrics at Indiana University School of Medicine in Indianapolis, offered advice to their peers on how to help adolescent patients and young adults in a post-Roe world in a “Viewpoint” article in JAMA Pediatrics.

Wilkinson is a colleague of Dr. Caitlin Bernard, an Indiana obstetrician who came under public attack after aborting a 10-year-old girl who reported rape in Ohio.

The authors said the context of states allowing varying degrees of access to abortion will create uncertainty and challenges for young people and their pediatricians.

An “arbitrary” upper age limit for pediatric care was removed by the American Academy of Pediatrics in 2017 because the transition to adult care is considered an individualized experience.

Previously, the group had inscribed an upper age limit of 16 to 18 in the 1930s, raising it to 21 in 1988 and reaffirming the age of 21 in 2012.

The problem becomes even more complicated because pregnancy rates are higher among young people from racial and ethnic minority groups, those living in or near poverty, and young lesbian, gay, bisexual, transgender and queer people, said the authors.

And these young people “are less likely to have the resources and social networks to support them as they overcome additional barriers to abortion access,” they said.

In their article, two pediatricians and a public health researcher said many of the new restrictions are happening in states where access to reproductive health care for adolescents and young adults is already restricted – and where pregnancy rates unwanted are above average.

Yet access to abortion is an essential component of reproductive health care for all, the authors said. And although people under the age of 20 account for 12% of abortions nationwide, teenage pregnancies are more likely to be unintended and end in abortion, so teenage girls will be affected by disproportionately by the judicial decision.

Young people already face significant barriers to abortion access, including “financial challenges, transportation, state surveillance and laws that require parental consent and notification,” the authorities said. pediatricians.

Add to that poverty, race and other social inequalities and the situation gets worse, they say.

“Furthermore, when young people have no choice in becoming parents, we know that all of these inequalities increase,” the authors said.

To deal with the situation, they advise paediatricians to regularly provide counseling on topics such as sex, sexuality and relationships, tailoring it to a young person’s stage of development and introducing it “early and often”. .

The authors also suggest that pediatricians counsel their adolescent and young adult patients about contraceptives — and provide them — via telehealth or in-person visits.

Young patients should be supported in choosing the medically safe contraceptive method they believe best meets their needs and given same-day instructions on how to start it, the authors said.

And if they choose a short-acting contraceptive, such as pills, patches, ring or injection, prescriptions should be written with refills for 1 year, they added.

Patients should be educated about non-prescription forms of contraception, such as condoms and emergency contraceptive pills, the authors said.

And pediatricians should offer screening for sexually transmitted infections, when indicated, for patients of all genders – and fill knowledge gaps left by school sex education.

Pediatricians should also provide unbiased counseling to pregnant patients about their options – parenthood, adoption, or abortion – and be aware of state abortion access laws and whether there are parental consent laws. or notification.

The authors urged pediatricians to help their young patients avoid crisis pregnancy centers, which they described as “deceptive and harmful clinics” that “often are unlicensed and intentionally influence vulnerable pregnant women to continue their pregnancy”.

They also stressed that confidential care is necessary, so pediatricians should consider the potential for breaches of their young patients’ privacy in electronic health record documentation, billing and insurance claims.

By incorporating these steps into routine practice, pediatricians can help young people “continue to receive the support they need to be in control of if, when and how to parent,” the authors concluded.

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