Introduction

Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent.

Methods

Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis.

Results

Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements.

Conclusions

Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast.

Policy Implications

Removing parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

中文翻译：

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东南部未成年人堕胎的父母参与政策和护理质量

介绍

三十七个州要求未成年人通过通知或征得父母同意流产。很少有研究检查这些法律的实施如何影响涉及父母的人的服务提供和护理质量。

方法

在2018年5月至2019年9月之间，对东南部三个州的堕胎设施的34名工作人员进行了深入的采访，他们参与了日程安排，咨询和管理工作。访谈探讨了记录父母参与，未成年人和父母对要求的反应以及实施和遵守方面的挑战的程序。主题分析使用了医学研究所医疗保健质量框架提供的归纳代码和演绎代码。

结果

父母参与法律对四个质量护理领域产生了不利影响：效率，以患者为中心，及时性和公平性。行政效率低下源于证明成年人与未成年人的关系所需的大量文件，从而增加了遵守州报告要求的时间和精力。如果父母不支持未成年人的决定，参加者认为他们有责任进行干预，以确保未成年人的决定和需求始终处于中心地位。工作人员进一步指出，由于未成年人在父母的参与和其他州规定的约束下，及时护理的累积不断增加，使一些人超过了胎龄限制。低收入家庭和家庭安排复杂的家庭在满足州要求方面遇到更大的困难。

结论

父母参与的要求削弱了在东南部寻求堕胎服务的未成年人的保健服务的提供和质量。

政策含义

取消父母的参与要求将保护未成年人的生殖自主权，并支持提供以患者为中心的公平医疗保健。