As a pediatrician, I take care of girls: babies, elementary schoolers, and teenagers. I treat girls readying themselves for adulthood.
Girls break bones and get sick. They get cuts and bruises, fevers and cough. And if pediatricians like me do our jobs right, they grow. They also get pregnant.
If you took 1,000 teenage girls right now, about 55 of them would get pregnant this year. In fact, teen girls ages 15-to-19 have the highest rate of unintended pregnancy in the United States. Although that number has decreased in recent years, the need for comprehensive health services, including reproductive care, is just as real for teen girls as it is for women.
That’s something to consider as Republicans regroup after the party’s intended Obamacare replacement, the American Health Care Act (ACHA), failed to make it to a vote on the House floor. Whatever Republicans propose next, it’s likely that they’ll continue undermining the funding for women’s health care. And when they do that, they’re unraveling the safety net for teen girls too.
Sex. Abortion. Parenthood. Power.
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If it had passed, the ACHA would have added to a federal legislative legacy that disconnects abortion care from the other medical services women need, like family planning, preventive health screenings, and primary care.
Specifically, it proposed blocking federal funding from clinical sites that offer abortions (though the Hyde Amendment bars the use of federal funding for abortion except in cases of rape, incest, or life endangerment). Siphoning federal funds from abortion providers threatens clinic survival and patient access, forcing many facilities to stop offering abortion services and shrinking access nationwide. These changes were part of an ongoing effort to defund Planned Parenthood, but it isn’t the only organization on the legislative chopping block.
Eliminating federal funding for comprehensive reproductive coverage and clinical care uniquely affects girls and the providers who care for them.
First, teen girls, including those with disabilities, disproportionately rely on Medicaid for their medical care, as compared to women ages 18 and older. Continuing to prevent federally funded insurance from covering abortion places cost barriers alongside age-related barriers like required parental consent for minors to have abortions. While states could help close that gap for girls, as of January, more than half of all U.S. states employ various restrictions to abortion access such as excluding abortion services from qualifying state insurance plans. So, of the more than half of all women who pay out of pocket for abortions, some of those women are teen girls. With the majority of youth in part-time, minimum wage employment, those out-of-pocket costs can easily prohibit teen girls from affording the reproductive services they need.
Second, punishing abortion providers by eliminating federal funding to offer other health services actually hurts teens for whom this may be their only contact with health-care providers. As of 2016, about one in five teens did not receive their recommended annual checkup. And teens who have chronic illness may require frequent follow-up appointments or screenings. Not engaging those teens jeopardizes a valuable moment to provide developmentally appropriate primary care.
Low-income teens, trans adolescents, and teens of color—who face other barriers to accessing medical care—may forgo recommended preventive care. But teens count on their providers for preventive services, like sex education. For example, in a recent study of American Indian teen girls, who have higher rates of sexual activity, births, and sexually transmitted infections than the national average, the researchers noted reproductive health-care access was important to “make it easier to have safe sex” and learn about safer sex practices, not simply for direct services.
As many of us applaud the ACHA’s defeat, we must not overlook the important role federal policy plays in the lives and health-care options of girls and teenagers. Fragmenting health care for adolescent girls creates a dangerous and artificial line between a girl’s other medical needs and her reproductive needs. Already, that line extends across different facilities, different providers, and depending on the part of the country she lives in, maybe even across different states.
Isolating the female body from institutions that support clinical care stigmatizes the already complicated process by which girls reconcile their bodies and their sexuality. These harms are not easily undone. We may have recently dodged a bullet in the AHCA, but continued vigilance will be necessary to ensure future iterations of health reform don’t continue to threaten the care our girls need.