It Should not be Illegal for Minors to Cross State Lines for an Abortion Without the Parents' Consent

TESTIMONY OF WARREN SEIGEL, M.D., DIRECTOR OF ADOLESCENT MEDICINE, CHAIRMAN OF PEDIATRICS, CONEY ISLAND HOSPITAL, HEARING ON THE CHILD INTERSTATE ABORTION NOTIFICATION ACT BEFORE THE SUBCOMMITTEE ON THE CONSTITUTION, HOUSE JUDICIARY COMMITTEE, MARCH 3, 2005

… I am submitting testimony today as a resident of New York State, an experienced health care provider, a leader in the American Academy of Pediatrics and the Society for Adolescent Medicine, and a member of Physicians for Reproductive Choice and Health, known as PRCH….

I submit this testimony to you today on behalf of the PRCH Board of Directors and our more than 6,500 physician and non-physician members to express our opposition to H.R. 748, known as the "Child Interstate Abortion Notification Act," or CIANA. This bill puts young women's lives at risk, makes criminals out of caring physicians, and affects the care of all patients.

I recognize that parents ideally should be—and usually are—involved in health decisions regarding their children. However, the Child Interstate Abortion Notification Act does nothing to promote such communication. Instead, CIANA places incredible burdens on both young women and physicians; infringes on the rights of adolescents to health care that does not violate their safety and health; makes caring family, friends and doctors criminals; and could be detrimental to the health and emotional well-being of all patients.

As a pediatrician, I believe CIANA will create insurmountable obstacles for adolescents. Young women seeking abortions in a state other than their home state will be forced to comply with the parental notification laws in both states. They will also have to navigate through the complex and emotionally draining judicial bypass procedure in both states. This will cause delays that may be harmful to the young woman's health by forcing her to undergo a later-term procedure. The American Medical Association states that a delay in receiving care will "increase the gestational age at which the induced pregnancy termination occurs, thereby also increasing the risk associated with the procedure." Requiring adolescents to comply with laws in more than one state will certainly increase the delay in receiving care.

CIANA also requires parental notification for young women receiving abortions in states where they are not permanent residents. Young women who are not trying to circumvent parental notification laws but are, in fact, living temporarily in a state for college, boarding school or other reasons will need to seek the care that is closest to them. CIANA would prohibit these women from the most available health care.

Women from states with no parental notification legislation face an additional burden. Even if a young woman is not subject to any parental notification laws in either the state where she is from or the state where she is accessing care, CIANA will require parental notification. Judicial bypass procedures only exist in states with parental notification laws in place. Thus, in states with no parental notification legislation, young women will not have access to the judicial bypass option.

When judicial bypass is available, the delays it may cause are compounded by a mandatory delay period of at least 24 hours, which is required by CIANA…. Additionally, young women as a population are already more likely to be seeking abortion later in their pregnancy. The Centers for Disease Control have shown that adolescents obtain 30% of all abortions performed after the first trimester, and younger women are more likely to obtain abortions at 21 weeks or more gestation. Mandatory delays will only serve to increase these trends. CIANA also requires a mandatory delay even if a parent is present and consenting. If this legislation is about parental notification, then what is the purpose of this delay if not to keep young women from accessing the care that they need in a timely manner?

I am also concerned that CIANA places extreme and unreasonable burdens on physicians and the other patients they treat. Physicians will be required to have detailed knowledge of the parental notification laws in the 49 states where they do not practice….

Physicians will be required in some cases to travel to the home state of the young woman to give notification in person to the parents…. What becomes of all the other patients seeing their physician for other health care issues during this time? This requirement will not only increase the delay for the procedure but is simply impossible for a physician to carry out, thereby denying a young woman her right to an abortion….

This legislation contains an inadequate exception to protect a young woman's life and no exception to protect her health….

Although this legislation is supposedly aimed at increasing parent-child communication, the government cannot mandate healthy families and, indeed, it is dangerous to attempt to do so…. The American Academy of Pediatrics, a national medical organization representing the 60,000 physician leaders in pediatric medicine—of which I am a member and leader—has adopted the following statement regarding mandatory parental notification: "Adolescents should be strongly encouraged to involve their parents and other trusted adults in decisions regarding pregnancy termination, and the majority of them voluntarily do so. Legislation mandating parental involvement does not achieve the intended benefit of promoting family communication, but it does increase the risk of harm to the adolescent by delaying access to appropriate medical care."

It is important to consider why a minority of young women cannot inform their parents. The threat of physical or emotional abuse upon disclosure of the pregnancy to their parents or a pregnancy that is the result of incest make it impossible for these adolescents to inform their parents. Under CIANA, young women would be forced to put themselves in dangerous situations in order to receive medical care.

Young women have many reasons for needing to travel out of state to have an abortion. Eighty-seven percent of U.S. counties have no abortion provider. In some states, there is only one provider available. In cases like these, the nearest abortion provider may be in another state. Financially, an abortion may be more affordable at a facility in another state. As I mentioned before, an adolescent may be temporarily residing in another state and need local care. CIANA penalizes young women for seeking the closest and most affordable health care….

Physicians for Reproductive Choice and Health is in absolute agreement with leading medical organizations on this issue. The American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Public Health Association all oppose mandatory parental-involvement laws because they endanger the health of adolescents and pose undue burdens on physicians. Additionally, the American Academy of Pediatrics and the Society for Adolescent Medicine have opposed similar legislation, entitled the Child Custody Protection Act, currently under consideration in the Senate as S. 8, because of the harm it may cause adolescents.

It is for all of these reasons that we must protect the rights of young women to access safe, affordable and appropriate health care. We must make it easier for physicians to provide needed services, not more difficult. As a physician, I believe that this legislation represents bad medicine and places politics before the health of our youth. Practicing physicians and scientific evidence overwhelmingly agree that this legislation would negatively impact the health of adolescents. It is for this reason that I appear in opposition to H.R. 748.

STATEMENT OF CONGRESSWOMAN LOUISE M. SLAUGHTER (D), 28TH DISTRICT OF NEW YORK, OPPOSING THE 2005 VERSION OF THE CHILD INTERSTATE ABORTION NOTIFICATION ACT (H.R. 748), APRIL 27, 2005

… This bill is another invasion into the private lives of American families making the decisions for themselves, and it is an invasion into the legal rights afforded all women in this country. I am talking about the legal right for women to choose, which is protected by the Constitution of the United States.

We have a duty in this body to consider legislation which will maximize our freedom and equality, values which are the very fabric of our society. Our job here is to protect the legal rights of those we serve and not to take them away, and I urge a "no" vote on this bill….

STATEMENT OF CONGRESSWOMAN SHEILA JACKSON LEE (D), 18TH DISTRICT OF TEXAS, OPPOSING THE 2005 VERSION OF THE CHILD INTERSTATE ABORTION NOTIFICATION ACT (H.R. 748), APRIL 27, 2005

… The Child Interstate Abortion Notification Act (CIANA), while good in its intention, was written with several areas of vagueness, overly punitive nature, and constitutional violations that very much deserve debate in order to save lives and to obviate the need for piles upon piles of legal pleadings.

The mandatory parental-involvement laws already create a draconian framework under which a young woman loses many of her civil rights. My state, Texas, is one of 23 states (AL, AZ, AR, GA, IN, KS, KY, LA, MA, MI, MN, MS, MO, NE, ND, PA, RI, SD, TN, UT, TX, VA, WY) that follows old provisions of the "Child Custody Protection Act" which make it a federal crime for an adult to accompany a minor across state lines for abortion services if a woman comes from a state with a strict parental-involvement mandate. There are 10 states (CO, DE, IA, ME, MD, NC, OH, SC, WI, WV) that are "non-compliant," or require some parental notice but other adults may be notified, may give consent, or the requirement may be waived by a health care provider in lieu of the parental consent. Finally, there are 17 states (AK, CA, CT, DC, FL, ID, IL, MT, NV, NH, NJ, NM, NY, OK, OR, VT, WA) that have no law restricting a woman's access to abortion in this case. The base bill, if passed, would take away the States' rights to make their own determination as to legislating the abortion issue for minors with respect to parental notification.

My amendment to the Child Interstate Abortion Notification Act, would change the prohibitions to exempt grandparents of the minor or clergy persons. This must be done because some minors want the counsel of a responsible adult, and are unable to turn to their parents….

H.R. 748, as drafted, will not improve family communication or help young women facing crisis pregnancies. We all hope that loving parents will be involved when their daughter faces a crisis pregnancy. Every parent hopes that a child confronting a crisis will seek the advice and counsel of those who care for her most and know her best. In fact, even in the absence of laws mandating parental involvement, many young women do turn to their parents when they are considering an abortion. One study found that 61 percent of parents in states without mandatory parental consent or notice laws knew of their daughter's pregnancy.

Unfortunately, some young women cannot involve their parents because they come from homes where physical violence or emotional abuse is prevalent or because their pregnancies are the result of incest. In these situations, the government cannot force healthy family communication where it does not already exist—and attempts to do so can have tragic consequences for some girls.

Major medical associations—including the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Public Health Association—all have longstanding policies opposing mandatory parental-involvement laws because of the dangers they pose to young women and the need for confidential access to physicians. These physicians see young ladies on a daily basis and hear their stories. They would not protest this law unless they felt there were severe stakes.

CIANA criminalizes caring adults—including grandparents of the minor, who attempt to assist young women facing crisis pregnancies. In one study, 93 percent of minors who did not involve a parent in their decision to obtain an abortion were still accompanied by someone to the doctor's office. If CIANA becomes law, a person could be prosecuted for accompanying a minor to a neighboring state, even if that person does not intend, or even know, that the parental-involvement law of the state of residence has not been followed. Although legal abortion is very safe, it is typically advisable to accompany any patient undergoing even minor surgery. Without the Jackson Lee-Nadler Amendment, a grandmother could be subject to criminal charges for accompanying her granddaughter to an out-of-state facility—even if the facility was the closest to the young woman's home and they were not attempting to evade a parental involvement law….

STATEMENT OF CONGRESSWOMAN MAXINE WATERS (D), 35TH DISTRICT OF CALIFORNIA, OPPOSING THE 2005 VERSION OF THE CHILD INTERSTATE ABORTION NOTIFICATION ACT (H.R. 748), APRIL 27, 2005

Mr. Speaker, I rise in strong opposition to the bill and to the proposed rule for this bill.

The two amendments made in order under the proposed rule, the Scott amendment and the Jackson-Lee/Nadler amendment are very important amendments. At the same time, it is instructive to note that many of the nine Democratic amendments that were not made in order seek to protect the people most directly affected by the bill: the young girls who wish to exercise their constitutional right to end their pregnancy.

For example, I offered an amendment before the Committee on Rules to create an exception to the criminal penalties and a civil suit imposed on a person transporting a young girl across State lines in cases where the minor is a victim of incest. Because the bill lacks a judicial bypass procedure in circumstances where the Federal notification requirements apply, under this bill a young girl could be required to notify a parent who impregnated her before obtaining an abortion even though it would be inappropriate, traumatic, and potentially dangerous to require her to do so.

Mr. Speaker, if a young girl is required to notify a parent who has molested her that she is pregnant before traveling to another State to seek an abortion, I fear that some girls may seek to end their pregnancy without help, whether they do so by traveling alone to another State for the procedure, or even worse, through a self-induced or illegal back-alley abortion. However, the Republican members on the Committee on Rules refused to make this amendment in order on a party-line vote.

Mr. Speaker, the gentleman from New York (Mr. Nadler) and I also offered a commonsense amendment barring a parent who has molested his daughter and caused her to be pregnant from any relief under this bill.

However, this too was rejected on a party-line vote.

Mr. Speaker, this bill should be considered under an open rule that would allow consideration of amendments to protect the young girls who choose to seek an abortion. In its current form, the bill gives rights to a parent who has victimized his daughter.

I urge my colleagues to reject the rule.