In This Issue:

Research Update:
The Impact of Laws Requiring Parental Involvement for Abortion

Clinic Dedicated to the Memory of Charlotte Ellertson

Ibis Course at the Harvard School of Public Health

Board Updates

Dear Friend,

We were very excited about the March release of the first in a series of reports with the Guttmacher Institute on the impact of restrictions on abortion in the United States. The first report, "The Impact of Laws Requiring Parental Involvement for Abortion: A Literature Review," described in detail below, highlights some important barriers to access for young women in an increasing number of US states. One of the main messages of the piece is that parental involvement abortion restrictions do not result in lower abortion rates. Research shows that what does make a difference in lowering minors' abortion rates is helping teens prevent unintended pregnancies through medically accurate comprehensive sex education and better access to effective contraceptives. Even making abortion illegal does not reduce the abortion rate, it only makes it more difficult to obtain and more dangerous. Based on global data, the lowest abortion rates are in Western Europe, where contraceptive services and use are widespread, and safe abortion is legal and easily accessible. By contrast, Africa, Asia, and Latin America have the highest abortion rates, even though abortion is generally restricted and often unsafe. Restricting access to abortion puts women's lives at risk, and we at Ibis look forward to continuing to conduct research to highlight how restrictions impact women in the US and around the world. This research will arm advocates aiming to remove such restrictions and give women the ability to make and carry out their decisions about their reproductive lives and health.


Kelly Blanchard, President

Research Update: The Impact of Laws Requiring Parental Involvement for Abortion

As of 2008, 34 states in the US have laws in effect that mandate parental involvement in minors’ abortions. Parental involvement laws have varied requirements in different states. Although many require the consent or notification of only one parent, usually at least 24 or 48 hours before the procedure, a handful of states mandate the involvement of both parents, and six states allow certain other adult relatives to be notified about or give permission for a young woman’s abortion.

On March 11, 2009, Ibis and the Guttmacher Institute released a new report, "The Impact of Laws Requiring Parental Involvement for Abortion: A Literature Review." Ibis Project Manager Amanda Dennis was the lead author on the comprehensive review that analyzed the existing published research on US laws restricting access to abortion for young women under the age of 18.

According to this review, these laws appear to do little to reduce teen abortion or pregnancy rates. Studies that find parental involvement laws cause a decrease in teenagers’ abortion rates have often inaccurately measured state abortion rates or have major flaws in their research methodologies. Most of these studies did not measure abortions among young women who leave the state, or stop coming into the state, because of the law. This is an important trend to measure because minors in states with restrictive laws often travel outside of their home states to a place with a less restrictive law to obtain an abortion. Studies have documented such travel in Massachusetts, Mississippi, and Missouri. For example, in Massachusetts, 29% of teenagers who had abortions did so in neighboring states, most in response to a parental consent requirement. The impact of these laws on minors' travel appears to vary in different states, depending on transportation accessibility, the specifics of the requirements, the abortion regulations of surrounding states, and the state’s geography. Additionally, most young women do include their parents in their decisions about abortion. Previous research at Guttmacher has found that 60% of minors seeking abortions talk to their parents about their pregnancy. This is truest among younger minors (under the age of 16) and black minors.

Moreover, the review’s authors concluded that, in at least one state, parental involvement laws led to an increase in teen birthrates, because teens were unable to travel the long distances necessary to access less restricted abortion services out of state. This example indicates that if more states enact these restrictions, teens may be faced with greater challenges in accessing safe and timely abortion services. “Most teens—regardless of whether or not they live in a state with a parental involvement law—do involve their parents when deciding whether to have an abortion. But the reality is you can’t legislate good parent-child communication,” says Dennis. “If we want to protect young women’s health and safety, access to confidential reproductive health services—both contraception and abortion—is critical."

Parental involvement laws can make abortions more difficult to access for young women. Travel out of state or judicial bypass procedures can lead to delays in obtaining abortions and can increase the risks associated with a procedure that is generally very safe. However, data limitations make it hard to know how many minors experience delays. Young women with fewer resources are particularly vulnerable to these risks. To travel out of state, she must have access to transportation and must be within a reasonable distance of a state with less restrictive laws. The degree to which a teenager can do so may vary by her age, socioeconomic status, and access to public transportation. Considering that the vast majority of states currently have parental involvement laws, this makes traveling to a state without a law very challenging. The availability of judicial bypasses varies by state. In some states, streamlined systems are easily accessible to most young women, although even in these states, some rural teens have to travel a long distance to find a judge willing to hear their case. In other states, judges rarely grant bypasses.

Many gaps in knowledge about parental involvement laws remain. The biggest difficulty in evaluating parental involvement laws is the lack of population-based data on abortions. The available data come from two main sources: the Guttmacher Institute and the Centers for Disease Control and Prevention (CDC), which aggregates state health department reports. Each source has advantages and disadvantages, but no source has a comprehensive set of data (for example, not all states report abortions to the CDC) that would be needed for a rigorous analysis. The lack of data on abortions by state of residence is another major limitation. Studies of parental involvement laws based on data by state of occurrence will overestimate the decline in abortions associated with the law, not only because resident teenagers may leave the state to have an abortion in another state, but also because nonresidents stop entering the state for an abortion. Further, no studies have evaluated minors’ experiences with parental involvement laws or their opinions of them; the increased costs in obtaining abortion due to delays, travel, or bypass proceedings; or the impact on teenage girls of being forced to consult their parents. These are also important areas for future study.

Ibis and Guttmacher are currently working on the two additional reviews for this series. “The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review” and “The Impact of Medicaid Restrictions on Abortion: A Literature Review” will be released over the coming months.

Clinic Dedicated to the Memory of Charlotte Ellertson

On March 27, Mexico City’s Ministry of Health dedicated a public health clinic to the memory of Charlotte Ellertson, Ibis’s founder who passed away from breast cancer in 2004. Charlotte was an energetic and innovative researcher in the field of reproductive health, and prior to founding Ibis, she spent four years as the Population Council’s Director of Reproductive Health for Latin America and the Caribbean in Mexico City. In addition to using her amazing research skills to generate evidence to support changes in policy and health care provision in Mexico, Charlotte loved the country on a personal level. Both her daughters were born in Mexico City and both have Mexican middle names, which will forever serve as treasured reminders of their mother and her time there. The Population Council and the Mexico City Ministry of Health organized a dedication ceremony to honor Charlotte’s vision, leadership, and tireless dedication to improving the lives of women, which helped promote the sexual and reproductive rights of women in Mexico City. We at Ibis continue Charlotte’s work and add our own passion to hers, and we were touched and excited by the news of this dedication.

Ibis Course at the Harvard School of Public Health

For four years, the Ibis staff has been collaboratively teaching a seminar course at the Harvard School of Public Health called “International reproductive health issues: Moving from theory to practice.” The seminar offers students the opportunity to learn about designing and carrying out research on reproductive health in international settings. Students benefit from the broad range of experience of Ibis staff, who share weekly case studies from their work to illustrate the various methods and perspectives of medical and social science research. Session topics this semester included contraception, emergency contraception, abortion, HIV/AIDS, and the sexual and reproductive health needs of women in refugee settings. Presenters, including some fabulous guest speakers from the reproductive health community in Boston, shared experiences from Latin America, Sub-Saharan Africa, and the Middle East. The course wrapped up with presentations from the very bright and thoughtful students on their final projects. For her project, one student conducted background research for a study she plans to implement this year to assess the impact of providing free condoms on the HIV infection rate in Ghana. This student is working with a population of clients at anti-retroviral clinics in an effort to examine the efficacy of novel interventions combining treatment and prevention. We anticipate and hope that many of our students will become new contributors to the field of reproductive health research.

Board Updates

We are thrilled to introduce our two newest Board members, Carmen Barosso and Angela Hooton. Carmen and Angela have a wealth of experience in the field of reproductive health and we are honored to have them work with us at Ibis.