Pregnant Minors Research Articles

Civil Monetary Penalties for EMTALA Violations Involving Minors, 2002-2023.

The Emergency Medical Treatment and Labor Act (EMTALA) is intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (EDs). EMTALA requirements pertain to patients of all ages presenting to dedicated EDs regardless of whether facilities have dedicated pediatric specialty services. This study aims to describe EMTALA-related civil monetary penalty (CMP) settlements involving minors. Descriptions of all EMTALA-related CMPs occurring between 2002 and 2023 were obtained from the Office of the Inspector General web site and reviewed for involvement of minors (<18 years of age) using keywords in settlement summaries. Characteristics of settlements involving minors were described and compared with settlements not involving minors. Of 260 EMTALA-related CMPs, 38 (14.6%) involved minors. Most involved failure to provide a medical screening exam (MSE) (86.8%) and/or stabilizing treatment (52.6%). Seven (18.4%) involved pregnant minors. Eleven (28.9%) involved ED staff directing a patient (or guardian) to another facility, typically by private vehicle, and another involved 2 patients referred to on-campus outpatient clinics without an MSE. One in 7 CMPs related to EMTALA violations involved minors, and 1 in 5 of these minors was pregnant. One-third of CMPs involving minors included ED staff directing patients to proceed to another facility or on-campus clinic without MSE or stabilization. Findings suggest a need for providers to understand EMTALA-specific requirements for appropriate MSE, stabilization, and transfer, and for EDs at hospitals with limited pediatric services to implement policies for the evaluation of minors and protocols for transfer when indicated.

Reconsidering pregnancy screening policies for minors: patient-specific estimate of fetus and effective dose for potentially pregnant minors undergoing optimized dose CT of the pelvis.

Only verbal pregnancy screening is recommended for post-menarcheal females undergoing pelvic radiographs. In contrast, usually, a urine/serum pregnancy test for pelvic computed tomographic (CT) exams is required out of concern for higher radiation exposure. To estimate patient-specific fetus absorbed dose to a potentially pregnant minor from an optimized dose CT of the pelvis for femoral version and surgical planning and provide evidence that such examinations of the pelvis can be performed with only verbal pregnancy screening. A retrospective study was performed on 102 female patients between 12-18years of age (15.4 ± 2.1years) who underwent optimized dose CT of the pelvis for orthopedic evaluation of femoral version and surgical planning. Optimized CT exams were performed with weight-adjusted kVp and tube current modulation. Patient-specific dose from the optimized dose CT was calculated using the National Cancer Institute Dosimetry System for CT (NCICT) database by matching each patient to a phantom from the NCI non-reference phantom library based on patient sex, weight, and height. The calculated absorbed uterus dose was used as a surrogate for the fetus dose. Furthermore, patient-specific organ doses were used to estimate the effective dose.The strengths of the linear relationships between the dose metrics and patient characteristics were assessed using Pearson correlation coefficients throughlinear regression. The mean patient-specific effective dose for an optimized dose CT of the pelvis was 0.54 ± 0.20mSv (range: 0.15-1.22mSv). The mean estimated absorbed uterine dose was 1.57 ± 0.67mGy (range: 0.42-4.81mGy). Both effective dose and estimated uterine dose correlated poorly with patient physical characteristics (R = -0.26; 95% CI: [-0.43, -0.007] for age, R = 0.03; 95% CI: [-0.17, 0.22] for weight) but correlated strongly (R = 0.79, 95% CI: [0.7, 0.85]) with CTDIvol. The estimated fetus dose in case of pregnancy was significantly lower than 20mGy for urine/serum pregnancy screening, suggesting that the pregnancy screening protocols in minors undergoing optimized dose CT require reassessment and may be safely performed by verbal attestation only.

Undue burdens created by the Texas Abortion Law for vulnerable pregnant women

The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a "medical emergency necessitated the abortion." These and other provisions of the statute are to be enforced through "civil actions" brought by private citizens. This article identifies 3 populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 US Supreme Court case, Planned Parenthood v. Casey of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for 3 populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these 3 populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these 3 populations of vulnerable women. For these women, it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Planned Parenthood v. Casey because a "significant number of women will likely be prevented from obtaining an abortion." Federal courts should therefore strike down this law.

Abortion Costs and Single Parenthood: A Life-Cycle Model of Fertility and Partnership Behavior

I estimate a structural model that nests four channels through which abortion costs impact partnership and fertility. Variation in parental consent laws helps to identify the relative importance of each theoretical channel, and simulations decompose total policy effects into theoretical channels. Results indicate that the largest effect of parental consent laws is on the abortion decision for pregnant minors. But there are also meaningful effects on marriage opportunities for pregnant minors and on sexual and contraceptive behavior. These effects combine to impact family structure and human capital accumulation over the life-cycle. Simulations show that parental consent laws reduce the accumulation of human capital via impacts of children on school attendance and also increase the probability that women spend time as unwed mothers. A counterfactual abortion ban is predicted to increase birth rates at all ages and subsequently increase unwed motherhood and reduce schooling.

Judicial bypass attorneys' experiences with abortion stigma in Texas courts.

Texas requires pregnant young people under 18 (i.e., minors) seeking abortion without parental consent to go to court with an attorney to petition a judge for permission to obtain abortion. There is a lack of empirical data on the process through which abortion laws stigmatize abortion and on the actors involved. We use data from in-depth qualitative interviews with 19 attorneys who participated in a collective 800 judicial bypass cases to explore what's at stake for multiple actors within a shared social space and how interactions between those actors reproduce stigma. We extend stigma theory to explain how structural abortion restrictions produce stigma at the individual level. We find that to protect their interests in "keeping pregnant minors in," the Texas court system constrains attorneys' ability to represent minors through politicization and stigmatization; attorneys face logistical and emotional challenges, including navigating hostile or ill-informed courts, witnessing court actors humiliate their clients without means of recourse, and experiencing stigma themselves. Although what's most at stake for their clients becomes most at stake for attorneys- helping young people obtain a judicial bypass so they can access abortion and protecting them from humiliation and trauma- they must reconcile their own violation of norms stigmatizing abortion with their consciences' motivation to represent bypass clients and protect their professional identity and career advancement from being "tainted" by taking judicial bypass cases. In order to protect what is at stake for their clients in the context of the highly stigmatized Texas courts, attorneys rationally make trade-offs that protect some stakes while undermining others. Moreover, attorneys' management of experienced stigma and their violation of norms stigmatizing abortion leads some to reproduce abortion stigma in their interactions with minors.

The Impact of Parental Involvement Laws on the Abortion Rate of Minors.

In this article, we conduct a comprehensive analysis of the effect of parental involvement (PI) laws on the incidence of abortions to minors in the United States. We contribute to the extant literature in several ways. First, we explore differences in estimates of the effect of PI laws across time that may result from changes in contraception, the composition of pregnant minors, abortion access in nearby states, and differences in how these laws are enforced. We find that PI laws enacted before the mid-1990s are associated with a 15% to 20% reduction in abortions to minors, but PI laws enacted after this time are not associated with declines in abortions to minors. Second, we assess the role of out-of-state travel by minors and find that it is not a significant factor moderating the effect of PI laws. Third, we use a synthetic control approach to explore state-level heterogeneity in the effect of PI laws and find large differences in the effect of PI laws on abortions to minors by state that appear unrelated to the type of PI law or whether contiguous states have enacted PI laws. Finally, we show that estimates of the effect of PI laws using data from either the Centers for Disease Control or the Guttmacher Institute do not differ qualitatively once differences in the states and years available across these data are harmonized.

Denials of Judicial Bypass Petitions for Abortion in Texas Before and After the 2016 Bypass Process Change: 2001-2018.

Objectives. To estimate the percentage of Texas judicial bypass petitions for abortion denied annually from 2001 to 2018, and to assess whether that fraction changed after the state's 2016 bypass process change.Methods. Because official statistics on Texas judicial bypass case counts and outcomes are only available for 2016 and later, we systematically reviewed monthly internal reports from Jane's Due Process (JDP), an organization providing legal representation to pregnant minors seeking bypass from 2001 to 2018. We report numbers and percentages of JDP cases denied for 2001 to 2018 and numbers and percentages of all cases denied from official Texas statistics for 2016 to 2018 (all available years).Results. At least 1 denial occurred in 11 out of 15 years observed before the bypass law changed in Texas (percentages = 0%-6.2%). After Texas made its bypass process more restrictive, the percentage denied increased (from 2.8% in 2015 to 10.3% in 2016 among JDP cases).Conclusions. We found the greatest percentages of judicial bypass for abortion petitions denied after the policy was implemented and after the bypass process changed. Judicial bypass for abortion may expose pregnant minors to judicial veto of their abortion decision.

The Story of a Class: Uses of Narrative in Public Interest Class Actions Before Certification

Stories have power. When litigants in public interest class actions tell their stories, the narratives can advance the law and influence public debate. But before class members’ stories can vindicate civil rights on the merits, plaintiffs must overcome the hurdle of class certification. For decades, class certification under Federal Rule of Civil Procedure 23 was not a significant challenge for plaintiffs seeking to litigate as a class. But recent restrictive procedural developments—including heightened standards for class certification—threaten the powerful stories that can be told through public interest class actions. Missing in the critical analysis of class action jurisprudence is any discussion of how advocates can use narrative techniques to meet that heightened certification standard. Similarly, law and narrative scholarship has devoted little attention to the class action. This article begins to fill that gap by engaging in a critical reading of two recent public interest class actions: one challenging family separations at the border, and one challenging the denial of abortion care to pregnant unaccompanied minors in immigration custody. The article identifies narrative choices that ultimately enable class certification and further storytelling in public interest class actions. The article argues that narrative theory can provide an important perspective on the debate over restrictive class action procedure, and makes recommendations for courts and lawyers to pay greater attention to narrative in class action cases.

A Hermeneutic Phenomenological Study of Teen Mothers Who Graduated from an Alternative School

Many studies support the recurring theme that due to early childbearing, the education of teen mothers is jeopardized. Negative stereotypes towards them also prevail representing the view that teen mothers are wayward, divergent, and burdensome to society. However, there is support from the literature that the majority of them maintain career and educational aspirations. Moreover, access of pregnant minors and teen mothers to public education is guaranteed by law. With this in view, the researcher explored the educational experiences of teen mothers, particularly those who chose to enroll in and eventually graduated from an alternative public school that exclusively serves this population. A hermeneutic phenomenological approach was used in interviewing seven teen mothers who graduated from an alternative school. This qualitative method was useful in understanding subjective experiences, forming insights about individuals’ motivations and actions. The participants were selected by purposive sampling. Inductive analysis of the data indicated that attending an alternative school provided academic reengagement, structure, motivation, and a safe and caring learning environment for the participants. This study makes a contribution to the scant literature about the educational experiences of teen mothers, providing evidence that they strive to succeed and can succeed educationally when given support and access to academic services. The conclusions serve as a counter discourse to the prevailing negative perceptions towards this challenged population.

85 Obstetrical-Related Civil Monetary Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act, 2002-2018

To describe characteristics of obstetrical-related civil monetary penalty (CMP) settlements levied by the Office of the Inspector General (OIG) related to violation of the Emergency Medical Treatment and Labor Act (EMTALA). Descriptions of all CMP settlements from 2002 to April 2018 related to EMTALA violations were obtained from the OIG. Characteristics of settlements including settlement date, location, amount, whether the settlement was against a hospital or individual physician, and nature of the allegation were described. Obstetrical-related cases were identified in settlement descriptions using keywords: pregnant, pregnancy, birth, and labor. Cases where the term “labor” was included in the CMP description as part of the acronym for EMTALA without relevance to an obstetrical context were not included. Of 229 total CMPs levied by the OIG during the study period, 38 (17%) were related to obstetrical emergencies. Three (8%) of the CMP settlements related to obstetrical emergencies were levied against individual physicians and the remaining 35 (92%) were levied against hospitals. Of 8 total CMPs levied against individual physicians during the study period, 3 (37.5%) were related to obstetrical cases, including 2 against obstetricians, 1 of whom failed to respond to a request to evaluate and treat a pregnant patient with preeclampsia, and another who failed to provide appropriate medical screening examination, stabilizing treatment, and appropriate transfer for a pregnant woman in labor. The third case involved an emergency physician who repeatedly failed to provide medical screening exam and stabilizing treatment to a pregnant minor with vaginal bleeding. Of 38 penalties related to obstetrical emergencies, 15 (40%) occurred in CMS region IV, and 8 (21%) in CMS region VI. Eight of 15 (53%) settlements in CMS region IV occurred in Florida, and 5 of 8 (63%) in CMS region VI occurred in Texas. The average CMP settlement amount for obstetrical-related cases ($35,908) was not significantly different than the average amount for non-obstetrical cases ($43,585)(p=0.63). While ages of patients involved in cases resulting in CMP settlements are not systematically reported, 7 (18%) of CMP settlements related to obstetrical emergencies were specifically noted to involve a pregnant minor. We found that approximately 1 in 6 CMPs related to EMTALA violations were related to obstetrical emergencies. CMP settlements related to obstetrical conditions concentrate in 2 of the 10 CMS regions - with 3 of 5 settlements occurring in CMS regions IV and VI. Further research is needed to determine if the high rates of CMPs in these regions reflect inadequate obstetrical emergency care or enhanced enforcement in these regions. Of note, nearly 1 in 5 cases was specifically noted to involve a pregnant minor indicating that emergency physicians and obstetricians may benefit from education regarding obligations to evaluate, stabilize, and when necessary arrange for appropriate transfer of pregnant minors with active labor or other obstetrical emergencies even absent parental consent.

Judicial bypass of parental consent for abortion: characteristics of pregnant minor "Jane Doe's".

Pregnant minors can obtain an abortion without parental consent through a judicial bypass procedure in 38 states. To grant such a petition in Ohio, the Court must determine that the young woman is either "sufficiently mature and well enough informed to intelligently decide whether to have an abortion," or that notification of her parents is "not in her best interest," usually due to abuse. For the sake of anonymity in these emotionally and politically charged cases, the evaluee is referred to as "Jane Doe." This project sought to describe characteristics of teenagers seeking judicial bypass for abortion, which have not been well described in the scientific literature. Data were collected from Jane Doe evaluations completed at a metropolitan juvenile court psychiatric clinic, over 3 years. The mean age of the evaluees (N = 55) was 16.4 years. The vast majority (95%) were granted a judicial bypass. They usually had long-term boyfriends of comparable age. They had often told trusted adults about their pregnancy, though not their parents, due to concerns of violence or being excluded from the family. This study presents the first comprehensive description of characteristics of minors seeking judicial bypasses for abortion. Psychiatrists may apply general principles of informed consent in such evaluations, including ascertaining whether the decision is being made voluntarily, knowingly, and with sufficient decision-making capacity.

Эмоционально-оценочный компонент самосознания несовершеннолетних беременных

Эмоционально-оценочный компонент самосознания несовершеннолетних беременных

Features of pregnancy and delivery in minors female in a metropolis (by the example of St. Petersburg)

The article presents a retrospective analysis of peculiarities of pregnancy and childbirth in 483 pregnant women minors, representing 15 % of all juveniles who have given birth in St. Petersburg from 2004 to 2013. Among somatic diseases prevailed kidney disease exacerbation during pregnancy, cardiovascular diseases, diseases of the gastrointestinal tract, eyes and skin. Among the complications of pregnancy among minors prevailed preeclampsia, threating of premature labor, anemia and chronic placental insufficiency. Among the complications of childbirth - preterm rupture of membranes, weakness of uterine activity and fetal hypoxia. Cesarean section was mainly carried out by emergency indications during childbirth. The above analysis basically confirms the literature data about the poor physical health and a lot of complications in pregnancy and childbirth in minors in metropolis because pregnancy is not a normal physiological phenomenon for minors.

Informed Consent in Obstetric Anesthesia

Patient consent for obstetric analgesia and anesthesia involves several confounding issues in addition to the basic elements of consent. These include capacity during active labor, maternal-fetal conflict, and the care of pregnant minors. In this review, we focus on these unique consent issues. Despite pain and anxiety, women maintain the capacity to understand and recall information imparted during labor. Anesthesia providers generally disclose high-frequency and high-morbidity side effects and complications. The use of written materials and early antenatal education may improve retention of information and maternal satisfaction. Successful navigation of the consent process requires knowledge of the guidelines and laws that govern each provider's individual jurisdiction.

Informed Consent in Obstetric Anesthesia

Patient consent for obstetric analgesia and anesthesia involves several confounding issues in addition to the basic elements of consent. These include capacity during active labor, maternal-fetal conflict, and the care of pregnant minors. In this review, we focus on these unique consent issues. Despite pain and anxiety, women maintain the capacity to understand and recall information imparted during labor. Anesthesia providers generally disclose high-frequency and high-morbidity side effects and complications. The use of written materials and early antenatal education may improve retention of information and maternal satisfaction. Successful navigation of the consent process requires knowledge of the guidelines and laws that govern each provider's individual jurisdiction.

Biased abortion counseling laws and abortion demand

Since the U.S. Supreme Court's 1992 Casey decision many states have enacted biased abortion counseling laws. These laws mandate that abortion providers furnish to women with unwanted pregnancies state-approved medical information about possible side effects from having an abortion that are false. The most egregious falsehoods are that abortion is linked to mental health problems (e.g., suicide, postabortion traumatic stress syndrome, and depression), breast cancer, infertility and fetal pain. This paper investigates whether these four biased abortion falsehoods have an impact on the demand for abortions in the year 2000. The empirical results find that these four biased abortion falsehoods have no significant impact on the abortion demand of pregnant women of childbearing age (15–44 years), adult pregnant women (18–44 years) or pregnant teen minors (15–17 years). The findings remain robust even after controlling for regional differences in antiabortion attitudes.

Lark Mirror: African Culture, Masculinity, and Migration to France in Alain Mabanckou's &lt;i&gt;Bleu Blanc Rouge&lt;/i&gt;

Every now and then, the Sahara Desert and the Mediterranean Sea claim the lives of hundreds of Africans willing to trek in the hot sun and board overloaded, rickety ships at the coast of Tunisia, Libya, and Morocco in search of a better life in Europe. Meanwhile, on the continent where the unfortunate immigrants hope to improve their fortunes, the European Union has passed the Returns Directive legislation which allows governments to detain illegal immigrants, including pregnant women and unaccompanied minors, for up to eighteen months and expel them. While the draconian immigration laws have been protested against by social groups within Europe and by world leaders such as Bolivian president Evo Morales, lingering questions remain.1 Is life in Africa so poor and des perate that it is worthwhile to endure the treacherous hazards of migrating to Europe, and the possibility that one may live in poverty or worse, be deported? Or, as Senegalese writer Boubacar Boris Diop asked in 2005, following the reports of West African migrants dying in the Sahara Desert and at barbed wire fences surrounding the Spanish enclaves of Ceuta and Mellila, people are ready to sacrifice their lives to leave their homeland, but where is the willingness to serve that country, to invest a life there, at least in the interest of future generations?2 These questions underlie the reading of Alain Mabanckou's Bleu Blanc Rouge [Blue white red]. The Congolese writer's first novel captures the fate of Massala-Massala, a poor, lackluster young man who decides to seek his fortunes in France upon inspiration by Charles Mold, a flamboyant migrant who regularly returns home for the holidays with considerable wealth and

Frühe Schwangerschaften – Ursachen und Möglichkeiten der ärztlichen Prävention

Die Zahlen minderjähriger Schwangerer steigen in der BRD seit Jahren kontinuierlich, parallel dazu steigen die Zahlen der Schwangerschaftsabbrüche bei Minderjährigen. Aus dem Trendvergleich wird deutlich, dass dies insbesondere und zunehmend die sehr jungen Mädchen betrifft. Auf den ersten Blick scheint das schwer verstehbar, weil die sexuelle Aufklärung ubiquitär verfügbar ist und weil nie zuvor eine Generation so unverstellten Zugang zu Kontrazeptiva hatte. Zur Klärung der Frage nach den Ursachen wird zunächst die körperliche und psychosexuelle Entwicklung von Mädchen in der Pubertät skizziert, um ableitend daraus die Defizite zu beschreiben, die die Gesellschaft im Umgang mit den tatsächlichen libidinösen Bedürfnissen junger Mädchen produziert: Mangelnde, sich an der Lebensrealität von Mädchen orientierende Aufklärung, Sexualisierung und massenmediale Stimulation, Pluralisierung von Lebensstilen, moralische Widersprüchlichkeiten, mangelnde Perspektiven am Arbeitsmarkt, Beziehungssehnsucht, Flucht in eine «heile Welt» einer eigenen kleinen Familie. Mädchen benötigen dringend kompetente, wertschätzende und praktisch umsetzbare Informationen zu den zyklischen Vorgängen im Mädchenkörper, zu Fruchtbarkeit und Schwangerschaft, mit denen ihre Fragen strukturiert und erklärbar werden und die sie wirklich handlungskompetent werden lassen – und das am besten im Vorfeld sexueller Beziehungen. Frauenärztinnen und Frauenärzte gelten hier als die idealen Ansprechpartner.

REGULATING TEENAGE ABORTION IN THE UNITED STATES: POLITICS AND POLICY

Thirty-four US states currently require pregnant minors either to notify their parents or get their consent before having a legal abortion. The Supreme Court has upheld the constitutionality of these statutes provided that minors are also given an alternative mechanism for abortion approval that does not involve parents. The mechanism used is the ‘judicial bypass hearing’ at which minors persuade judges that they are mature and informed enough to make the abortion decision themselves. While most minors receive judicial approval, the hearings intrude into the most personal aspects of a young woman’s life. The hearings, while formally civil in nature, can be punitive in tone. Parental involvement statutes are often couched in the language of family communications and protecting minors. They are politically popular because they offer politicians the chance to be pro-life, pro-choice, and pro-family all at once. This paper argues that parental involvement statutes are less concerned with developing nuanced policies to improve the quality of teenage health or decision making than with securing a set of political goals aimed at making abortion harder to get, restoring parental authority, and punishing girls for having sex.

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine