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. Author manuscript; available in PMC: 2023 Jun 26.
Published in final edited form as: JAMA Pediatr. 2022 Oct 1;176(10):967–968. doi: 10.1001/jamapediatrics.2022.2868

The Pediatrician in the Post-Roe Landscape

Tracey A Wilkinson a, Julie Maslowsky b, Elise D Berlan c,d
PMCID: PMC10291881  NIHMSID: NIHMS1905813  PMID: 35969386

The recent Supreme Court decision in the Dobbs v. Jackson case has instantly destabilized the landscape of reproductive healthcare access for adolescents and young adults (AYAs). Now that the federal legal protection to abortion access is no longer in place, states will permit varying degrees of access, creating challenges for both AYAs and pediatricians alike. Many of the new restrictions are expected to occur in states where AYAs’ reproductive healthcare access is already restricted and unintended pregnancy rates are higher than average.1

Abortion access is an essential component of reproductive healthcare for all people. Although AYAs under age 20 comprise 12% of abortions nationally, this small proportion is not trivial. Adolescent pregnancies are more likely to be unintended and end in abortion.1 Therefore, adolescents will be disproportionately impacted by this legal decision.

Already, AYAs’ barriers to abortion access include financial, transportation, state surveillance, and laws that mandate parental consent and notification (Figure 1).2 These barriers are compounded by poverty, race, and other social inequities. Furthermore, when young people are not given a choice about whether to become a parent, we know that all these inequities increase. Pregnancy rates are higher among minoritized youth, those living at or near poverty, LGBTQ, and systems-involved youth. These young people are less likely to have resources and social networks to support them as they navigate additional barriers to abortion access.

Figure 1:

Figure 1:

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Parental/Guardian Involvement in Abortion Access State-level legal requirements for parental/guardian involvement when minors access abortion as of 6/1/2022 https://www.guttmacher.org/state-policy/explore/parental-involvement-minors-abortions#:~:text=The%20majority%20of%20states%20require,the%20involvement%20of%20both%20parents..

Pediatricians must advocate and ensure their patients have access to essential reproductive and sexual health services, including abortion. This is more critical now than ever. It is imperative that this care is patient-centered and grounded in reproductive justice to help patients realize their reproductive goals.3

There are four main reproductive healthcare domains to guide pediatricians as they support their AYAs in this uncertain climate:

1. Anticipatory Guidance and Routine Pregnancy Intention Screening

Anticipatory guidance on topics such as sex, sexuality, relationships should be tailored to a young person’s developmental stage and introduced early and often. For example, incorporating routine and universal pregnancy intention screening regardless of their gender or sexual activity status, with the PATH (Pregnancy/Parenting Attitude, Timing, How Important; www.path-framework.com) framework.

  1. Do you want to have children someday?

  2. When do you think that may be?

  3. How important is it to prevent pregnancy until then?

2. Comprehensive Contraception Counseling and Provision

Counseling about and provision of contraceptives is within the scope of practice for all pediatricians and subspecialists and can be done via telehealth or in-person visits. Screening (including self-screening) for potential medical contraindications can be done prior to a visit or in a waiting room and quickly compared to CDC Medical Eligibility Contraindications, which are available on a phone app.4 Patients should be supported in choosing a medically safe method they desire and that they feel best meets their needs. Instructions on how to start the method the same day should be provided.

If a short-acting contraceptive (pills, patches, ring, injection) is selected, prescriptions should be written with refills for a year. Subcutaneous administration of depot medroxyprogesterone is also an alternative to in-clinic visits. For people interested in starting a long-acting reversible contraceptive (LARC), access to their desired method on the same day of the counseling session should be prioritized, if and when possible.

Pediatricians can incorporate placement of contraceptive implants into their clinical care practice. This often requires obtaining necessary supplies pre-emptively and acquiring the skill set for implant placement, if not trained previously. In instances when LARC cannot be provided within a given clinical setting, an awareness of clinical colleagues and health systems for referrals is essential for comprehensive contraception care. Providing a short-acting contraceptive method should be made available for patients who have a delay in initiation of their desired contraceptive method.

Patients should be educated about non-prescription forms of contraception, such as condoms and emergency contraceptive pills, and screening for sexually transmitted infections should be offered when indicated. This includes counseling and screening of patients of all genders.

Education about sex, sexuality, pregnancy, contraception, and consent is absent or inadequate within many school settings in the U.S.5 Pediatricians should be prepared to answer questions and fill in gaps of knowledge.

3. Healthcare Navigation

Pediatricians should provide unbiased options counseling (parenting, adoption, abortion) when a patient is pregnant. When additional information regarding abortion is needed, pediatricians should be aware of key resources:

3. Confidential Care

Most AYAs involve a trusted adult in their healthcare decisions, including abortion. Those adults can be, but are not always, their parents. Confidentiality about sensitive topics is important in AYA care, and attention to potential breaches of privacy such as electronic health record documentation, billing, and insurance claims all should be considered.

Title X clinics have a federal legal charge to provide affordable reproductive healthcare services, including confidential services for minors. It is beneficial to be aware of Title X clinical sites within your community when patients in need of confidential or low-cost contraceptive care are unable to obtain that from your clinical setting.7

Now more than ever, pediatricians have a critical role to protect and provide sexual and reproductive healthcare for AYA’s. As we prepare for potentially devastating changes in the legal and clinical landscape surrounding reproductive healthcare, the above elements can and should be incorporated into routine pediatric practice so that young people continue to receive the support they need to control if, when, and how to be parents.

Acknowledgements:

We thank Jessica Goldberg, JD, senior council at If/When/How, Nancy Berglas, DrPH, Annie Hoopes, MD, MPH, Melissa Kottke, MD, MPH, MBA, Laura Lindberg, PhD and Nichole Tyson, MD for their critical review of this manuscript.

Dr. Wilkinson receives project funding from Bayer, Cooper Surgical and Organon Dr. Berlan is a consultant to Merck, has received research funding from Merck and Organon, and is a Nexplanon Clinical Trainer

Footnotes

Conflicts of Interest: Dr. Maslowsky has no conflicts of interest to disclose.

References

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