Factors Influencing Parental Involvement Among Minors Seeking an Abortion: A Qualitative Study

Abstract

Objectives. We explored factors that influenced whether minors involved or excluded a parent when seeking an abortion.

Methods. In the summer of 2010, we conducted interviews with 30 minors who sought an abortion in a state that did not require parental involvement at the time. Interviews were coded and analyzed following the principles of the grounded theory method.

Results. The majority of minors involved a parent. Commonly cited factors were close or supportive parental relationships, a sense that disclosure was inevitable, a need for practical assistance, and compelled disclosure. Motivations for not wanting to involve a parent, although some minors ultimately did, included preservation of the parent–daughter relationship, fear or detachment, and preservation of autonomy.

Conclusions. Minors were motivated to involve parents and other adults who were engaged in their lives at the time of the pregnancy, particularly those who supported them in obtaining an abortion. Motivations to exclude a parent were often based on particular family circumstances or experiences that suggested that involvement would not be helpful, might be harmful, or might restrict a minor’s ability to obtain an abortion.

Nationally, nearly one third of pregnant women aged 18 years or younger seek an abortion.¹ Currently, 38 states have parental involvement laws that require a parent provide consent or receive notification before a minor can access abortion. States do allow some exceptions in cases of abuse, assault, and medical emergencies.² Courts have upheld parental involvement laws when an alternative for adolescents unable or unwilling to involve parents exists. In most states, this means a judge determines if the adolescent is sufficiently mature to waive parental involvement requirements, a process called “judicial bypass.” Although the majority of parental involvement laws have been in place since the 1990s, lawmakers have recently passed a new wave of legislation, including new parental involvement laws in states that lack them and stricter mandates for existing laws. Efforts to make parental involvement laws more restrictive include requiring parental consent instead of notification, mandating involvement of both parents, notarization of consent documents, heightened evidentiary requirements for judges to find a minor mature, and jurisdictional limitations on where minors can seek judicial bypass.^3–5

Previous studies, published in the 1980s and 1990s, found that parents were often involved in a minor’s decision regardless of the law. Those minors who did not wish to involve a parent often cited fear of negative parental reactions, lack of or fragile relationships with parents, and desire to avoid parental pressure in the decision-making process.^6–10 The legal landscape has changed since these seminal studies, with a shift toward increasingly strict laws. There is limited current research exploring minors’ experiences and the factors influencing their decisions to involve or exclude parents when seeking an abortion.¹¹

States without parental involvement laws provide an opportunity to examine minors’ experiences involving adults in their abortion-seeking process in the absence of a legal requirement. In Illinois, the Parental Notice of Abortion Act was passed in 1995. The law requires physicians to give notice to an adult family member (defined as a parent, legal guardian, grandparent, or cohabiting step-parent) 48 hours before providing abortion services to a minor.¹² However, because of legal challenges, the law was not implemented until August 2013. Previously, Illinois was the only state in the Midwest that did not enforce a parental involvement law. Our aim in this study was to explore the factors in abortion-seeking minors’ motivations regarding parental involvement. This snapshot before implementation of a new parental involvement law provided a rare opportunity to understand its potential impact.

METHODS

Minors who were seeking abortion services were recruited at 2 freestanding clinics and 1 hospital-based clinic in the Chicago, Illinois, area from June to September 2010. At that time, the state parental notification law was under legal challenge, and therefore, unenforced. Eligible participants were aged 12 to 17 years, English-speaking, medically approved for abortion, and scheduled to have a surgical or medication abortion that day. Participants were ineligible if their pregnancy was the result of sexual assault or if they decided not to have an abortion. After consenting to abortion procedures, minors were screened for eligibility and interest by clinic staff, and then referred to an on-site research assistant for further screening and informed consent. All research activities were conducted before any part of the procedure was initiated.

Participants gave oral consent and completed a brief demographic characteristic survey and a 10- to 15-minute semistructured interview with a trained female research assistant. The interview guide contained open-ended questions with set probes designed to explore motivations and experiences regarding disclosure of pregnancy and their abortion decision. Participants were asked whether each parent knew and how parents and other adults became involved. The interview also captured opinions about the unenforced parental notification law; these findings are described in depth elsewhere.¹³ Interviews were conducted in a private room in the clinic. No identifying information other than participants’ age and first name was collected. Sample size was based on the principle of thematic saturation, or that point at which the research team deemed collecting additional interviews would not contribute new information. Participants were compensated $15 upon completion of the interview.

Interviews were digitally recorded and transcribed verbatim. We used ATLAS.ti 5.0 (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) qualitative data analysis software to code and assist in data reduction and analysis. A code dictionary was developed based on the constructs in the interview guide. Two researchers independently coded each transcript, adding new codes for emerging concepts and themes following the principles of grounded theory.¹⁴ Disagreements in interpretation were reconciled through discussion. Once coding was reconciled, salient themes (those appearing in multiple interviews and widely endorsed) and representative quotations were identified. We constructed matrices organizing salient themes to facilitate in-depth analysis and synthesis.¹⁵

RESULTS

The final sample consisted of 30 participants, at which point research staff agreed thematic saturation had been reached. Fifty-five minors met the initial inclusion criteria and were approached by the clinic staff for participation. Twenty-two (40.0%) declined participation, most commonly citing an unwillingness to discuss their abortion or feeling stress and fatigue. Clinic staff deemed 2 participants ineligible. One participant declined participation after referral to research staff.

The majority of participants (80.0%) were aged 16 or 17 years and self-identified as African American (70.0%) and non-Hispanic (76.7%; Table 1). One third (30.0%) lived with both a mother and father figure; almost half (46.7%) reported living with just their mother and no father or stepfather. A majority (60.0%) reported living in households in which someone received public assistance. A large proportion (73.3%) considered themselves somewhat or very religious. Few participants (6.7%) reported having been pregnant before, and most (70.0%) had a gestational age of less than 12 weeks.

TABLE 1—

Selected Characteristics of Pregnant Minors Seeking Abortion Participating in Interviews Describing Parental Involvement: Chicago, IL, 2010

Characteristic	No. (%)
Total Participants	30 (100)
Age, y
14	1 (3.3)
15	5 (16.7)
16	9 (30.0)
17	15 (50.0)
Racea
White	4 (13.3)
African American	21 (70.0)
Other	9 (30.0)
Ethnicity
Hispanic	7 (23.3)
Non-Hispanic	23 (76.7)
Lives with
Biological mother only	14 (46.7)
Biological mother and father-figure	9 (30.0)
Other	7 (23.3)
Household on public assistance	18 (60.0)
Religiosity
Not at all	8 (26.7)
Somewhat	18 (60.0)
Very	4 (13.3)
Never been pregnant before	28 (93.3)
Gestational age of current pregnancy
< 12.0 wks	21 (70.0)
12.1–17.0 wks	7 (23.3)
Unknown	2 (6.7)

^aRespondents could choose more than 1 race.

Decision to Involve Parent or Guardian

Minors in this study involved an array of individuals in their pregnancy and abortion decision. Twenty-one participants (70.0%) ultimately involved a parent (defined in this article as a mother, father, or guardian) in their abortion decision, whereas 9 participants (30.0%) did not. In many cases, a participant involved a parent who lived with her. Among those who involved a parent, 8 (38.1%) involved only their mother, 10 (47.6%) involved both their mother and father, 1 minor (4.7%) involved only her father, and 2 minors (9.5%) involved their guardian grandmother. For 6 minors, at least 1 parent became involved after someone else revealed the pregnancy or required the minor to do so. All 6 participants aged 14 to 15 years had parental involvement; by contrast, more than one third (37.0%) of the 24 participants aged 16 or 17 years did not.

Outside of parents, participants informed other members of their support network, with many involving more than 1 person. More than half of the participants (53.3%) involved a boyfriend or the partner with whom she became pregnant, and a number (36.7%) involved a friend. Many participants (40%) informed an aunt or cousin. Other categories included a sister, a boyfriend’s parent, a nonguardian grandparent, and trusted school staff. Of the 9 minors who ultimately did not involve a parent, all but 1 were aged 17 years, and all of them voluntarily involved another person.

Parental Involvement Factors

Factors that influenced whether minors involved a parent were classified into 4 main categories: (1) relationships with parents that were close or supportive, (2) the sense that disclosure was inevitable, (3) the need for financial or logistical assistance, and (4) circumstances in which disclosure was forced upon the minor. These themes emerged among participants whether or not they ultimately involved a parent.

Strong relationships with parents and desire for emotional or decisional support were 2 critical factors. A close existing relationship facilitated parental involvement. As one young woman described talking with her mother, “Yeah, cuz, she’s like my best friend and she—like that’s who I talk—like I talk to her about it…I’ve cried about this a lot, and she just helps me, makes me feel better.” Another young woman observed the importance of unconditional support, “Because I knew, whatever my decision was, (my mother) would support me, and…I knew I didn’t have to hide anything…we have a good bond.” For some, the close relationship was with their father, “My dad’s like, he’s different than my mom. He loves me regardless, so I wasn’t really worried about what he would say.” Minors also looked to their parents for emotional support, as with one minor and her mother: “I needed her to be there for me. I needed her help to get this done, to get this procedure done.” In the words of another young woman, “I didn’t want to disappoint her, but I had to tell her ’cause it wasn’t something I could get through by myself. At least that’s how I felt.” One young woman observed the significance of support in her decision-making: “I know she can help me…in making a decision about what to do.” Overall, close relationships and anticipated support were strong motivating factors for parental involvement.

Some minors described their pregnancy and abortion decision as too difficult to keep secret from parents. Several participants believed their pregnancy symptoms would inevitably be detected: “We were living with our grandparents, and I couldn’t really hide it. I was sleepy, sleeping for hours, sick; I had throwing up and everything.” For one participant, close parental monitoring played a part in her mother’s involvement:

She keeps up with my period because it’s right after hers, so once I missed one, she noticed, and she asked me about it, and I acted like I didn’t know at first. But eventually, like a couple days later, . . . I was tired of holding it in, so I told her.

Such findings suggested that parental presence and engagement prompted involvement.

For other minors, navigating the logistics of obtaining an abortion was a factor in favor of telling a parent. Some described a general need for assistance, and others specifically cited cost; one young woman noted, “I mean, I wouldn’t normally tell my dad, but it came to a point where I needed another $50 for the abortion to be done, and so I relied on daddy.” Similarly, another found that the increased cost associated with advancing gestational age shaped her decision: “I wasn’t going to tell nobody ’cause it was easier, but it was too late, ’cause I was too far along. And that’s when I told them ’cause I knew had to get more money and stuff.” Another participant “figured out that I couldn’t do it on my own.”

Our findings also revealed that despite initial intentions not to involve a parent, some adolescents were pressured into parental involvement because of third party actions or outside forces. In one example, a sister informed a parent, and in another example, clinic staff strongly insisted one participant involve her mother:

They said, “you have to tell her,” and they was in the room with me, and they brought her in. I really didn’t tell her, I just kept crying and saying I was sorry, but then she figured it out afterwards.

Parental Exclusion Factors

Minors described a range of motivations for parental exclusion, although in some cases the parent was eventually involved. We categorized these motivations under 3 themes: (1) preservation of the parent–daughter relationship, (2) fear or detachment, and (3) preservation of autonomy.

Many minors were concerned that informing a parent about the abortion would damage their relationship. Typically, these were relationships that the participant deemed fragile. As one minor put it,

To me that (disclosing pregnancy and abortion) would start a whole lot of drama and right now, um, our relationship is like, is kind of on good terms, but it’s not, so for me telling her this um, I think it like would go back down the drain.

Some feared long-term consequences given their parent’s high expectations of them:

I’m the youngest daughter, and I feel like, you know, they would just be so disappointed in me. . . . She wouldn’t be angry, but she would really just be really disappointed, and I wasn’t ready for that.

Others were concerned that parental judgment could fundamentally alter their relationship, “’Cause it’s like, ‘man what are they going to think’ and ‘are they going to hate me for this?’ That is what goes through your mind.”

Minors with a troubled parent–daughter relationship described concerns based on fear of emotional or physical repercussions and detached relationships. One young woman said her father “Would probably kick me out of the house, and he would be really mad.” A number of participants noted a parent’s limited role in their life as a motivation for excluding him or her. This detachment was described in various ways, such as: “We don’t really communicate,” “He lives in another state,” and “I don’t know my dad.” One stated:

He’s really not that much involved with me anyway. . . . I feel that he barely does—he barely lives up to his own responsibilities, which is me. He barely does what he has to do with me, so why should he know. That’s how I feel. Why should I tell him? He wasn’t there, so he shouldn’t really have nothing to say about it.

Finally, many minors sought to preserve personal autonomy. In some cases, autonomy meant privacy and independent decision-making. As one minor put it,

I would like to make it easier for myself to move on from this . . . so I won’t feel like I’m being judged and at home, and stuff like that. Other people won’t be, you know, talking to me about it and, you know. I rather like try and forget about it myself, you know?

However, others believed parental involvement would mean they would not obtain an abortion. Specifically, they cited a concern that a parent would disagree with their decision or persuade them to continue the pregnancy against their wishes. For instance, a participant would describe her inability to “go against” a parent or observe that a parent was “against abortion” for religious or moral reasons. As another participant stated, “This was my first option, she (her mother) would want me to consider other options.” When asked if it would still be the participant’s choice in the end, she answered “no.” Another had heard her mother’s views, “She just told me, like, it’s not right . . . and she told me like, if I did get pregnant, like, she told me she wouldn’t let me have one. She said it’s my responsibility.” Several participants discussed how their parents “would not let” them get an abortion. One participant who ended up seeking an abortion without parental involvement confided, “I told her that I wanted one and that I was going to get it, but she told me no.” Significantly, most of the minors who did not involve a parent were concerned that one parent would disagree with their abortion decision. In these cases, the other parent was often uninvolved in the participant’s life, deceased, or a source of potential anger.

Motivations to Involve Other Adults

Nearly half of all participants described reaching out to adults other than parents for support and assistance. Most often this adult was an older sister, an aunt, or a cousin. In a few cases, a participant confided in her grandparents or the parents of the partner with whom she became pregnant; another participant spoke with a school football coach and a school engineer. Participants cited close relationships, a belief that the adult would support their decision, and established trust as motivations for involving these adults. For example, one participant stated, “My boyfriend, he definitely deserves to know, and his mother, I’m pretty close to her, she’s, she’s not judgmental with me at all, so I felt that it was safe to tell her.” Another motivation was the knowledge that the adult had been in a similar situation: “I wanted to tell my cousin because she got pregnant at 16, and I just wanted to get some advice from her. She’s 23 right now, and she has two kids.” Participants also cited the need for financial or logistical assistance in obtaining the abortion.

DISCUSSION

Research on parental involvement laws has largely focused on related health outcomes or the personal experiences of minors. The comprehensive literature review by Dennis et al. found few clear impacts of parental involvement laws on health outcomes when examining sexual activity and behavior, abortion rates, contraceptive use, birthrates, and pregnancy rates.¹⁶ Key findings included more minors traveling out of state to obtain an abortion in less restrictive settings and some delays among older minors in Texas who waited until turning 18 years of age.^16,17 Previous research that examined the experiences of minors demonstrated that parents often became involved regardless of the law, and that when parents were not involved, trusted adults, friends and other family often were involved.^3–6,18,19 Similarly, the majority of minors in our study ultimately involved a parent, and all minors confided in someone. As found in other studies, mothers and the minors’ male partners were most often involved, and the youngest participants were more likely to involve a parent.^7,18,20,21

Minors considered similar factors when deciding who they wanted to involve or exclude; as in other studies, their decisions were based on whom they felt close to, whom they could talk to about sex, whom they could trust, and who would support their decision.^6,7,10,18,22 Whether minors ultimately chose to involve a parent often involved a balancing of factors; for instance, one minor described wanting to involve her father, but knew that he would inform her mother, who would push her to continue the pregnancy. In our study, the most common motivations for wanting to involve a parent included desire for support or assistance, or the existence of a close relationship. In general, the minors wanted to involve those who were already part of their lives at the time of the pregnancy and those who would support them, regardless of the minor’s decision to seek abortion.

Our research, like others’, showed that minors considered excluding a parent for a number of reasons having to do with the role of the parent in their lives or the expected consequences.^{6,10,18,21,23} Minors in our study wanted to protect their relationship with their parent, protect themselves from personally harmful outcomes, and preserve their ability to make a decision for themselves. Many minors who did not involve either parent described concerns that one parent might interfere with their decision to obtain an abortion, whereas another parent was uninvolved in their life. This finding suggested that, for some minors, laws requiring parental notification could be as insurmountable as laws requiring consent, especially when research has revealed logistical and emotional challenges for minors navigating flawed judicial bypass systems.²⁴ New laws making judicial bypass more difficult have only increased burdens for those who do not involve a parent.^3–5

Proponents of parental involvement laws have often argued that requiring parent–daughter communication about abortion would lead to decision-making assistance and support for the minor. However, we found a lack of data demonstrating that such laws could lead to better communication, improved abortion experiences, or better health outcomes.²⁵ Our study, along with others, demonstrated that minors, like adult women, could identify where they would find support or assistance when they needed to seek it.^3,18 Previous studies demonstrated that minors and adult women might actually experience poorer outcomes when forced to involve unsupportive individuals.^11,26 One recent study found that when minors involved a nonsupportive parent, they were less likely to have confidence in their decision and more likely to anticipate difficulty coping.¹¹ Research also showed that minors’ assessments did not change over time; one study found that minors’ initial assessments of who was most and least helpful in their decision-making remained constant a year later.¹⁸

Study Limitations

Limitations to our study included a sample confined to minors obtaining an abortion. We lacked information on those minors who wanted an abortion, but who were unable to obtain one. We also lacked information on minors who declined to participate. Also, findings might be particular to our sample, which was predominantly low-income, African American, 16- to 17-year-old adolescents in an urban area. However, our population reflected current abortion demographics.^1,27 Lastly, because many participants described a range of motivations for wanting to involve or exclude one parent or another, we were unable to conclude which motivations were the most important factors in a minor’s involvement or exclusion of each parent.

Conclusions

The themes of our study helped illuminate the context within which minors considered parental involvement in their abortion. Findings suggested that minors recruited those who would respect their decision, including those parents who might have felt ambivalent about abortion, but who still offered support. Motivations to exclude a parent were often based on particular family circumstances or personal experiences, leading the minor to believe that they would not be helpful and might be harmful or obstructive.

Laws mandating parental involvement are generally not tailored to recognize the complex relationships described by our participants and have not been shown to improve communication. They also fail to establish the positive relationship factors that lead minors to want parental involvement. Support for parenting and other interventions to strengthen family relationships could be more effective in encouraging minors to seek parental support. With greater understanding of minors’ motivations and circumstances, policymakers can better assess whether parental involvement laws are necessary and minimize the harms of existing laws.