Before last week, adolescents seeking abortions in the U.S. already had to struggle through a thicket of legal hurdles and logistical challenges to access reproductive health care.
The Supreme Court decision striking down Roe v. Wade made it that much harder.
A number of states have already banned or severely restricted abortions in light of the ruling — laws that apply equally to adolescents and adults.
Young people who go out of state to seek abortions elsewhere in the U.S. may run up against laws requiring parental involvement, which are common across the country.
That's to say nothing of the unique logistical barriers young people face. Some adolescents aren't old enough to drive, and minors can't buy a plane ticket. Bus companies also have age-based restrictions.
Some states allow medication abortion to be prescribed via telehealth, in lieu of showing up for an appointment in person, but it's frequently unavailable to minors, experts say.
Finally, there's the cost. Young people who are still in school may not have enough money to pay for travel or the abortion itself. Even if they do, minors can't use some online payment services like PayPal or Venmo.
"Adolescents are going to be left with fewer options than adults," Julie Maslowsky, an associate professor of public health at the University of Illinois Chicago, told NPR.
"It will be difficult, stressful, harmful, and some adolescents will not be able to make the choice that they want to make," Maslowsky said.
Leading health groups say it's critical adolescents can access abortions
In 2019, women ages 19 and younger accounted for 8.9% of legal abortions in the U.S., according to data from the Centers for Disease Control and Prevention.
The Guttmacher Institute, a research organization that supports abortion rights, estimated that 12% of abortion patients in 2014 were under 20 years old.
"Adolescents get pregnant," Elizabeth Alderman, chair of the American Academy of Pediatrics' Committee on Adolescence, told NPR. "This has been a long-standing way of how things are in the United States and in all the countries in the world."
Since 1989, the American Academy of Pediatrics has recommended that pregnant adolescents are counseled on all of their options, including abortion.
The group reaffirmed that policy after last week's ruling, saying it supported its young patients' rights to "access comprehensive, evidence-based reproductive healthcare services, including abortion."
The Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology have said they oppose any restrictions on reproductive health care for adolescents, including bans on abortion.
Now, health experts worry the new restrictions on abortion will further harm adolescents who are already at a disadvantage when it comes to reproductive care.
Less than half of American adolescents receive comprehensive sexual education, according to Maslowsky of the University of Illinois Chicago, and it can be difficult for young people to access contraception.
Alderman also noted that adolescents are often still in school, have yet to reach their full income potential and face a higher risk of preterm labor and other pregnancy complications.
There can be added legal issues for minors seeking abortions
Adults in states with abortion bans or strict limits may seek reproductive care out of state. For adolescents, that presents legal hurdles.
Thirty-seven states require minors to either notify or obtain consent from a parent before they can get an abortion, according to the reproductive rights advocacy group If/When/How.
That's far more than the 26 states that are predicted to ban abortion after the fall of Roe, which means that young people going out-of-state for an abortion may not be able to get one in states that have offered themselves up as abortion refuges for adults.
"These barriers stack on top of each other to create real lack of access," Jessica Goldberg, senior youth access counsel at If/When/How, told NPR.
Research shows that more than 90% of adolescents involve an adult in their decision to get an abortion, according to Maslowsky, but others seek abortions on their own. And experts have expressed the need for minors to have the ability to access care confidentially.
Almost all of the states with parental notification laws have what's called a "judicial bypass" process, which allows minors to go directly to a judge to obtain permission to get an abortion. (Maryland allows physicians to give permission for the procedure.)
But Goldberg says even the judicial bypass process is inadequate in many cases, because it forces young people to understand a complex legal system and can take time to complete.
"So not only do they have to travel, but they still have to manage navigating the judicial bypass process in another state before they can access abortion care in that state," she said. "That's what I mean about these barriers really compounding or building on top of each other."