Here we go again. Another judge issuing irrational decisions despite case after case justifying the contrary. So where is this one going, if you guessed, and guessed another attack on reproductive rights, you were correct. Any guesses on what state it is coming out of? If you said Texas, you would be correct again.

Let’s start with the topic at hand…confidential reproductive health services for minors. As a healthcare provider, we always encourage the youth to have these critical conversations with a parent, guardian, or trusted adult. However, we must also acknowledge that these conversations cannot always happen, for a gamete of reasons. Maybe the parents are removed from the home, maybe the adolescent is being abused or trafficked by the parent, maybe the parent is just plain ignorant and turns their head to the obvious things that are happening. Because let’s be real, humans are sexual beings. The drive and exploration begin during puberty, and puberty begins during adolescence. That is biology, and there is no way to change that. The average age of sexual initiation is 16 with over 75% of the population being active by the time they are 20. So, although we educate on abstinence, we also educate on pregnancy and STI prevention, along with consent and healthy relationships. Because, again, humans are sexual beings and as a society, we should be giving them all of the resources possible to make informed decisions, instead of turning a blind eye and pretending it is not happening.

Now back to the basis of the irrational decision. On Tuesday evening, US District Court Judge Matthew Kacsmaryk issued his judgment in Deanda v. Becerra, a case seeking to override the prohibition on parental consent in Title X programming. The litigation was brought against US Department of Health and Human Services (HHS) Secretary Xavier Becerra, Deputy Assistant Secretary for Population Affairs Jessica Marcella, and the United States. What I find most interesting is that they are just targeting Title X clinics, because the concept of confidential reproductive health care is practiced in ALL healthcare settings. Have you ever been asked to leave the room when your adolescent is receiving an annual exam? That is because the provider is about to have a confidential discussion around sexual health with your youth.

The judgment follows a December 8 ruling from Kacsmaryk in which he held that administration of the Title X program by the defendants “violates the federal constitutional right of parents to direct the upbringing of their children” and the Texas Family Code, despite decades of legal precedent protecting the right of adolescents to access contraception in Title X without parental consent or notification. Again, this is part of general medical practice, not exclusive to Title X clinics.

The struck-through sentence is what Judge Kacsmaryk ruled is “unlawful.”

59.10 (b) To the extent practical, Title X projects shall encourage family participation. However, Title X projects may not require consent of parents or guardians for the provision of services to minors, nor can any Title X project staff notify a parent or guardian before or after a minor has requested and/or received Title X family planning services.

Thankfully, this is already being challenged by HHS, because of the erroneous judgement by Judge Kacsmaryk.

As for Wisconsin, while Wisconsin law does not explicitly provide minors with the right to consent to contraceptives, pregnancy testing or obstetrical care, the expectation of privacy in matters of reproductive health is so substantial that the US Supreme Court has declared, as a matter of constitutional law, that reproductive privacy is a protected right or “liberty interest” of individuals regardless of age or marital status. Planned Parenthood of Central Missouri v. Danforth, 428 US 52 (1976), Carey v. Populations Services International, 431 US 678 (1977). Again, this explains why Judge Kacsmaryk’s decision is erroneous.

Also, family planning clinics must treat all information gathered, including any personally identifiable information, as part of a confidential medical record. Information may not be released without informed consent with the exception of statistical information compiled without reference to anyone’s identity. No distinction is made based upon age. References: Wis. Stat. sec. 253.07(3)(c); 905.04(1)(c), (2), and (3). Patients may claim privileged communication for diagnosis or treatment of the patient's physical, mental, or emotional condition. Reference: Wis. Stat. sec. 905.04(1)(c), (2), and (3). Consequently, minors may access confidential family planning services. Relevant U.S. Supreme Court decisions include Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52 (1976) and Carey v. Population Services International, 431 U.S. 678 (1977).