Barton Child Law & Policy Center
August 9, 2011
Review the unique needs and common outcomes
among court involved children related to reproductive
Review the legal authority and policies that support
the delivery of reproductive health care and
educational information to court involved youth.
◦ Parental Notification Act
◦ The Right to Parent
Preventing pregnancy is a matter of child welfare
◦ Child health, bodily integrity/dignity, human development
◦ Control over reproductive outcomes
◦ Child well-being (emotional, physical, mental health)
◦ Positive outcomes, success, opportunity
◦ Societal impact
$10.9 billion in 2008 / $2.8 billion child welfare costs
$12,000 = Medicaid Birth / $200 = contraception
Principles apply to all court involved children
◦ Juvenile Justice/Child Welfare
◦ LGBTQ youth
◦ Developmentally disabled youth
By 19, nearly 50% of female youth in foster care have been
Female youth in foster care are 2.5 times more likely than
those not in foster care to have been pregnant by age 19.
46% of teen girls in foster care who have been pregnant have
had a subsequent pregnancy, compared to 29% of their peers
outside the system.
50% of 21-year-old men aging out of foster care reported
they had gotten someone pregnant, compared to 19% of their
peers who were not in foster care.
A Crucial Connection: Pregnancy in Foster Care
Early parenting compounds the challenges faced by court involved
children and increases the likelihood of poor outcomes:
◦ Limited educational opportunities
◦ Income disparity/poverty
◦ Poor health outcomes
◦ Higher rates of incarceration
Babies born to teen mothers face poor outcomes
◦ Cycle: Removal Foster Care Poor Outcomes
Teen pregnancies are often high risk for mother and baby
◦ Lack of prenatal care
“We can provide youth in care with all the contraception in the world, but
pregnancy rates among this population will remain exceptionally high
unless the factors that motivate so many of these adolescents to
become pregnant are addressed. For some youth in foster care, having a
child may be seen as a way to create a family of their own, a family who
will love them and who they can love, or to demonstrate that they can do
a better job of parenting than their birth parents had. Addressing these
motivations means giving teens in foster care a reason to delay pregnancy
and childbearing. They need to believe that they can complete their
education, find a good job and succeed in life.”
–Amy Dworsky, Chapin Hall-University of Chicago
1. Abuse and Dysfunction
2. Few positive alternatives
3. Meaning in being a parent
4. Lack of positive family influence
5. Family planning and sex education
6. Ambivalence and fatalism
Physical and Sexual Abuse
◦ American Academy of Pediatrics: A significantly higher
incidence of childhood sexual or physical abuse has been
reported in the backgrounds of teens who become
◦ Domestic violence
◦ Incarceration of family members
◦ Household substance abuse
◦ House hold mental illness
Juvenile Court Rules
Federal Law: Fostering Connections
OCGA § 49-5-3(12)(c)
◦ “Legal custody” means a legal status created by a court order embodying… the
responsibility to provide the child with… ordinary medical care.
DFCS Policy § 1011.4: Upon entering care, children are required to have a
“health check” within ten days.
A health check consists of: A comprehensive unclothed physical
examination, a comprehensive health and developmental history,
developmental assessment, anticipatory guidance, measurements, vision
and hearing tests, certain laboratory procedures and lead risk assessment.
DFCS Policy § 1011.2: All of the age appropriate components must be completed
for each screening visit.
The American Academy of Pediatrics recommends reproductive health
screenings/education as early as age 11.
§ 1011.2: Case manager responsibilities
◦ Arrange appropriate and timely medical care
◦ Follow-up on doctor’s recommendations
◦ Help children and teens learn about sexual development and sexuality
◦ Collaborate with foster family/provider to arrange medical services the
§ 1015.18: Major Decisions Exception for Foster Families
◦ Seek consultation and approval from case manager; involve parent if
rights have not been terminated
Section 20, Rule 20.1: Physical and Mental
Examinations By Court Order
◦ OCGA 15-11-12(b): “During the pendency of any proceeding,
the court may… order the child to be examined at a suitable
place by a physician…”
OCGA § 31-9-2(a)(5): Consent
◦ “Females, regardless of age, are authorized to consent on their own
behalf with respect to medical procedures or treatment in connection
with pregnancy, prevention of pregnancy, or childbirth.
Exception: Termination of pregnancy
OCGA § 31-17-7(b): Confidentiality
◦ The treating physician/medical staff may inform the minor’s custodian
as to the treatment given or needed. The minor patient’s consent is not
HIPAA: Not implicated—Parent/custodian may have access to records when
provided for by state law.
Title X Clinics
17+: Plan B, Plan B One-Step, and their generic
versions are approved by the FDA for OTC distribution
to youth 17+.
16 and under: Plan B, Plan B One-Step, and their
generic versions are available by prescription only for
youth 16 and under, per the FDA.
Requires states to develop a plan for ongoing oversight
and coordination of health services.
Provides opportunities for prevention by way of:
◦ Health Care
Transition Plan for Children
Aging Out of Care
•Health education and services in the transition
•Encourage case workers to distribute resources
on health care, healthy relationships, and the
consequences of early pregnancy.
Short Term Training
•Training for staff and guardians to increase their
ability to discuss health education and locate
Health Oversight and
•Regularly scheduled, age appropriate physical
exams with appropriate doctor.
Review your client’s case files for documentation of a
comprehensive assessment of health at entry and
If lacking, ask the court to order.
Expect inquiries from the court about the health of your
client or ask for an inquiry.
OCGA §§ 15-11-110 to 15-11-118; Juvenile Court Rule
◦ Parental Notification
◦ Judicial Bypass
Mature + Well Informed
Notice is not in the minor’s best interests
In re E.H., 240 Ga.App. 91 (1999).
Title IV-E Funding
◦ Mom (foster care) / Baby
◦ Mom (foster care) / Baby (foster care)
◦ Mom (foster care) / Baby (foster care)
DFCS Policy: “The IV-E program allows a state to claim IV-E reimbursement for the cost
of an infant living in the same placement as his/her minor parent. This provision does
NOT require DFCS to obtain custody of the child.”
◦ NOTE: The child shall remain in the custody of his or her minor parent, unless it is
otherwise determined by the SSCM that the minor parent’s protective capacities
places the infant in danger of imminent harm and that the placement resource’s
protective capacities are not sufficient to mitigate the risk of harm.
GA Campaign for Adolescent
The National Campaign to Prevent
American Bar Association
Ask the court to order education/health
◦ High risk cases
◦ No birth control mandates
Counsel case workers
Convene a community action group
Direct youth and case workers to resources