Adolescents are fully aware and concerned about how abortion restrictions can affect them, and most use the internet and social media for information on abortion, new research shows.1
“This study examined young people’s knowledge of where they would go online to find information about getting an abortion,” says Bianca A. Allison, MD, MPH, lead study author and an assistant professor in the department of pediatrics, division of general pediatrics and adolescent medicine at the University of North Carolina at Chapel Hill School of Medicine. “The fact they’re using the internet and social media is a great thing — as long as they do it with a critical eye. I have seen patients in some capacity since 2011, and I definitely have seen an evolution in access to information. The conversations young people have with me as a physician are different. They’re empowered in a way because of the internet.”
Allison and colleagues surveyed 654 people, ages 14 to 24 years, across the United States. “The most referenced specific online destination was Planned Parenthood,” she says. “Planned Parenthood has many website pages with general abortion information and how to find services based on age, location, and gestation.”
Using data from a national survey in May 2022, Allison and colleagues found that 85% of adolescents knew about abortion access changes, and many could cite the leaked Dobbs v. Jackson Women’s Health decision. The participants described total abortion bans and restrictions based on age and telehealth to investigators, who published the study, “Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications” in the Journal of Adolescent Health (JAH) in 2023.1,2 The journal’s editors selected the article to be recognized as a member of “The Distinguished Dozen: 2023 JAH Articles Making Distinguished Contributions to Adolescent and Young Adult Health.”
At the time of the study’s first survey, abortion access was restricted in many states but still available to most women in the United States. That changed a month later in June 2022, when the U.S. Supreme Court overturned Roe v. Wade.
“By the time the [Supreme Court] decision came out, laws were changing, and there were a lot of questions about policy and safety,” Allison says. “We also wanted to capture their emotions around the changing laws.”
They found that 42% of adolescents expressed negative emotions about the potential legal changes to abortion care. They discussed their anger, fear, and sadness. One participant told researchers, “I feel hurt because I don’t want kids, [and] I want other women to be able to have a choice.”1
Another 26% said they disagreed with abortion bans, 12% had mixed or neutral opinions, and 7% said they were happy with the change because they were against abortion. Few of the adolescents surveyed reported having conducted a search for abortion information online, and a notable minority of adolescents and young adults did not know where to find information or they were concerned about online surveillance. Those concerned about cybersecurity may have heard about digital health data being collected and used in criminalization.1
Allison and colleagues wanted adolescents’ voices to highlight what should be priorities in improving access to abortion care for young people. “It was tremendously important for us to have waves of data collection to see how things are evolving over time as the rhetoric and policies evolved,” she explains. “This was the driving force for us to do this research.”
The young people who responded were diverse geographically and by age and included people who identified as transgender. Fifty-six percent were white. Other races represented were Black, Asian, Hispanic, and others.
“What I thought was interesting was most adolescents we spoke with were aware that there were going to be changes to abortion access, and they were able to describe some of the things discussed in their states and some things happening federally,” Allison explains. “This was reassuring to me that adolescents, even though they were not yet able to vote, were very aware that this was happening and how it would impact their peers.”
Another recent study revealed that young people were most likely to go to their parents and friends for social support if they or their partner needed an abortion. Eighteen percent said would seek support from a healthcare provider. Only 9% said they had no sources of social support.3
This research also found that adolescents and young adults have the knowledge and capacity to consider what they would do if they needed an abortion. The participants also understood that they would need financial support and transportation, especially if they had to travel far to reach an abortion clinic.3
There are several ways clinicians can help young people discuss the effects of abortion law changes, including holding conversations about abortion — at least in states where these conversations are safe.
“Clinicians could bring up abortion in conversations with young people and ask them if they’re aware that the laws have changed,” Allison suggests. “They can say, ‘How can I support you as you think about your reproductive health needs?’”
This type of approach helps young people feel the clinician’s office is a safe place to express their fears and feelings. They might trust their provider and ask questions.
“It’s also helpful to have a sheet or summary that gives young people links to specific resources that could be helpful to them,” Allison says. “Give them trusted websites, like PlanBpill.org, and other websites that would be helpful and not give them misinformation.” It would also help if clinics had a list of specific clinics and referral pathways for young people, she adds.
When working with pregnant adolescents, clinicians could help them understand their options. Clinicians could contact the patients a week or two later to see how they are doing and how they feel about their decision.
“The vast majority of young people do engage a family member or guardian [to help],” Allison notes. “If we can support them, that would be very helpful.”
Other advice to clinicians is to educate themselves about their state laws and updates on abortion access as it applies to minors in their state.
“We can safely refer or recommend patients go outside to get care if [it is not] legally allowed in North Carolina,” Allison says. “It’s a service to young people who may not know what’s available to them and what the steps may be. We need to stay one step ahead of young people in our information.”
For clinicians in states that limit what physicians can say about abortion through threats of legal repercussions or institutional rules, there are informal ways to have these conversations. “People are finding creative solutions,” Allison says. “I’ve seen articles where they mention the weather is really nice in this [different] state.”
Some providers could share the name of a website that shares accurate information about where women can obtain a legal abortion. “Have you heard of the website called Abortion Finder? I’m not recommending you use it, but have you heard it exists?” Allison adds.
In places where this is allowed, providers could include the names of safe websites on printed materials that patients could access.
Many adolescents and young adults can name an online resource for abortion information, such as Planned Parenthood, but they may need guidance on how to look for accurate abortion-related information online, research suggests. For example, only a few respondents to a national survey thought they would go directly to abortion-finding websites like AbortionFinder.org, plancpills.org, or ineedana.com. Investigators theorized that this was because most of the respondents considered the question hypothetically and had never needed to find one of these sites. Still, it suggests that reproductive health providers could help patients find accurate, reliable online resources, including the websites mentioned earlier.2
“Not having any conversation or giving any information is against our ethical code of conduct,” Allison says. “[Anti-abortion laws] are trying to muzzle what physicians can say, but there’s always a way to share information.”
For instance, providers could share past experiences and what they might have counseled a patient four years earlier. “It’s not providing direct medical advice, but hopefully they can read between the lines,” Allison says. “We as a society need to acknowledge that young people are more empowered and more aware. This work we’re doing is demonstrating that and bringing young people into conversations as key stakeholders and key demographics impacted by these laws.”
REFERENCES
- Allison BA, Vear K, Hoopes AJ, Maslowsky J. Adolescent awareness of the changing legal landscape of abortion in the United States and its implications. J Adolesc Health 2023;73:230-236.
- Allison BA, Odom RM, Vear K, et al. A nationwide sample of adolescents and young adults share where they would go online for abortion information after Dobbs v. Jackson. J Adolesc Health 2023;73:1153-1157.
- Vear KR, Esbrook E, Padley E, et al. “Time and money and support:” Adolescents and young adults’ perceived social and logistical support needs for safe abortion care. Contraception 2023;126:110128.
Adolescents are fully aware and concerned about how abortion restrictions can affect them, and most use the internet and social media for information on abortion, new research shows.
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