Bodily autonomy—or the ability to make decisions about our bodies, health, and sexuality without policing or coercion by others—is essential to living a life with dignity, and yet, in this country, it is not guaranteed to all. The U.S. has a long and sordid history of exploiting and controlling people’s bodies, especially those of Black, Indigenous, and poor people. For youth in foster care, a glaring lack of autonomy and control over their lives and decision making is reflected in their lack of bodily autonomy.
Nearly every decision youth in foster care make requires oversight. Their choices are constrained and their actions surveilled. They may, at times, not be able to obtain health services from their provider of choice or forced to waive their right to confidential medical care. Their health care information may be accessed by adults around them without their consent. Child welfare workers, foster parents, and other caregivers may not talk with them about their sexual and reproductive health for various reasons, including lack of comfort or training, or unclear protocols around how to have these conversations or what they should include.i Their foster parent or caregiver may proactively interfere with their access to health care by, for example, refusing to take them to doctor’s appointments. In some group homes,youth are forced to sign abstinence agreements and others report that staff search their belongings for contraceptives and confiscate those they find. In many states, foster youth must go before a judge if they seek an abortion.
Now, because of how racism has shaped public policies and systems, people who have historically been oppressed, marginalized, and surveilled by systems—including youth in foster care—will undoubtedly be most impacted and further harmed by the Supreme Court’s decision to strike down Roe v. Wade. In a post-Roe world, the bodily autonomy of youth in foster care, which was already limited, will be further surveilled and constrained. Many will be forced into health care decisions they do not want, with lasting consequences.
In response to the overturning of Roe v. Wade, this issue brief reviews state and federal policy levers that can support the sexual and reproductive health and well-being of youth in foster care and puts forth recommendations for strengthening coverage and access to comprehensive care and ensuring autonomy and consent for care.
Youth in Foster Care Lack Coverage for and Access to Comprehensive Sexual and Reproductive Health Care
Even before the recent Supreme Court decision to strike down Roe v. Wade, youth in foster care were forced to navigate unique barriers to accessing sexual and reproductive health care. They often reported not receiving adequate or timely information about available options or services, difficulty obtaining this information and discomfort with seeking it out, and barriers to accessing contraceptives including condoms.6 In one study, less than half of youth in foster care reported receiving information on birth control or knew how to access it. In another, foster youth were more than twice as likely as their peers outside the child welfare system to report not using contraception during intercourse in the last year. It is not surprising then that research has found that youth and young women in foster care are up to two times more likely to have an unplanned pregnancy before age 19 than their peers outside the child welfare system, and that youth in care are at higher risk for sexually transmitted infections (STIs).
When children and youth are in foster care, with few exceptions, they are eligible for Medicaid coverage. Medicaid accounts for 75% of all federal family planning dollars, making it an important lever for ensuring youth in foster care can access this care. Yet key barriers exist. The Hyde Amendment, which took effect just three years after Roe v. Wade, bans coverage for abortion through federally funded programs, including Medicaid, unless the pregnancy is a result of rape, incest, or endangers a woman’s life. As a result, abortion coverage is very limited in the Medicaid program as well as other federally financed programs.ii While the Hyde Amendment limits the use of federal funds for abortions, states have the option to use state-only funds to cover abortions for Medicaid recipients under other circumstances, however only 15 states currently do.iii The other 34 states and the District of Columbia bar the use of their state Medicaid funds for abortions except in limited cases. In addition, several states have attempted to further limit access to abortions for Medicaid recipients.iv In some states, regulation explicitly prohibits child welfare agencies from authorizing abortions on the assumption that it violates the Hyde Amendment and jeopardizes their agency funding. Even when states don’t have explicit policies prohibiting child welfare from providing notification or consenting to a youth’s abortion, caseworkers may impose a prohibition on it for various reasons including uncertainty or confusion around policies relevant to the sexual and reproductive health of youth in care.
Youth in Care Lack Autonomy and the Ability to Consent for Sexual and Reproductive Health Care
Even prior to the reversal of Roe v. Wade, youth in foster care had limited bodily autonomy. States frequently fail to provide youth in foster care with the privacy, rights, resources, and support necessary to make informed choices about their sexual and reproductive health. Decisions about their bodies, relationships, and sexual and reproductive health are constrained or dictated by those around them with significant barriers in place in law and policy. The Supreme Court’s decision to overturn Roe will only make these existing barriers greater, further restricting the rights of youth in care, and limiting access to the supports and services they need to thrive.
Without access to information about available options, youth in foster care are deprived of the ability to make choices about their own sexual and reproductive health and well-being, including choosing to have children, not have children, and to parent the children they have. Youth in foster care often have concerns about privacy that make it less likely they will seek out and access needed services or look for the information they need to make informed choices.