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Laws and Policies Affecting Adolescent Health

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Laws and Policies Affecting Adolescent Health LAWS AND POLICIES AFFECTING ADOLESCENT HEALTH by JOHN M. PAXMAN Senior Policy Adviser, The Pathfinder Fund, and Lecturer, School of Public Health, Boston University, Boston, MA. USA and RUTH JANE ZUCKERMAN Judge, Family Court of the State of New York New York, NY, USA WORLD HEALTH ORGANIZATION GENEVA 1987 The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 165 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of health manpower, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other com­ municable diseases including tuberculosis and leprosy; having achieved the eradication of smallpox, promoting mass immunization against a number of other preventable diseases; improving mental health; providing safe water supplies; and training health personnel of all categories. Progress towards better health throughout the world also demands international cooperation in such matters as establishing international standards for biological substances, pesticides and pharmaceuticals; for­ mulating environmental health criteria; recommending international non­ proprietary names for drugs; administering the International Health Regulations; revising the International Classification of Diseases, Injuries, and Causes of Death; and collecting and disseminating health statistical information. Further information on many aspects of WHO's work is presented in the Organization's publications. ISBN 92 4 156095 9 © World Health Organization 1987 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The authors alone are responsible for the views expressed in this publication. TYPESET IN INDIA PRINTED IN ENGLAND 85/664O--Macmillan/Clays-5500 LAWS AND POLICIES AFFECTING ADOLESCENT HEA.LTH CONTENTS Acknowledgements. Pagex 1. INTRODUCTION................................ 1 References and notes. 3 2. BACKGROUND AND GENERAL LEGAL FRAMEWORK. 4 Definition of adolescence. 4 Legislative framework of adolescent health care. 6 General legislation . 6 Legislation on special categories of adolescents. 7 Consent. 8 Legislation on consent . 10 Exemptions from parental consent . 12 The nature of consent . 14 Legal alternatives to consent . 17 Conclusions. 18 References and notes. 19 Legislation. 20 3. HEALTH IN SCHOOLS AND UNIVERSITIES . 22 Health education. 22 Health services. 23 Physical training and sports. 25 Conclusions. 26 Reference. 26 Legislation. 26 4. REPRODUCTIVE HEALTH CARE: BACKGROUND AND GENERAL LEGAL FRAMEWORK. 28 Adolescent sexuality and fertility. 28 Minimum age for marriage . 33 Minimum age for consensual intercourse. 34 Conclusions. 35 References and notes ......... '. 36 Legislation. 37 5. REPRODUCTIVE HEALTH EDUCATION AND INFORMATION. 38 Reproductive health education. 38 Compulsory sex education . 40 Elective sex education. 41 Absence of laws or regulations. 45 v CONTENTS VI Prohibition or restriction of sex education . 45 Reproductive health information . 47 The impact of criminal law . 47 Public morality and obscenity. 49 Counselling. 52 Advertising. 53 Conclusions. 54 References and notes. 55 Legislation. 56 6. A VAILABILITY OF REPRODUCTIVE HEALTH CARE SERVICES 59 Contraception . 59 Acquisition of contraceptives . 60 Doctor's prescription requirement . 60 Regulation of place of sale or distribution . 61 Insertion of IUDs . 61 Access to contraception and consent. 62 Access. 62 Consent ....................'. 67 Pregnancy termination. 70 Abortion on medical grounds. 73 Abortion for reasons particularly relevant to adolescents 74 Social and economic factors, age, marital status 74 Rape, incest, illegal intercourse . 79 Consent as a prerequisite to abortion. 80 Consent of parent, spouse or guardian . 80 Alternatives to parental consent . 81 Right of minors to consent. 82 Counselling on abortion. 84 Procedural requirements. 84 Stage of pregnancy. 85 Screening . 86 Financing pregnancy termination. 86 Concluding remarks. 87 Voluntary surgical contraception . 88 Legal background. 89 Legislation affecting sterilization of adolescents. 90 Consent. 91 Minimum age. 93 Minimum number of living children. 94 Medical indications for voluntary sterilization. 94 Sterilization of mentally ill or retarded adolescents 95 Concluding remarks . 97 Health care for pregnant adolescents. 98 General legislative schemes. 99 Legislation on care in pregnancy . 100 Conclusions ... , . 101 CONTENTS vii References and notes. 101 Legislation. 104 7. HEALTH CARE FOR SEXUALLY TRANSMITTED DISEASE .. General legislative framework ................... I I I 112 Obligation to undergo treatment and disclose contacts Notification .............................. 112 Premarital examinations...................... 112 Criminal sanctions ......................... 113 Access to treatment .......................... 113 Responsibility for ensuring that minors obtain treatment 113 Conclusions ................................ 114 References and notes ......................... 114 Legislation ................................. 115 8. 115 SMOKING ................................... Prohibition of sales to minors .................. 117 Minimum age ............................. 123 Sale, distribution and supply ................. 124 Place of sale ............................. 125 Enforcement .............................. 125 Prohibition of smoking in places frequented by young 127 people .................................. Prohibition of smoking by young people in pUblic 128 places ................................... Restrictions on advertising and promotion of tobacco 131 products ................................ Banning of all advertising .................... 131 Special restrictions affecting adolescents ......... 132 Health warnings (negative advertising) .......... 134 Promotion of anti-smoking health education ....... 136 Conclusions ................................ 137 References and notes ......................... 140 Legislation ................................. 142 9. 144 ALCOHOL USE AND ABUSE ....................... Control of production and trade ................ 147 Prohibition ............................... 152 Control of purchase and minimum drinking age ... 152 Restrictions on access to alcohol ................ 152 Enforcement ............ 156 - . Restrictions on advertising ..................... 157 Health education ............................ 159 Conclu~ons ................................ 162 References and notes ......................... 163 Legislation ................................. 164 10. 166 DRUG DEPENDENCE ........................... Prevention of drug use and abuse ............... 168 Definitions ............................... 174 176 CONTENTS Vlll Lawful prescribing and use of drugs. 177 Prohibition. 178 Educational measures. 179 Treatment and rehabilitation. 182 Identification of drug users. 185 Entry into treatment. 187 Voluntary admission. 187 Compulsory civil commitment . 189 Diversion from the criminal justice system. 191 International agreements . 193 Conclusions. 194 References and notes. 196 Legislation. 199 11. HEALTH CARE FOR THE HANDICAPPED AND DISABLED. 201 Legislative framework . 202 Definitions. 203 Approaches to health care for the handicapped. 205 Health care as a part of comprehensive care . 205 Health care for specific categories of handicap . 205 Elements of health care programmes. 206 Prevention . 206 Detection and reporting . 207 Treatment and rehabilitation. 208 Responsibility for providing assistance to the handicapped 2090 Conclusions. 21 References and notes. 211 Legislation. 212 12. MENTAL HEALTH CARE. 214 History of mental health legislation. 216 Legislative definitions of mental illness and retardation 218 Voluntary commitment for treatment. 221 Access for adolescents . 221 Age of consent to voluntary treatment. 223 Request for discharge. ..
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