Changes to parental consent requirements for abortion in massachusetts and impact on timeliness of care for minors

Objectives Adolescent minors account for 3.2% of abortions in the US. Historically, Massachusetts required parental consent or judicial bypass for minors aged 17 or younger to receive abortion care resulting in delays compared to adults. In December 2020, the Massachusetts state legislature removed this requirement for adolescent pregnant persons aged 16–17 through passage of the ROE Act. This study measured the impact of the ROE Act on timing of abortion for this population. Methods The primary outcome was gestational age at abortion among adolescents aged 16–17 seeking care at Planned Parenthood League of Massachusetts (PPLM) from 2017 to 2021. Our control group consisted of pregnant persons aged 18–19. Our primary analysis was a comparative interrupted time series utilizing a linear model with terms to capture temporal trends, seasonality, the acute phase of the COVID-19 pandemic, prior abortion, and race and Hispanic ethnicity categories. Results Minors aged 16–17 underwent 669 abortions in our study period. Older teens aged 18–19 underwent 2,473 abortions. The ROE Act resulted in a 4.5 day decrease in gestational age at abortion among minors (95% CI, -10.83–1.92). Medication abortion increased among minors (39.3% to 51.7%; p=0.01) and among the control group (49.7% to 61.2%; p<0.01). Conclusions We found evidence that the initiation of the ROE Act led to minors undergoing abortions at earlier gestational ages. This highlights the importance of collecting additional abortion data from 2022 and 2023 to further analyze this trend overall and by race and Hispanic ethnicity. Adolescent minors account for 3.2% of abortions in the US. Historically, Massachusetts required parental consent or judicial bypass for minors aged 17 or younger to receive abortion care resulting in delays compared to adults. In December 2020, the Massachusetts state legislature removed this requirement for adolescent pregnant persons aged 16–17 through passage of the ROE Act. This study measured the impact of the ROE Act on timing of abortion for this population. The primary outcome was gestational age at abortion among adolescents aged 16–17 seeking care at Planned Parenthood League of Massachusetts (PPLM) from 2017 to 2021. Our control group consisted of pregnant persons aged 18–19. Our primary analysis was a comparative interrupted time series utilizing a linear model with terms to capture temporal trends, seasonality, the acute phase of the COVID-19 pandemic, prior abortion, and race and Hispanic ethnicity categories. Minors aged 16–17 underwent 669 abortions in our study period. Older teens aged 18–19 underwent 2,473 abortions. The ROE Act resulted in a 4.5 day decrease in gestational age at abortion among minors (95% CI, -10.83–1.92). Medication abortion increased among minors (39.3% to 51.7%; p=0.01) and among the control group (49.7% to 61.2%; p<0.01). We found evidence that the initiation of the ROE Act led to minors undergoing abortions at earlier gestational ages. This highlights the importance of collecting additional abortion data from 2022 and 2023 to further analyze this trend overall and by race and Hispanic ethnicity.