(In paragraph 2, changes “2016” to “2000” and in paragraph 3, corrects researcher’s affiliation.)

(Reuters Health) - The judicial bypass process for abortion in Texas could be used as a form of punishment, allowing officials to humiliate young women for their personal decisions, a small study suggests.

While the process was implemented in 2000 in Texas to protect teens from the negative emotional consequences of abortion, it has the potential to cause emotional harm, researchers report in the Journal of Adolescent Health.

“These laws are more common than people think, and we’ve known little about what the process is like for the adolescents who go through it,” said lead study author Kate Coleman-Minahan of the University of Colorado College of Nursing in Aurora.

In the U.S., 37 states require parental involvement for young women under age 18 to access abortion care. Under Texas law, the judicial bypass process allows teens to seek an abortion without parental consent if they can prove to a judge that they are either mature and well-informed or that obtaining parental consent is not in their best interest.

Since 2016, judges’ capacity to deny cases has been expanded, and the bypass experience is often intensified by other abortion restrictions such as mandatory sonograms, state-authorized counseling, mandatory waiting periods, and gestational age limits, the study authors wrote.

“With these laws, the health and well-being of adolescents is often overlooked,” Coleman-Minahan told Reuters Health by phone.

Coleman-Minahan and colleagues interviewed 20 teens about their experiences trying to obtain a judicial bypass in Texas. They partnered with staff at Jane’s Due Process, a non-profit organization in Texas that provides legal representation and resources for teens facing unintended pregnancies. About 368 minors sought bypass in Texas in 2015 and 2016, and 294 worked through Jane’s Due Process.

The 20 teens were from different areas of Texas. All but three were at least 17 years old during the bypass process; the others were 16.

For some, family trauma was the main motivation for seeking bypass. They often worried about their pregnancy and abortion being discovered and that it might risk their safety. Others were concerned about disappointing or damaging relationships with parents or didn’t feel close to a parent at all.

One teen described her father’s reaction when he discovered she had a boyfriend: “The day he found out, he wanted to kick me out of the house and it was a really, really big conflict so I couldn’t imagine what he would do if I told him, ‘You know what? I’m pregnant.’”

The women also feared judgment and shame from others. One teen said her family is very religious, so if they found out she was pregnant, they’d shame her. Another said her parents would disown her and force her to keep the baby.

“What was most surprising is that many of them felt this process was something they deserved, which shows the internalization of stigma that occurs,” Coleman-Minahan said. “They’ve already learned to rationalize abuse and a general lack of support.”

The interviews revealed that the judicial bypass process is burdensome from a logistical standpoint, often requiring transportation arrangements on multiple days, meetings with attorneys and judges during school or work hours, and lying to parents about where they were. The process also delayed abortion care from a few days to a few months; for one teen, the process advanced her past the gestational age limit of her clinic.

The bypass process is also unpredictable because cases are randomly assigned to a judge, so experiences and outcomes differ vastly, even in the same courthouse, the study authors wrote. Attorneys weren’t always able to prepare their clients or predict the process timeline. For many, the emotional burden was traumatic, and they described going to the courthouse as “nerve-racking” and “intimidating.” They found it difficult to talk to strangers about their family lives and explain why they couldn’t get parental consent. Several women cried during their interviews for this study and said they still think about the hearing, even months later.

Three of the young women were denied judicial bypass. One of them said, during her hearing, “You guys keep telling me I’m not mature enough to make this decision and I don’t know what I’m getting myself into, yet . . . if I’m not mature enough to make a decision like this how am I mature enough to even have a baby and to go through the emotional and physical changes of having a kid?”

Ted Joyce of Baruch College at the City University of New York, who has studied the judicial bypass process in Arkansas but who wasn’t involved with this study, told Reuters Health, “We need more empathy toward kids in this situation. This is not a frivolous decision.”

“As a father of girls, you’d hate to see your daughters struggling with something like this,” Joyce told Reuters Health by phone. “From a humanitarian perspective, teens shouldn’t have to navigate this alone.”

SOURCE: bit.ly/2OBmLZo Journal of Adolescent Health, online September 6, 2018.