Today, teenagers in Maryland and more than twenty other states have the legal right to get birth control on their own.

But Maryland lawmakers want to make certain kinds of birth control — intrauterine devices (IUDs) and implants — subject to parental approval. And reproductive health advocates say it’s part of a bigger push across the country that could jeopardize teens’ access to care.

State Del. Neil Parrott, a Republican, proposed the bill after a mother said her daughter had a contraceptive implant improperly inserted at a school-based health center. The implant caused the student pain and had to be removed, according to Baltimore’s WMAR-2 News.

Parrott says the bill is necessary to keep parents informed about their children’s health. “The issue really is parents having no knowledge at all,” he told the Frederick News-Post.

But others say that Nexplanon (a brand name for the implant) and the IUD are generally very safe, and that the bill could keep teens from getting reproductive health care they need. A parental permission requirement could block young people in abusive or otherwise unsafe homes from getting birth control, Rebecca Thimmesch, manager of Advocates for Youth’s Free the Pill Youth Council, told Vox. And regardless of home environment, having to notify a parent places an additional obstacle in front of teens seeking birth control, making it more likely they will experience an unintended pregnancy.

While laws specifically targeting methods of birth control are rare, the law is part of a larger pattern of states requiring parental notification and consent for reproductive health services from abortion to childbirth care when teens do have children, Thimmesch said.

“It is really tricky, across the country, for young people to be getting the care that they need safely and confidentially and affordably,” she said. “Any efforts to make that harder are definitely moving in the wrong direction.”

Maryland lawmakers want to require parental consent for teens to get contraceptive implants or IUDs

The story behind the Maryland bill began this fall, when a 16-year-old Baltimore student got a Nexplanon implant at a school-based health center, according to WMAR-2. The city has 17 health centers based at schools, several of which provide birth control.

The Nexplanon is a small rod inserted into a patient’s arm, which can prevent pregnancy for up to five years. It is more than 99 percent effective, according to Planned Parenthood, and serious side effects are rare.

But the Baltimore teen, who has not been named publicly, began experiencing headaches and arm pain. Her mother, Nicole Lambert, took her to a pediatrician, who said the implant had been inserted in the wrong spot on her arm. The doctor recommended that the implant be taken out to avoid complications, including a risk of blood clots, WMAR-2 reported.

The Baltimore City Health Department, which oversees the school-based health centers, did not respond to questions from WMAR-2, citing a pending legal case. Wendy Smith, president of the union representing nurses within the department, said in a statement to the network that while the union would not comment directly, “we do stand behind our members, and I hope the student receives the care she needs.”

Lambert, who hadn’t been notified that her daughter got the implant, was “furious,” she told WMAR-2. “I instantly started crying because just to hear that your child, anything could happen to your child and you didn’t even know what’s going on, it’s a scary feeling,” she said.

Maryland is one of 23 states that allow all minors to consent to contraceptive services, without requiring them to get parental permission, according to the Guttmacher Institute (the District of Columbia also allows all minors to consent). In some other states, laws allow minors to get birth control without parental permission under some circumstances, such as if a doctor determines the minor would face health hazards if not permitted to get contraception.

But after Del. Parrott heard the Lambert family’s story, he decided to spearhead a change to his state’s law. In January, he and several co-sponsors introduced House Bill 53, which would require parental permission before minors in Maryland can get an IUD or contraceptive implant. Other forms of birth control, like the pill or patch, are not affected by the law.

Del. Lauren Arikan, a Republican and one of the bill’s co-sponsors, told the News-Post that the bill was written to focus on forms of birth control “that are really invasive.”

“Not that oral birth control doesn’t cause real issues,” she said, but “this is specifically for things that have serious health concerns.”

The implant and the IUD are very safe — and they’re more effective for teens than other forms of birth control

But others say that while they can have side effects, both the IUD and the implant are generally very safe. Many methods of hormonal birth control carry a risk of blood clots, Dr. Anne-Marie E. Amies Oelschlager, chief of pediatric and adolescent gynecology at Seattle Children’s Hospital, told Vox. But the risks are actually lower with the implant and the IUD than with other hormonal methods, since the implant and IUD do not contain estrogen.

In fewer than 1 percent of cases, Amies Oelschlager said, the implant is misplaced, which can cause arm pain and potentially make the implant less effective. In those cases, doctors recommend removing the device and implanting a new one or using a different method.

But in general, the implant and the IUD are extremely effective in preventing pregnancy among teenagers — 20 times more effective than other methods like the pill, Amies Oelschlager said. Teenagers are more likely than adults to have a contraceptive failure with methods like the pill, where they aren’t able to take their medication as directed.

It’s not just about forgetting to take the pill every day. “It is harder for them to get to a pharmacy to fill a prescription,” and “they may not have the income to be able to do it,” Amies Oelschlager said.

A bill making the most effective types of birth control for teenagers harder to get could do young people more harm than good, advocates say.

Teenagers who are being abused or neglected may not have a safe parent to ask about birth control, Advocates for Youth’s Thimmesch said. LGBTQ young people, who are at disproportionate risk of being thrown out of a home due to homophobia or transphobia, may have an especially difficult time seeking permission.

Safety isn’t the only concern. Requiring a teenager to get a parent’s permission also increases the time the young person has to wait before getting on birth control, Thimmesch said.

Advocates for Youth recommends that teenagers be able to get contraception on the same day they see a doctor for contraceptive counseling, in part because of the difficulties young people face in getting to a doctor or pharmacy in the first place. A delay could make unintended pregnancy more likely.

“Anytime young people are having to take additional steps, it reduces the likelihood that they’re going to be able to get the care that they need,” Thimmesch said.

The Maryland law is part of a bigger trend around the country

The Maryland law is part of a years-long push by lawmakers to require parental notification and consent for various types of reproductive health care, Thimmesch explained. For example, 21 states require parental consent for a minor to obtain an abortion, according to the Guttmacher Institute. Many states require minors to get parental consent for contraception unless they meet certain criteria, like being married or being a high-school graduate. And in North Dakota, pregnant minors must get parental consent for most prenatal care in the second and third trimesters.

Such laws are part of “a general trend of disrespect for young people’s autonomy,” Thimmesch said.

Reproductive health advocates generally support teenagers talking to parents about reproductive health care if it’s safe to do so. “Ideally, we’d live in a world where all young people are comfortable coming to their parents for any type of concern,” Thimmesch said. But rather than mandating consent by law, parents should “be doing the work of becoming an approachable parent for your child,” she said.

In her practice, many teenagers come to a doctor’s visit with a parent, Amies Oelschlager said. But at some point, she will request time to speak with the young patient alone, and “this is often when adolescents will be able to speak more truthfully about sexual activity.”

“We know that adolescents don’t often talk to their family members about everything that they’re doing,” she said, and “we believe that adolescents should be able to access things that are going to improve their long-term health without parental consent.”