Abstract
INTRODUCTION: Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. METHODS: Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors' and parents' reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine's healthcare quality framework, were used in the thematic analysis. RESULTS: Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult's relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor's decision, participants felt they had a duty to intervene to ensure the minor's decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. CONCLUSIONS: Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. POLICY IMPLICATIONS: Removing parental involvement requirements would protect minors' reproductive autonomy and support the provision of equitable, patient-centered healthcare.