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Contraception: X
journal homepage: www.elsevier.com/locate/conx
Adolescents’ political and personal responses to recent policies
restricting abortion and gender-affirming care
☆
Madeline Quasebarth
⁎
, Vanya Manthena, Sophie Knifton, Lee Hasselbacher
Department of Obstetrics and Gynecology, Section of Compex Family Planning, Ci3 at the University of Chicago, Chicago, IL, United States
article info
Article history:
Received 16 August 2024
Received in revised form 12 December 2024
Accepted 12 December 2024
Keywords:
Adolescent perspectives
Abortion
Gender-affirming care
Qualitative
State policies
abstract
Objectives: Restrictive policies on abortion and gender-affirming care have increased in recent years, par-
ticularly in some Midwest states, and can have a disproportionate impact on young people. We sought to
explore adolescent perspectives on such policies.
Study design: We conducted virtual semistructured interviews with 39 participants aged 16 to 19 residing in
the Midwest between April and June 2023, exploring participant reactions to state policies on abortion and
gender-affirming care.
Results: Analysis revealed most participants opposed these restrictions, expressing concerns about the
politicization of health care and the impact on their lives and the lives of loved ones. Policies also influenced
future living decisions, with many expressing that a state’s policies on abortion and gender-affirming care
would impact whether they wanted to attend college or live there.
Conclusions: This study highlights the largely negative responses of young people who will be voting for the
first time in the 2024 elections to restrictive policies on abortion and gender-affirming care in the Midwest.
Implication: Findings indicate that policy makers should take into account young peoples attitude towards
gender affeiming care and abortion bans when conaidering future legislation.
© 2024 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
The United States has experienced an increase in antiabortion
and antitransgender legislation and rhetoric [1]. These policies can
disproportionately affect adolescents, particularly in the Midwest
(Fig. 1) [2,3]. Compared to adults, adolescents may face additional
barriers to abortion access, such as reduced ability to travel, lack of
familial support, and state regulations that apply only to adoles-
cents’ underage, such as parental involvement laws [1,4]. State re-
strictions on access to gender-affirming care frequently target
adolescents [4–7]. Several studies have examined the broader im-
pact of restrictive laws on abortion and gender-affirming care for
providers and patients, but little research focuses on adolescents’
perspectives [4,8–12]. Gender-affirming care encompasses social,
psychological, physical, and emotional activities that help an in-
dividual align with their gender identity [13].
Prior research demonstrates that adolescents have knowledge and
strong opinions on policies regarding issues of reproductive health,
bodily autonomy, and identity [1,4,14–16]. For instance, a series of stu-
dies drawing on data from a 2022 national text-message survey with
youth aged 14 to 24 revealed that most participants were aware of
changes to abortion legality, and many expressed negative feelings or
general disagreement with these changes [1,4]. These studies also found
that adolescents could identify social and logistical support needs for
seeking out-of-state abortion care [17]. Recent research primarily relies
on survey responses to abortion policy. In-depth interviews exploring
how adolescents think about both abortion and gender-affirming care
restrictions could offer a richer context for understanding the actions
they may take in response to these policies [1,4,17,18].
Our study aims to explore the perspectives and responses of
adolescents in the Midwest, focusing on how they perceive recent
laws regulating both abortion and gender-affirming care. Given the
significant focus on these topics in political discourse, we focused on
hearing from adolescents eligible to vote for the first time in the
2024 presidential election.
2. Materials and methods
2.1. Recruitment
We recruited a sample of English-speaking participants aged 16
to 19 years residing in the Midwest (Illinois, Wisconsin, Indiana,
Contraception: X 6 (2024) 100116
https://doi.org/10.1016/j.conx.2024.100116
2590-1516/© 2024 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
☆
Funding: This research was supported by the Funders for Adolescent Science
Translation. The funder had no role in study design; data collection, analysis, and
interpretation of data; writing of the report; or decision to submit.
]]]]
]]]]]]
⁎
Corresponding author.
E-mail address: mquasebarth@bsd.uchicago.edu (M. Quasebarth),
Iowa, Missouri, Minnesota, Ohio, and Michigan) between April and
June 2023. We determined the age range of participants’ likely ability to
vote in the 2024 presidential election. Participants were recruited via
targeted Instagram ads, email lists, and snowball sampling. Potential
participants completed an online screener that collected demographic
information. The research team then contacted eligible participants for
an interview. In total, we contacted 108 potential participants who
filled out the screener on REDCap for interviews. During consent,
participants verified their state of residence, and the research team
identified 24 participants residing outside the Midwest. Thirty-eight
participants did not respond after three contact attempts and eight did
not show up to their scheduled interview.
2.2. Data collection
Interviews were conducted by MQ VM, and LH, research staff
trained in qualitative data collection. We obtained oral parental con-
sent and assent with minors. Interviews lasted 30 to 45 minutes, were
audio-recorded, and conducted virtually via Zoom. We used a semi-
structured interview guide to explore participant reactions to recent
shifts in state policies on abortion and gender-affirming care. The
semistructured interview guide covered a range of topics, including
questions regarding knowledge, feelings, and responses to such po-
licies. Our interview guide was developed using insight from literature
reviews and iterative feedback from our center’s Youth Advisory
Council, a cohort of 10 to 12 high school students ages 14 to 18 from
across Chicago who advise on our research projects throughout the
year. If needed, we used the World Health Organization’s definition of
gender-affirming care [13]. Participants received a $25 e-gift card upon
completion of the interview. All study activities were approved by the
Institutional Review Board at the University of Chicago.
2.3. Analysis
Interviews were transcribed using a secure third-party transcription
service. The study team, including MQ, SK, and VM, verified all tran-
scripts and removed any identifiable data. We looked for themes
arising from the data and thematic patterns across transcripts [19]. We
utilized intuitive inductive analysis without predetermined categories
for content analysis. Researchers created a codebook through iterative
discussion of themes based on the interview guide and insights from
interviews. Three study team members MQ, SK, and VM coded the
same three transcripts, reviewing line-by-line for coding agreement
after each transcript, then modified the codebook based upon emer-
gent themes. The research team resolved conflicts through iterative
conversations and meetings between the coders. Once the coding team
established agreement, the remaining transcripts were coded in-
dividually by study team members using Dedoose software (version
9.2.012). The researchers created code summaries based on excerpts
from each code and summarized overarching themes for each code.
Further, MQ tallied emotive words used when participants were asked
how they felt about abortion/gender-affirming care restrictions. MQ
then imported this information into a word cloud generator.
2.4. Positionality
Authors are generationally diverse, ranging from Gen X, Millennial,
and Gen Z. One author is from the Midwest, one is from the East Coast,
one is from the Southwest, and one is from outside of the United States.
The majority of the team identifies as White and cisgender women, we
bring varied experiences related to cultural, economic, and regional
identities. These experiences inform how we approach topics while
requiring us to reflect on blind spots. We acknowledge that our posi-
tions as cisgender women and the majority White composition of our
team may have influenced how we interpreted participants’ narratives.
We engaged in reflexivity throughout the research process. We de-
signed our study to center adolescent voices. By using a semistructured
interview guide informed by literature and youth input, we aimed to
minimize researcher-led framing and amplify participants’ lived ex-
periences. The authors made efforts to limit bias when collecting and
analyzing data. We recognize this process is iterative and incomplete;
our goal is to contribute responsibly to research on issues affecting
marginalized populations while holding ourselves accountable to the
communities we work with.
3. Results
We interviewed 39 participants (mean age 17.75) from diverse
racial and sexual backgrounds, with the most common identifiers
being White and cisgender women (Table 1). For one 16-year-old
Fig. 1. Gender identity policy tally and abortion laws in the Midwest in 2023. *The Gender Identity Policy Tally comes from https://www.lgbtmap.org/equality-maps, with high
indicating more protections for gender identity and negative indicating restrictive protections on gender identity, while abortion policy comes from https://www.guttmacher.org/
state-policy/explore/state-policies-abortion-bans. A low gender identity policy tally means that there are few to no policies around protections for gender-affirming care. Medium
gender identity policy tally means that there are a medium number of protections for gender-affirming care. A high gender identity policy tally means that there are a large
number of protections for gender-affirming care. A negative gender identity policy tally means that there are restrictive policies in place against gender-affirming care. Legal
abortion policy indicates that abortion is legal but not protected in the state’s constitution. Protected means that the state has added access to abortion into the state’s con-
stitution. Restrictive indicates that there are some types of abortion restrictions, generally around gestational limits. A total ban means that the state has a total abortion ban.
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
2
participant, we did not confirm they would be 18 by the 2024
election, but the rest would be eligible to vote. Participants lived
across the Midwest, with the majority living in Illinois (39%) or
Minnesota (17%).
Several themes emerged as we explored participants’ reactions to
policies that limit access to abortion and gender-affirming care;
most participants opposed these restrictions, with specific concerns
over the politicization of health care and concerns about living in
states with these types of restrictions and the impact they could
have on their lives and the lives of loved ones.
3.1. Largely negative response to restrictions
With some exceptions, most participants expressed negative
reactions to recent policies that restricted abortion or gender-af-
firming care. In response to abortion policies, many participants
described the feelings they had about restrictions, including feeling
angry and unsafe (Fig. 2). Similarly, many participants described
feeling sad, angry, and disapproving of policies that restricted
gender-affirming care (Fig. 3). Participants noted a clearer under-
standing of abortion restrictions as opposed to gender-affirming care
restrictions. In general, participants could articulate a stronger re-
action to abortion restrictions as opposed to gender-affirming care
restrictions. Participants expressed feelings such as discomfort, un-
fairness, and sadness when talking about abortion restrictions, while
when talking about gender-affirming care restrictions participants
mentioned feelings such as sadness, over-politicization, and con-
cerns around mental health access (Figs. 2 and 3).
3.1.1. Response to abortion restrictions
Many participants voiced opposition to abortion bans; those who
felt negatively about abortion bans highlighted their disagreement
with laws that control personal choices, described a sense that the
country was “regressing,” and observed that these laws impact al-
ready vulnerable populations. As one cisgender woman explained,
“They make me mad, furious. It should be the person’s choice of
their body. Most definitely when we’re living in the United
States… the freest state of all. And it sucks that there’s so many
laws controlling a person while telling them they’re free.”
Several participants felt that abortion restrictions signaled that
the country was headed “backwards” or “in the wrong direction.” A
Table 1
Participant characteristics and demographic information
in a qualitative study of U.S. midwestern adolescents in
2023 (N = 39)
Characteristic N
Age (Mean = 17.75)
16 3
17 15
18 10
19 11
State of residency
Illinois 15
Wisconsin 1
Indiana 5
Iowa 1
Michigan 4
Ohio 6
Minnesota 7
Race
White 14
Black 8
Asian 9
Other 8
Hispanic 8
Not Hispanic 31
Gender
Cisgender woman 27
Cisgender man 8
Transman 1
Other 1
Decline 2
Sexuality
Straight 18
Queer 2
Gay 3
Lesbian 1
Bisexual 7
Pansexual 2
Asexual 3
Other 3
School type
Private 5
Public 34
Geography
Urban 16
Rural 2
Suburban 21
Fig. 2. World cloud of participants feelings about abortion restrictions in a qualitative study of U.S. midwestern adolescents in 2023 (Word cloud created by tallying emotive
words within relevant code excerpts).
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
3
cisgender man observed, “it kind of puts more of restraint on income
disparity and people who might not have that much income and
they’re kind of forcing them to go out of their way to get these
procedures and it’s more expensive for them.” Similarly, a cisgender
woman noted “there’s a lot of evidence I guess, that when bans like
this go into place, then the people who are most affected are the
people who already are vulnerable in the first place or don’t have a
lot of resources. So, it feels frustrating in that it feels a justice issue
as well.”
A few participants expressed discomfort with abortion bans and
concern for health risks—for their future selves, as well as for those
who would have to carry a pregnancy against their will or those who
might seek abortion through unsafe means. One participant who
declined to provide their gender identity described that abortion
restrictions “make me feel violated because I should have the right
to choose how I want to carry out a pregnancy, or if I want to carry
out a pregnancy…It’s very scary because if abortion were banned
and I’m a teenager, if I got pregnant, then I wouldn’t have a choice…
it’s definitely very scary.” Several participants expressed concern for
the lives of children who might be placed for adoption or end up in
foster care if their parent was forced to carry a pregnancy.
Finally, several participants did express mixed feelings about
abortion bans, with some who personally opposed abortion but
disagreed with restrictions and others who felt some restrictions
were permissible.
3.1.2. Response to gender-affirming care restrictions
Most participants were aware of gender-affirming care restric-
tions, though to varying degrees of familiarity, and some had not
heard of them at all. As opposed to abortion-restrictive policies,
participants voiced fewer clear oppositions and more confusion
around gender-affirming care policies. A few participants expressed
confusion about their implications. While some participants felt that
care restrictions for those under age 18 were permissible, many
disapproved of policies that restrict gender-affirming care as a
whole, describing feeling sad, mad, and uncomfortable (Fig. 3). As a
cisgender woman explained, “they feel frustrating to me…and I
guess maybe a little bit hopeless. It feels like people are taking steps
back…It feels like we’re getting farther away from being a place
that’s welcoming to trans and nonbinary people and that allows
people to get the care that they need and deserve.” Similarly, par-
ticipants felt that restrictions came from “a place of fear” or were
“indicative of a misguided desire to enforce a certain ideology on to
the people that is not constitutionally supported.” Others disagreed
with bans because it made them feel uncomfortable, “con-
trolled,” and worried about their friends.
3.2. Concerns about the politicization of medical care
Specifically, most participants articulated some level of fatigue or
frustration with what they viewed as the politicization of both
abortion and gender-affirming care. Many participants mentioned
that there should be a distinction between medical and political
framing of these issues. Most of these participants indicated that
they would prefer lawmakers to be informed by science rather than
political or religious influence when developing policy related to
medical care. As one cisgender woman observed, “I feel like we
really need to consider that these [abortion and gender-affirming
care needs] are medical conditions, sometimes, and medically ne-
cessary… and these are things that really should be left between a
doctor and patient to decide on what is appropriate versus legisla-
tion at a state or national level.”
3.2.1. Concerns specific to abortion access
Participants voiced frustration with the role of policymakers,
especially those without medical training, in determining access to
abortion care. As a cisgender woman explained:
“It frustrates me a lot because I feel like a lot of the legislators
who pass these bans … don’t actually have any scientific basis on
what they’re talking about … I feel like there’s just so many facts
around abortion that just not considered facts by the people who
are passing the laws…So when I think about it, … a lot of these
people should not be in the position to be making these rulings.”
Another cisgender woman suggested that abortion “should just
be treated as another thing you talk about with your doctor and with
yourself and with your family.” One participant who declined to
share their gender explained that in an ideal world they would like
to have “somebody” who is impartial decide what happens with
abortion care, they did not feel like this reflected the reality of the
current U.S. political system. Several participants suggested that
politicians prioritized politics over the health and well-being of
those seeking abortion care; as one cisgender woman explained, “I
feel like a lot of politicians are acting in the interest of either their
own personal interests or their party’s, so I don’t know how much to
trust them.” Similarly, others pointed to abortion restrictions as an
indication that “church and state” are increasingly intertwined.
Several participants mentioned that the politicization of abortion
also made it confusing to discuss abortion with peers without
talking about politics.
3.2.2. Concerns specific to gender-affirming care access
When asked about responses to restrictions on gender-affirming
care, there was a similar resistance to policy-making that restricts
Fig. 3. World cloud of participants feelings about gender-affirming care restrictions in a qualitative study of U.S. midwestern adolescents in 2023 (Word cloud created by tallying
emotive words within relevant code excerpts).
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
4
access to health care. Many participants thought that no one should
restrict anyone’s ability to choose gender-affirming care. Some par-
ticipants thought rules should be made by medical experts in the
field, such as doctors, stipulating that the group of experts should be
diverse.
As one cisgender man explained, “[gender-affirming care is] an
issue of medical autonomy, and your doctor, rather than the gov-
ernment, is in the best position to know what is the best care for
you.” Another echoed this sentiment, describing feeling “very ner-
vous” about restrictions on gender-affirming care because “it seems
like things are being banned based on some people’s opinions rather
than what is, I guess, best for the nation, and where that type of
thinking will lead us.”
Participants felt that laws around gender-affirming care are “not
the government’s place” and that it was more about “political dis-
course.” Some participants expressed specific concern that the
policy focus on gender-affirming care stemmed from political
strategy. Another cisgender man echoed this, suggesting that those
opposing gender-affirming care were “creating fake moral panic in
the minds of parents.”
3.3. Restrictive policies influence residency preferences
3.3.1. Residency preferences in response to abortion restrictions
Some participants felt that abortion policy would not affect their
future choices because they did not think they would need to access
abortion, most participants indicated that the state’s abortion policy
would affect where they would want to live in the near future.
Participants highlighted specific concerns around living in a state
with restrictive abortion policies, including the high incidence of
sexual assault on college campuses, burdens associated with having
to travel for abortion care, living in a state with limited freedoms and
the relationship to other policies in the state, and considerations for
future children.
Several participants voiced explicit concern about moving to an
abortion-restrictive state for college, citing fears about sexual assault
and the possible difficulties in accessing abortion care if needed. For
example, a cisgender woman stated:
“It is no secret that a lot of girls who go to college are sexually
assaulted. So, I feel like being able to, at minimum, rely on the
fact that if something were to happen, I would be able to access
an abortion is something that I’ve definitely taken into account.
So, any states that are planning or have already planned a lot of
abortion practices and are very restrictive on it, I would im-
mediately cancel it out of my choice.”
Another cisgender woman explained that “because you never
know what can happen … I ain’t taking the risks … I’m not going to
leave a state to get an abortion…Not doing it” as the primary reason
for her desire not to move to a state with restrictive abortion po-
licies.
Beyond specific concerns of assault, some participants voiced a
worry that states with abortion restrictions threatened their broader
sense of safety and autonomy. A cisgender woman explained that
she would not go to college in a state with abortion restrictions
because she would not want to live somewhere that “restrict[s]
people from their body decisions… [that would prohibit] anything
that’ll make them feel in safe hands.”
Some participants felt “that abortion policy is indicative of other
laws that may be passed later.” These participants explained that
they had concerns about living in a state with restrictive abortion
policies since they may reflect or lead to other restrictive policies.
The above participant, a cisgender woman, articulated that “I would
probably go in the state that is more lenient with abortion, because I
think it’s a good measure of how much that state values bodily
autonomy.” Even for a few participants who could not become
pregnant, abortion represented a significant marker for them on
state policy. A cisgender man explained that even though he was
queer he would not want to live in a state with abortion restrictions
as he felt “there’s not a good sense of acceptance in that state…so
definitely thinking about the community and I guess the general
political sense in that way.”
Some participants did not feel that a state’s abortion restrictions
would affect their choices in the near term but did explain that they
would want to raise future children in a state without restrictions. A
cisgender woman explained this distinction by saying: “I would say
when I was older, it [a state’s restrictive abortion policy] would
matter to me … for my kids … I would want to raise them in an area
where they wouldn’t have to hear about how their choices aren’t
available for them.”
3.3.2. Residency preferences in response to gender-affirming care
restrictions
When asked whether a states’ policies on gender-affirming care
would impact where they would want to live in the future, partici-
pants expressed various opinions, with many reporting they would
have an effect. Among those explaining it would impact their re-
sidency preferences, participants cited: general disagreement with
policies unsupportive of gender identity and gender-affirming
care, specific concerns centering friends and family, and considera-
tions for future children.
Like concerns with abortion, some participants voiced resistance
to living somewhere with restrictions on gender-affirming care be-
cause of what it communicated about the state’s values. As a cis-
gender woman summarized, “I wouldn’t want to be in, or work in a
community that doesn’t support gender-affirming care, or doesn’t
respect people’s sexual orientation, or gender…identity…that’s why
I would definitely probably pick Illinois, or the state that does sup-
port it.” A few noted that if a state restricts gender-affirming care,
they are more likely to restrict other freedoms. Another cisgender
woman asked, “if they’re not accepting of that [gender-affirming
care], then what else are they not accepting of?”.
A few participants said that they would not want to live
somewhere that restricts gender-affirming care because they have
loved ones who are transgender. A cisgender queer woman ex-
plained that “I am…in a long-term relationship with someone who
is nonbinary…state policy around gender-affirming care would be a
big factor in where we decide to stay or move to.” In general, par-
ticipants who had indicated that they had loved ones or they
themselves were queer were more likely to use strong language to
describe locations with gender-affirming care restrictions than
those who did not disclose a personal connection to the queer
community.
Not all participants who identified as queer felt that gender-af-
firming care policies would change their near future life choices. A
transman felt that there was a distinction between a future college
community and the overall state’s policy. “I have that stuff legally
changed [gender identity], so it [the state’s policy] wouldn’t concern
me as much because I don’t think they could really do anything”; he
continued that despite not feeling fear over state policy, “I’d want to
be in a place that is respectful.”
Several participants expressed concern for how restrictions on
gender-affirming care would impact their future children. These
participants expressed that they want their children to grow up in
supportive and gender-inclusive environments, which would con-
tribute to why they would ultimately prefer to live in a state without
bans on gender-affirming care. A cisgender woman summarized this
response: “if I were older and I had a family and one of my children
were transgender, that would 100% affect where I would choose to
go for a job.”
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
5
Several participants said that a states’ policies on gender-af-
firming care would not affect where they would want to live in the
future. These participants explained that policies on gender-af-
firming care would not impact their decision because they do not
personally want or need gender-affirming care. Several participants
were unsure about whether a states’ policies on gender-affirming
care would impact their decision. Some participants felt “like I ha-
ven’t thought that far ahead.”
4. Discussion
Our study aligns with existing literature suggesting adolescents
have strong feelings about restrictions on abortion and gender-af-
firming care [1–4,14,17]. Themes in our study reinforce and add
context for findings by Allison et al. [4], which outlines a qualitative
analysis of open-response texts in a national survey of adolescents
(age 15–25) regarding abortion access. As in our findings, re-
searchers in that study reported that predominant emotions about
abortion restrictions included feeling scared and sad (42%), with
reasons for these feelings ranging from favoring a right to abortion to
concern for autonomy, safety, and choice [4]. Our study also con-
tributes to knowledge regarding adolescent perspectives on gender-
affirming care restrictions and access; past research with adoles-
cents and parents has suggested similar negative emotions and
concerns [20–22].
Participants in our study expressed concerns about the politici-
zation of health care with these laws. In other areas of health, such
as with COVID-19, research has demonstrated that politicization of
health topics can result in attention fatigue, distrust, anxiety, and
loss of sleep, especially for those who were younger and politically
engaged [23,24]. Gen Z has proven to be more politically involved
than previous generations, posing a higher vulnerability to political
fatigue due to their political engagement [25,26].
Most participants were aware of restrictive national policies
across the United States [27]. At the same time, adolescents in our
study—similar to those in a recent national poll—preferred not to live
in states with these restrictions, such as Indiana or Iowa [28]. Fur-
thermore, the complex reasons adolescents gave for why restrictive
policies would affect where they want to live in the future suggest
that adolescents can conceptualize the impact of restrictions on
their health and life choices, and those of loved ones. Participants
cited concerns over college sexual assault, the burdens of traveling
out of state for abortion, the impact on transgender friends and fa-
mily, and the implications for the well-being of future children. Such
awareness points to adolescents’ ability to consider short and long-
term implications of health care decisions, supporting laws that
allow adolescents to be decision-makers in their own care [1,29–34].
Our sample size limits generalizability, and results may reflect
greater participation from those adolescents with stronger opinions
on these topics and who were able to obtain parental consent, re-
sulting in selection bias. Participants were not evenly distributed
across states nor gender identity. Another factor possibly affecting
results was that we talked to very few participants who supported
restrictions. Our approach of using social media ads that only tar-
geted age and geographic region may have ensured a broader re-
presentation than recruitment approaches in other settings.
Findings suggest that adolescents in this study generally oppose
restrictions on abortion and gender-affirming care and experience
negative emotions, such as anger, fear, sadness, and concern about
the politicization of health care in response. Many participants also
expressed a level of willingness to relocate if state policies did not
facilitate a safe environment for themselves or future families.
Policymakers should prioritize adolescents’ voices, perspectives, and
mental well-being when enacting laws that impact their rights and
access to care.
Author contributions
S.K.: writing – review & editing, formal analysis. L.H.: writing –
review & editing, methodology, investigation, funding acquisition,
conceptualization. M.Q.: writing – review & editing, writing – ori-
ginal draft, supervision, project administration, formal analysis,
conceptualization. V.M.: writing – review & editing, project admin-
istration, formal analysis, data curation.
Declaration of Competing Interest
The authors declare that they have no known competing fi-
nancial interests or personal relationships that could have appeared
to influence the work reported in this article.
References
[1] Allison BA, Vear K, Hoopes AJ, Maslowsky J. Adolescent awareness of the changing
legal landscape of abortion in the United States and its implications. J Adolesc
Health 2023;73(2):230–6. https://doi.org/10.1016/j.jadohealth.2023.04.008
[2] Movement Advancement Project. Snapshot: LGBTQ equality by state. 2023.
https://www.lgbtmap.org/equality-maps (accessed November 15, 2024).
[3] Guttmacher Institute. State bans on abortion throughout pregnancy. https://
www.guttmacher.org/state-policy/explore/state-policies-abortion-
bans (accessed April 9, 2024).
[4] Allison BA, Odom RM, Vear K, Hoopes AJ, Maslowsky J. A nationwide sample of
adolescents and young adults share where they would go online for abortion
information after Dobbs v. Jackson. J Adolesc Health 2023;73(6):1153–7. https://
doi.org/10.1016/j.jadohealth.2023.05.010
[5] Hughes LD, Kidd KM, Gamarel KE, Operario D, Dowshen N. “These laws will be
devastating”: provider perspectives on legislation banning gender-affirming
care for transgender adolescents. J Adolesc Health 2021;69(6):976–82. https://
doi.org/10.1016/j.jadohealth.2021.08.020
[6] Miller-Jacobs C, Operario D, Hughto JMW. State-level policies and health outcomes
in U.S. transgender adolescents: findings from the 2019 Youth Risk Behavior Survey.
LGBT Health 2023;10(6):447–55. https://doi.org/10.1089/lgbt.2022.0247
[7] Schanzle J, Kennedy J, Rahman F, Hill S. 4. Anti-trans legislation in the US: po-
tential implications on self-reported victimization and suicidality among trans
youth. J Adolesc Health 2023;72(3):S17–8. https://doi.org/10.1016/j.jadohealth.
2022.11.018
[8] Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K.
Mental health outcomes in transgender and nonbinary youths receiving gender-
affirming care. JAMA Netw Open 2022;5(2):e220978. https://doi.org/10.1001/
jamanetworkopen.2022.0978
[9] Baker CC, Smith E, Creinin MD, Chen MJ, Moayedi G. Texas Senate Bill 8 and
abortion experiences in patients with fetal diagnoses. Obstet Gynecol
2023;141(3):602–7. https://doi.org/10.1097/aog.0000000000005071
[10] Hartwig SA, Youm A, Contreras A, Mosley EA, McCloud C, Goedken P, et al. “The
right thing to do would be to provide care… and we can’t”: provider experiences
with Georgia’s 22-week abortion ban. Contraception 2023;124:110059. https://
doi.org/10.1016/j.contraception.2023.110059
[11] Jerman J, Frohwirth L, Kavanaugh ML, Blades N. Barriers to abortion care and
their consequences for patients traveling for services: qualitative findings from
two states. Perspect Sex Reprod Health 2017;49(2):95–102. https://doi.org/10.
1363/psrh.12024
[12] Thaxton L, Gonzaga MI, Tristan S. Abortion policy: legal, clinical, and medical
education considerations. Clin Obstet Gynecol 2023;66(4):759. https://doi.org/
10.1097/GRF.000 00000 0000 0824
[13] World Health Organization. Gender incongruence and transgender health in the
ICD: frequently asked questions. WHO. https://www.who.int/standards/
classifications/frequently-asked-questions/gender-incongruence-and-
transgender-health-in-the-icd (accessed December 19, 2024).
[14] Brandon-Friedman RA, Tabb A, Canada M, Imburgia T, Swafford TR, Fortenberry
JD, et al. 14. The perspectives of gender-diverse youth and caregivers coping with
legislation banning gender-affirming medical interventions. J Adolesc Health
2024;74(3):S8–9. https://doi.org/10.1016/j.jadohealth.2023.11.033
[15] Franceschi CL, Richards M, Sheeder J. 189. Young people’s knowledge and under-
standing of abortion laws in a non-restrictive state following the Dobbs decision. J
Adolesc Health 2024;74(3):S100–1. https://doi.org/10.1016/j.jadohealth.2023.11.388
[16] Weiner S. States are banning gender-affirming care for minors. What does that
mean for patients and providers? Assoc Am Med Coll. 2024. https://www.aamc.
org/news/states-are-banning-gender-affirming-care-minors-what-does-mean-
patients-and-providers.
[17] Vear K, Esbrook E, Padley E, Maslowsky J, Allison BA, Hoopes AJ. “Time and
money and support”: adolescents and young adults’ perceived social and logis-
tical support needs for safe abortion care. Contraception 2023;126:110128.
https://doi.org/10.1016/j.contraception.2023.110128
[18] Wu JP, Van Sparrentak M, Waselewski M, DeJonckheere M, Remen R, Chang T.
Youth opinions about Title X funding and policy in the United States: a mixed
methods text message survey. Contraception 2020;103(2). https://doi.org/10.
1016/j.contraception.2020.10.008
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
6
[19] Green J, Thorogood N. Qualitative methods for health research. 4th ed. London,
UK: Sage Publications; 2018.
[20] Abreu RL, Sostre JP, Gonzalez KA, Lockett GM, Matsuno E, Mosley DV. Impact of
gender-affirming care bans on transgender and gender diverse youth: parental
figures’ perspective. J Fam Psychol 2022;36(5):643–52. https://doi.org/10.1037/
fam0000987
[21] Gridley SJ, Crouch JM, Evans Y, Eng W, Antoon E, Lyapustina M, et al. Youth and
caregiver perspectives on barriers to gender-affirming health care for trans-
gender youth. J Adolesc Health 2016;59(3):254–61. https://doi.org/10.1016/j.
jadohealth.2016.03.017
[22] Sequeria GM, Guler J, Reyes V, Asante PG, Kahn N, Anan Y, et al. Adolescent
and caregiver perspectives on receiving gender-affirming care in primary
care. Pediatrics 2023;152(4):e2023062210. https://doi.org/10.1542/peds.2023-
062210
[23] Shi C-F, So MC, Stelmach S, Earn A, Earn DJD, Dushoff J. From science to politics:
COVID-19 information fatigue on YouTube. BMC Public Health 2022;22(1):816.
https://doi.org/10.1186/s12889-022-13151-7
[24] Smith KB. Politics is making us sick: the negative impact of political engagement
on public health during the Trump administration. PLoS One 2022;17(1):
e0262022. https://doi.org/10.1371/journal.pone.0262022
[25] Medina A. Gen Z.voted at a higher rate in 2022 than previous generations in their
first midterm election. Circle.tufts.edu. https://circle.tufts.edu/latest-research/
gen-z-voted-higher-rate-2022-previous-generations-their-first-midterm-
election (August 7, 2023).
[26] PPRI. A political and cultural glimpse into America’s future. PRRI. 2023. https://
www.prri.org/wp-content/uploads/2024/01/PRRI-Jan-2024-Gen-Z-Draft.pdf
(accessed December 19, 2024).
[27] Kruesi K, Mulvihill G. Some state abortion bans stir confusion, and it’s uncertain
if lawmakers will clarify them. AP News. https://apnews.com/article/abortion-
exception-lawsuit-legislature-confusion-b2808df90937e96887aa4e1f9c565771
(December 20, 2023).
[28] Gallup, Lumina Foundation. The 2024 state of higher education. Gallup. 2024.
https://www.luminafoundation.org/wp-content/uploads/2024/05/State-of-
Higher-Education-2024.pdf (accessed December 19, 2024).
[29] Akers AY, Schwarz EB, Borrero S, Corbie-Smith G. Family discussions about
contraception and family planning: a qualitative exploration of Black parent and
adolescent perspectives. Perspect Sex Reprod Health 2010;42(3):160–7. https://
doi.org/10.1363/4216010
[30] English A. Adolescent experiences and the policy landscape for sexual and re-
productive health services: past, present, and future. J Adolesc Health
2019;64(1):1–2. https://doi.org/10.1016/j.jadohealth.2018.10.012
[31] Hasselbacher L, Truehart A. Forced parental involvement in youth abortion
creates obstacles to access, even with judicial bypass. J Adolesc Health
2021;68(1):5–6. https://doi.org/10.1016/j.jadohealth.2020.10.013
[32] Kavanagh EK, Hasselbacher LA, Betham B, Tristan S, Gilliam ML. Abortion-
seeking minors’ views on the Illinois parental notification law: a qualitative
study. Perspect Sex Reprod Health 2012;44(3):159–66. https://doi.org/10.1363/
4415912
[33] Ralph L, Hasselbacher L. Adolescents and abortion restrictions: disproportionate
burdens and critical warnings. J Adolesc Health 2023;73(2):221–3. https://doi.
org/10.1016/j.jadohealth.2023.05.002
[34] Ralph L, Brindis C, Shields WC. Mandating parental involvement in adolescents’
abortion: implications of a short-sighted policy. Contraception 2006;73(2):
211–3. https://doi.org/10.1016/j.contraception.2005.10.002
M. Quasebarth, V. Manthena, S. Knifton et al. Contraception: X 6 (2024) 100116
7
