Pregnant minor: prenatal care without parental consent

This is the Act that solves a very concrete problem: a pregnant teenager who does not want, or cannot, ask her parents’ permission to see a doctor. Before 1992 a doctor who attended her without that consent was exposed to a claim, so many minors reached prenatal care late or never. Act 27-1992 cuts that knot: a pregnant unemancipated minor may receive prenatal and postpartum care herself, without the prior consent of whoever would legally consent for her. The Act also carries an express boundary, and we publish it exactly as it writes it: nothing in it authorises measures to interrupt the pregnancy or sterilisation services.

Article 1 names two groups: any unemancipated minor woman who is pregnant, and any mentally incapacitated woman who is pregnant. For the minor, the Act asks nothing further: no minimum age within minority, no income, no residence, no health plan, no reason. For the mentally incapacitated woman the Act does set up a signing procedure that ends, where there is no tutor or judicial defender, before the district prosecutor. Article 1 also opens with a declaration broader than the two categories: it is of high public interest to ensure that a pregnant woman, regardless of her age, has access to these services.

• Be pregnant and be an unemancipated minor woman, or a mentally incapacitated woman (Article 1).Verified against the official source
• The minor completes and signs the consent form the Department of Health designs and distributes (Article 3).Verified against the official source

• The Department of Health consent form, which Health provides to public and private professionals and institutions (Article 3).

1. 1

   Step 1: What Article 1 says, which is what matters

   The full sentence: any unemancipated minor or mentally incapacitated woman who is pregnant “may receive pre and postnatal health care and services and counselling services including education in nutrition, in conduct and attitudes protective of the foetus, in evaluation and postnatal care of the newborn, without the requirement of the prior consent of the persons legally called to consent for that minor having to be met.” That last clause is the whole Act. Nobody’s permission is needed.

2. 2

   Step 2: What exactly that care covers

   Article 2 defines it and it is worth having to hand, because it is broader than it sounds: diagnostic studies, physical examinations, vaccination, prescription and administration of medicines, referrals to other health service professionals or institutions for consultations and treatment, surgical procedures associated with the pregnancy or its complications, and any other consultations, counselling services and treatments associated with adequate care during the period after birth. That is, not just the prenatal appointment: it includes vaccines, medicines, referrals and surgery associated with the pregnancy or its complications.

3. 3

   Step 3: The boundary the Act itself sets

   Article 2 closes with a sentence we quote in full because it marks this guide’s limit: “Nothing provided herein may be interpreted as authorising measures to interrupt the pregnancy or to provide sterilisation services to any unemancipated minor or mentally incapacitated woman.” We publish it as the Act writes it. This guide says nothing further on those two subjects, for or against, because this source says nothing further.

4. 4

   Step 4: The form and the only thing that may be charged

   Article 3 orders the Department of Health to establish the implementation rules by regulation, including the design and distribution of the document the pregnant minor completes and signs expressing her consent. The Secretary of Health provides those forms to public and private professionals and institutions. And here is the only charge the Act mentions: private professionals and institutions “may be charged a fee not exceeding the cost of producing the forms.” Note what that means: it is a charge for the form, levied on the private provider. The Act sets no price at all for the medical care itself.

5. 5

   Step 5: The separate route for a mentally incapacitated woman

   Article 3 sets up a different procedure. In the case of pregnant mentally incapacitated women, failing the person legally called to consent, the form is signed by the person accompanying her to receive the services; and the same article says that in the case of pregnant mentally incapacitated women the form shall be signed by her tutor or judicial defender. If there is no tutor or judicial defender, the health official or professional at the institution — public or private — completes the document recording the mental incapacity, the circumstance of the pregnancy and the need for treatment, and sends it to the district prosecutor, who authorises the treatment after learning and, if he deems it necessary, corroborating the information. The Act sets the term: the procedure shall not exceed five days.

6. 6

   Step 6: If a provider tells you they need the permission

   The Act applies equally to public and private institutions: Article 3 expressly names health service professionals and institutions “public or private” when speaking of the form. What this Act does not carry is a consequence: it creates no complaint, forum or sanction for a provider who demands the parents’ consent anyway. If that happens to you, the route does not come from this text. You can turn to the general patient complaint routes, which sit outside this Act and therefore outside what this guide can assert.

Where the service is given: any health service professional or institution, public or private, that attends the pregnancy. Article 3 binds them equally and it is the Department of Health that provides them with the consent form. The Act creates no office, centre or special window one must go to first.

• Believing the minor needs her parents to sign: Article 1 expressly says the prior consent of whoever would legally consent for her is not required.
• Thinking it covers only the prenatal appointment: Article 2 includes vaccination, medicines, referrals and surgery associated with the pregnancy or its complications.
• Reading into this Act something about interrupting the pregnancy or sterilisation: Article 2 itself says nothing provided there authorises it.
• Confusing the form charge with the price of care: the only thing the Act allows to be charged is the cost of producing the form, and to the private provider.
• Applying the five days to the minor: that term belongs to the procedure before the district prosecutor in the route for a mentally incapacitated woman with no tutor.
• Assuming the Act forbids telling the parents: there is no confidentiality clause; what is not needed is their prior consent.
• Believing it binds only public hospitals: Article 3 names public and private professionals and institutions.
• Taking it for granted there is a complaint if you are refused: the Act creates no forum, sanction or remedy against a provider who breaches it.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov