HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE March 31, 1998 3:08 p.m. MEMBERS PRESENT Representative Con Bunde, Chairman Representative Joe Green, Vice Chairman Representative Brian Porter Representative Fred Dyson Representative J. Allen Kemplen Representative Tom Brice MEMBERS ABSENT Representative Al Vezey COMMITTEE CALENDAR CONFIRMATION HEARINGS: Board of Education Bettye Davis - Anchorage Mike Williams - Akiak - CONFIRMATIONS ADVANCED Alaska Mental Health Trust Authority Board of Trustees Susan LaBelle, MSW - Anchorage - CONFIRMATION ADVANCED Professional Teaching Practices Commission Georgia S. Cast - Bethel Patricia E. Chitty - Nikolaevsk Linda Connelly - Palmer Judith Entwife - Juneau - CONFIRMATIONS ADVANCED State Commission for Human Rights Christine R. Marasigan - Anchorage James H. Chase - Anchorage - CONFIRMATIONS ADVANCED * HOUSE BILL NO. 270 "An Act relating to premarital relationship counseling; amending Rule 9(e)(7), Administrative Rules of Court." - HEARD AND HELD * SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 372 "An Act placing limits on prescribing and providing a contraceptive drug or device to a minor." - HEARD AND HELD * HOUSE BILL NO. 420 "An Act requiring that health care insurers offer certain coverage for treatment of diabetes." - SCHEDULED BUT NOT HEARD * HOUSE JOINT RESOLUTION NO. 58 Proposing amendments to the Constitution of the State of Alaska relating to the education fund. - SCHEDULED BUT NOT HEARD (* First public hearing) PREVIOUS ACTION BILL: HB 270 SHORT TITLE: REQUIRED PREMARITAL COUNSELING SPONSOR(S): REPRESENTATIVES(S) KEMPLEN Jrn-Date Jrn-Page Action 5/02/97 1467 (H) READ THE FIRST TIME - REFERRAL(S) 5/02/97 1467 (H) HES, JUDICIARY 3/31/98 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 372 SHORT TITLE: LIMITS ON CONTRACEPTIVES TO MINORS SPONSOR(S): REPRESENTATIVES(S) DYSON Jrn-Date Jrn-Page Action 1/30/98 2182 (H) READ THE FIRST TIME - REFERRAL(S) 1/30/98 2182 (H) HES, JUDICIARY 3/18/98 2647 (H) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS 3/18/98 2647 (H) READ THE FIRST TIME - REFERRAL(S) 3/18/98 2647 (H) HES, JUDICIARY 3/31/98 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER AL ZANGRI, Chief Bureau of Vital Statistics Department of Health and Social Services P.O. Box 110675 Juneau, Alaska 99811-0675 Telephone: (907) 465-3392 POSITION STATEMENT: Testified in support on HB 270 as amended. LISA TORKELSON, Legislative Assistant to Representative Fred Dyson Alaska State Legislature Capitol Building, Room 428 Juneau, Alaska 99801-1182 Telephone: (907) 465-3467 POSITION STATEMENT: Testified on SSHB 372. CYNTHIA BROOKE, M.D., Representative American College of Obstetricians and Gynecologists 3340 Providence Drive, Number 454 Anchorage, Alaska 99508 Telephone: (907) 563-8588 POSITION STATEMENT: Testified in opposition to SSHB 372. JANE CONARD P.O. Box 2042 Bethel, Alaska 99559 Telephone: (907) 543-3629 POSITION STATEMENT: Testified in opposition to SSHB 372. JENNIFER SCHMIDT P.O. Box 82944 Fairbanks, Alaska 99708 Telephone: (907) 457-2312 POSITION STATEMENT: Testified in opposition to SSHB 372. NANCY ROLLINS P.O. Box 1492 Soldotna, Alaska 99669 Telephone: (907) 262-2622 POSITION STATEMENT: Testified in opposition to SSHB 372. ANGELA MOEHRING 49301B Palmer-Wasilla Highway Wasilla, Alaska 99654 Telephone: (907) 357-5559 POSITION STATEMENT: Testified on SSHB 372. JO CAMPBELL 3701 Amalga Street Juneau, Alaska 99801 Telephone: (907) 789-2080 POSITION STATEMENT: Testified in opposition to SSHB 372. PATRICIA MARK, Representative Anchorage American Civil Liberties Union 419 Barrow Street Anchorage, Alaska 99507 Telephone: (907) 495-0044 POSITION STATEMENT: Testified on SSHB 372. CYNTHIA MOEHRING 4930B Palmer Wasilla Highway Wasilla, Alaska 99654 Telephone: (907) 373-5559 POSITION STATEMENT: Testified on SSHB 372. KAREN PEARSON, Health Programs Manager Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, Alaska 99811-0610 Telephone: (907) 465-3090 POSITION STATEMENT: Testified on SSHB 372. ROBIN SMITH 14100 Jarvi Anchorage, Alaska 99515 Telephone: (907) 345-4407 POSITION STATEMENT: Testified on SSHB 372. ANDREA ELLENSON P.O. Box 877276 Wasilla, Alaska 99687 Telephone: (907) 376-2206 POSITION STATEMENT: Testified on SSHB 372. PETER NAKAMURA, M.D., MPH, Director Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, Alaska 99811-0610 Telephone: (907) 465-3090 POSITION STATEMENT: Testified on SSHB 372. LANA HENLEY P.O. Box 3136 Palmer, Alaska 99645 Telephone: (907) 746-1327 POSITION STATEMENT: Testified on SSHB 372. RON KREHER, Program Policy Analyst Division of Public Assistance Department of Health and Social Services P.O. Box 110640 Juneau, Alaska 99811-0640 Telephone: (907) 465-2680 POSITION STATEMENT: Testified on SSHB 372. BECCA BROWN 536 Park Street Juneau, Alaska 99801 Telephone: (907) 586-1448 POSITION STATEMENT: Testified on SSHB 372. ACTION NARRATIVE TAPE 98-35, SIDE A Number 0001 CHAIRMAN CON BUNDE called the House Health, Education and Social Services Standing Committee meeting to order at 3:08 p.m. Members present at the call to order were Representatives Bunde, Green, Porter and Kemplen. Representatives Dyson and Brice arrived while the meeting was in progress. Representative Vezey was absent. Number 0115 CHAIRMAN BUNDE announced the first order of business to come before the committee was confirmation hearings. Committee members had a packet containing background information and recommendations for each of the nominees; resumes of the nominees had been previously distributed to committee members for their review. He announced the committee would review the recommendations and forward them to the full session of the House of Representatives. It does not reflect the intent of any committee member to vote for or against an individual in further legislative sessions for the purpose of confirmation. Board of Education Number 0232 REPRESENTATIVE JOE GREEN made a motion to advance the slate of nominees for the Board of Education. There being no objection, the confirmations of Bettye Davis and Mike Williams were advanced from the House Health, Education and Social Services Standing Committee. Alaska Mental Health Trust Authority Board of Trustees Number 0285 REPRESENTATIVE BRIAN PORTER made a motion to advance the name of Susan LaBelle for the Alaska Mental Health Trust Authority Board of Trustees. There being no objection, the confirmation of Susan LaBelle was advanced from the House Health, Education and Social Services Standing Committee. Professional Teaching Practices Commission Number 0313 REPRESENTATIVE FRED DYSON made a motion to advance the slate of nominees for the Professional Teaching Practices Commission. There being no objection, the confirmations of Georgia S. Cast, Patricia E. Chitty, Linda Connelly and Judith Entwife were advanced from the House Health, Education and Social Services Standing Committee. State Commission for Human Rights REPRESENTATIVE J. ALAN KEMPLEN made a motion to advance the slate of nominees for the State Commission for Human Rights. There being no objection, the confirmations of Christine R. Marasigan and James H. Chase were advanced from the House Health, Education and Social Services Standing Committee. HB 270 - REQUIRED PREMARITAL COUNSELING Number 0453 CHAIRMAN BUNDE announced the committee would next hear HB 270, "An Act relating to premarital relationship counseling; amending Rule 9(e)(7), Administrative Rules of Court." He asked Representative Kemplen to introduce his bill. Number 0478 REPRESENTATIVE KEMPLEN said HB 270 is an attempt to address one of the fundamental problems of society in terms of broken families and it provides an economic incentive for people contemplating holy matrimony to engage in premarital counseling. He directed the committee's attention to the background information in committee packets; specifically, the study, "Predicting Marital Satisfaction Using PREPARE: A Replication Study" showing a correlation between premarital counseling and the success of the marriage. An excerpt from Policy Review indicates that of the 100,000 couples per year that complete PREPARE, a premarital inventory developed by Lutheran psychologist David Olson, a questionnaire can predict with 85 percent accuracy who will divorce. It's a good indicator of whether or not two people who are contemplating the marriage commitment are compatible. It allows the couple to discuss key issues and to determine how to address those key issues during their relationship. REPRESENTATIVE KEMPLEN explained HB 270 is fairly simple and it establishes an incentive for marriage applicants in Alaska to attend a minimum of four hours of relationship counseling. The marriage license fee for couples attending the counseling is $25 and $300 for couples who have not met the minimum of four hours counseling. He explained HB 270 does not mandate the counseling; it provides an economic incentive for couples to participate in relationship counseling prior to marriage. Number 0701 CHAIRMAN BUNDE wondered if the $300 fee would discourage marriage for people in lower income levels in some areas of the state. REPRESENTATIVE KEMPLEN believes it would serve as an incentive for couples to attend the premarital counseling. CHAIRMAN BUNDE asked what the anticipated cost was for the premarital counseling. REPRESENTATIVE KEMPLEN said counseling done through a social worker is anticipated to cost about $275, whereas if counseling is done through a tribal elder or through a church, it would be easier and less expensive. Number 0755 REPRESENTATIVE GREEN confirmed, "So if I know a couple who decides they don't want the counseling, their fee is $300 and they can go ahead and do their thing. If they want to save some bucks and they go to a minister who has sent off two boxtops and a $20 bill and he's considered a minister by four people that go to his church, does that negate the $275?" Number 0890 REPRESENTATIVE KEMPLEN said it was a possibility based on the definition of "counselor" in subsection (d) of HB 270. Number 0830 REPRESENTATIVE GREEN expressed concern this may be kind of a "limited entry to a license to steal" in that several years ago ministers were declared nonprofit so they didn't have to pay the tax rate, and suddenly everyone was sending away for certificates declaring them to be a minister. His concern was that HB 270 would set up a situation whereby these "ministers" would advertise their services as a way for people to save $275. Number 0890 REPRESENTATIVE KEMPLEN noted he had an amendment he would like to introduce at some point. Number 0920 REPRESENTATIVE TOM BRICE made a motion to adopt Amendment 1 which reads: Page 1, line 5, following (b) Delete all through line 9 Insert "A surcharge of $275.00 shall apply to the fee for all marriage license applications unless the applicants submit acceptable evidence of having received at least 4 hours of relationship counseling. Acceptable evidence of such counseling shall be a certificate attesting under oath or affirmation of the counselor and the parties that the parties have completed at least 4 hours of relationship counseling in the six months immediately preceding application for a marriage license." CHAIRMAN BUNDE objected for discussion purposes. REPRESENTATIVE KEMPLEN explained the department had expressed concern with getting locked into a $25 fee in statute and Amendment 1 allows the flexibility to change the fee without having to introduce legislation. REPRESENTATIVE GREEN asked if it was Representative Kemplen's intention that the remaining language in (b), as it exists, would follow the language in Amendment 1. REPRESENTATIVE KEMPLEN pointed out the language in (b) is replaced by Amendment 1. CHAIRMAN BUNDE removed his objection and asked if there was further objection to Amendment 1. Hearing none, Amendment 1 was adopted. CHAIRMAN BUNDE asked Al Zangri to come before the committee to present his remarks at this time. Number 1000 AL ZANGRI, Chief, Bureau of Vital Statistics, Department of Health and Social Services, testified in support of HB 270 as amended. It is the department's belief that some revenue can actually be generated from this legislation and is attempting to find additional studies and literature that discuss the effect of this legislation. In response to Representative Green's question regarding the impact and effectiveness of this legislation as written, individuals will certainly be able to get around it; however, in order for that to happen someone will have to commit fraud certifying the 4 hours of counseling have been fulfilled. On the other hand, he believed counseling sessions from a minister would be of great help to individuals before making a commitment. He pointed out that most of the ministers in Juneau require a counseling session of at least a full day prior to performing a marriage. Number 1000 REPRESENTATIVE GREEN asked if the department has found in its statistical review there are in fact, charlatans claiming to be ministers. MR. ZANGRI said he was certain those situations do exist, but the department has no way of knowing how many exist because there is no licensing provision. CHAIRMAN BUNDE said, "I would guess there wouldn't be any financial gain there if it was just somebody that wanted to fight the state or the system, but if you can get free counseling or very inexpensive counseling from a legitimate - I use the word (indisc.) ministers ...." REPRESENTATIVE GREEN said he was in favor of the counseling session; he believed that too many people rush into marriage and don't consider certain things. CHAIRMAN BUNDE asked if there were further questions or additional testimony on HB 270. Number 1178 REPRESENTATIVE FRED DYSON asked if Representative Kemplen had had any discussions with Representative Kelly regarding his covenant marriage bill and how these two pieces of legislation might fit together. REPRESENTATIVE KEMPLEN said he has not had discussions with Representative Kelly but he has reviewed Representative Kelly's bill and he believes the two pieces of legislation actually compliment each other. He added the only impact would be in terms of the fiscal note; if Representative Kelly's legislation passes, the fiscal note for HB 270 would be moot because the department's computer system would need to be modified only once. REPRESENTATIVE GREEN understood Representative Kelly's legislation was voluntary, whereas HB 270 was compulsory. Number 1244 MR. ZANGRI explained that in terms of the fiscal note, if both pieces of legislation pass this session, the department would need to change their forms and computer program only once. CHAIRMAN BUNDE noted this was the first hearing for HB 270 and it would be held in committee for further consideration. SSHB 372 - LIMITS ON CONTRACEPTIVES TO MINORS Number 1268 CHAIRMAN BUNDE announced the next bill to come before the committee was HB 372, "An Act placing limits on prescribing and providing a contraceptive drug or device to a minor." He requested that Representative Dyson present his bill at this time. Number 1330 REPRESENTATIVE DYSON said he had been contacted by the parents of a teenage daughter who were outraged to find out their daughter had been provided prescription contraception without the parent's knowledge and without the prescriber doing an adequate job of checking the child's and family's medical records and history. Faced with the deadline of submitting personal bills, he had drafted a bill that contained a provision requiring parental consent; however, after the judge's decision striking down parental consent on abortions, he surmised the parental consent provision wouldn't withstand a court challenge, so he redrafted the legislation so it now requires the medical prescriber to check the patient's and family's medical history to avoid medical risk and to notify the parents. He stated his belief that this will withstand a court challenge. REPRESENTATIVE DYSON said subsequent to that, he had been in contact with U.S. Congressmen Istook and Manzullo and Congressman Istook was outraged to find out that the 13-year-old daughter of one of his constituents was taken to a local clinic by her 37-year- old teacher and was given a shot of depoprovera. The whole situation outraged the parents which has caused them to go forward on the federal level with similar legislation. He also has been talking with professionals in the medical field and has learned there is a series of medical conditions for which some of the prescription contraceptions are counter-indicated; in particular, there are a number of things heart related and stroke related. He said the committee would be hearing testimony from a parent whose child had been put in significant danger as a result of the prescription of a contraception without knowing the family's significant risk for permanent heart damage. He offered to answer any questions. Number 1493 LISA TORKELSON, Legislative Assistant to Representative Fred Dyson, Alaska State Legislature, clarified that it was the daughter of a constituent of Representative Manzullo who was taken to the clinic by her teacher. CHAIRMAN BUNDE said, "It sounds like perhaps two issues here; one of medical malpractice and the other of access to parent's control - perhaps access." REPRESENTATIVE DYSON pointed out HB 372 requires parental notification, not parental control or consent. It's his understanding that here in Alaska, very young girls are becoming pregnant by males who are averaging 7 1/2 to 8 1/2 years older, which from his perspective as a father, speaks of exploitative relationships. He commented the entire system of statutory rape laws is set up on the inordinate amount of pressure males, in particular, can put on young women to exploit them. The goal is to do the best, under existing law and court interpretations, to make sure the medical risk is minimized and the parents are in the information loop regarding their children. Number 1575 REPRESENTATIVE PORTER said, "Just so the record is not ambiguous on the point that the behavior described by the sponsor reminds me of felonious criminal behavior, which it is, so ...." CHAIRMAN BUNDE commented 13 and 7 1/2 certainly should be statutory rape. REPRESENTATIVE DYSON interjected, "Which is not often prosecuted in our jurisdiction." CHAIRMAN BUNDE announced he would begin taking public testimony at this time. He asked Cynthia Brooke to present her comments. Number 1600 CYNTHIA BROOKE, M.D., Representative, American College of Obstetricians and Gynecologists (ACOG), testified via teleconference from Anchorage. She explained that ACOG is a national organization of Board Certified OB/GYN physicians which is a specialty dealing with women's health. Many local ACOG physicians are concerned about recent bills which they feel will have a negative impact on Alaskan women. ACOG is especially concerned by Representative Dyson's bill, SSHB 372. She said contraceptives save lives. A healthy nonsmoking female who carries a pregnancy to full term is six times more likely to die than if she used oral contraceptives. And this is just the beginning of the story. Oral contraceptives alone save this country millions of health care dollars every year. Some people feel this figure is conservative and may extend into the billions of dollars. It does this by preventing about 130,000 hospitalizations annually. This includes hospitalization for women with breast disease, ovarian cysts, anemia, pelvic inflammatory disease and other sexually transmitted diseases, ectopic pregnancy, rheumatoid arthritis, and uterine and ovarian cancer. In addition to the prevention of death and severe illness from unwanted pregnancies, oral contraceptives also have a profound beneficial effect on many diseases in women, including a 50 percent reduction in uterine and ovarian cancer. DR. BROOKE continued that SSHB 372 as amended, would now require parental notification of oral contraceptives for minors. The ACOG believes that teenagers will not want to go to physicians to request contraceptives if their parents will be notified. Teenagers frequently will not admit sexual activity to their parents, the result would be decreased access to teenagers of contraceptives and sexually transmitted disease counseling. In light of the medical benefits of oral contraceptives, it seems this bill would discriminate on the basis of age; minors would not have access to the same health care benefits that older women enjoy. Beyond this, the logic of this bill is not apparent in light of current knowledge regarding teenage pregnancy. Multiple studies have shown that teenage sexual activity is not affected by availability of contraception. Rather, the most successful deterrent to teenage sexual activity is parental openness to discussion of sexual issues with their teenagers. DR. BROOKE stated a recent USA Today article summarized studies from the Center for Disease Control which showed a link between teenagers who delay their first sexual encounter beyond 20 years of age with educational level of their parents. Whether or not a teenager will have intercourse is determined by an internal moral compass which is most profoundly influenced by his or her parents, personal goals and sense of self-esteem. Teenage pregnancy in this country costs $37 billion annually. This is because teenage mothers are significantly less likely to receive a high school diploma, adolescent fathers finish fewer years of schooling and earn less income annually by age 27, children of adolescents are more likely to have health and cognitive disadvantages and to be neglected or abused, the daughters of adolescents are more likely to become adolescent mothers themselves, and the sons of adolescents are more likely to be incarcerated. She concluded on the basis of this information, the position of ACOG is that limiting access of contraceptives to teenagers would increase health care costs significantly and would have a negative impact on everyone. Number 1780 CHAIRMAN BUNDE noted that Representative Dyson had mentioned cases of young women being prescribed birth control without a full knowledge of their medical history. He asked Dr. Brooke if that was standard medical practice. DR. BROOKE responded it is not a standard medical practice and in her experience, she is not aware of any instances where that has happened. People coming into her office to receive contraceptives are given a full history physical, but she can't speak to what happens in other places. CHAIRMAN BUNDE inquired if a doctor were to prescribe contraceptives to a 14-year-old girl, would the doctor be totally dependent on the minor for the medical history or would the doctor have to request a more detailed medical history from the parents. DR. BROOKE said the doctor would be dependent on the minor in terms of the medical history. Overall, teenagers are better off on oral contraceptives than off them; women are at decreased risk for diseases in general on oral contraceptives than off them. Number 1860 REPRESENTATIVE GREEN referred to Dr. Brooke's remarks that the availability of contraceptives doesn't necessarily have any effect on promiscuity of teens and asked if Dr. Brooke had discussed with her peers that HB 372 would deter teens from perhaps seeking contraceptives that might otherwise prevent pregnancies or does it work in reverse. DR. BROOKE stated in her opinion the requirement for parental permission would deter teenagers from getting contraception. CHAIRMAN BUNDE thanked Dr. Brooke for her comments and asked Jane Conard to present her testimony at this time. Number 1895 JANE CONARD testified via teleconference from Bethel on behalf of her teenagers and as a registered nurse. She said her concern with HB 372 is multiple and she highly applauds Dr. Brooke. The problems with a pregnant teen with a heart condition are much worse than a teen not pregnant with a heart condition. She has discussed sex and the ramifications with her two daughters and son and her daughters have received counseling at a family planning clinic. She discussed the various services her daughters received at the clinic. She thought there were other resources available to address some of the concerns that have been expressed rather than changing the possibility of teenagers being able to get access to control their reproductive lives, especially responsible teenagers who have plans for the future. Just because a teenager is under the age of 18 doesn't mean they're incapable of making some good decisions in their lives. While she may not be pleased with all the decisions her teenagers have made, she is pleased that they haven't become pregnant. Speaking as a mother, she believes that reproductive rights for both sexes are important and considering that teenage years are the age of experimentation with many things other than sex, she is hopeful her discussions with her children have impacted their decisions and also that the resources are available for them to seek and receive the proper medical intervention needed to make responsible decisions. REPRESENTATIVE DYSON agreed that some children under 18 years of age are capable of making adult decisions. He asked Ms. Conard at what age did she think children were not capable of making of adult decisions - 13? MS. CONARD responded, "I think if a sexually active 13-year-old came in and told me that they were having sex and were afraid of getting pregnant, they can't find their mother most of the time, live with their aunt or other people around the state, they don't have a guardian, then I think that child needs first to know that some parts of her body should be private - but as you have so rightly said, sometimes these people are preyed upon - I would think that to allow her to become pregnant would be a gross misjustice to her as well as the fact that she's being exploited. As a mother and as a nurse, I would also encourage her and empower her to control parts of her life so that she wouldn't get pregnant and then I would encourage and try to do other intervention so that if she's being preyed upon, that that could be rectified as soon as possible. So, I don't care if it's 10, 11, 5 or 2 - if a child is being abused, it needs to be addressed. But if they're at an age where they can't control anything, where they are being preyed upon, then I think they must have some resource to not add more of a burden on their young lives with an unwanted pregnancy." REPRESENTATIVE DYSON inquired if there were other medical interventions other than contraception and he assumed, abortion, that Ms. Conard felt that parents should be cut out of the loop. MS. CONARD responded that reproductive information or prevention of reproduction should be information that's available to anyone. She would feel very bad if her daughter chose to terminate a pregnancy, but she would also feel bad if her daughter was forced to have a pregnancy with complications and died. She stated her belief that it is incumbent upon parents to be responsible and talk to their children even though she knows it doesn't happen all that often. CHAIRMAN BUNDE thanked Ms. Conard for her remarks and asked Jennifer Schmidt to testify at this time. Number 2125 JENNIFER SCHMIDT testified via teleconference from Fairbanks. As a parent and nurse of 27 years, she urged the committee to oppose SSHB 372. She said it's important to prevent unintended pregnancy in every way possible - through education of teens and parents, encouraging communication within a family but not legislating it, and providing preventative contraceptive methods when requested. She said the local public health clinic provides almost 400 pregnancy tests each year of which a number are young women 19 years of age, but 80 percent of these tests are negative. She said it is unconscionable and in her mind, poor practice, to only provide information and encourage family communication and then let these young girls leave without a more reliable method of birth control. She stated many women with sexually transmitted diseases (STD) are identified when they come to the clinic not for sexually transmitted disease exams, but because they have already had sex and want a reliable method of birth control. These young people may not come in for a STD exam or for birth control if they knew their parents would be notified, but if they hadn't come in for the birth control method, they might suffer from pelvic inflammatory disease or future infertility. It is the practice for the staff at public health centers to encourage young people to communicate with their parents. In terms of medical background, people coming to the public health clinic complete a 3-page health history form and it's surprising how much information these young people have regarding their family's health history. It is incumbent upon the parents to inform their children of health risks in the family so that information can be transmitted to the health care provider regardless of age. She concluded that we do need to encourage communication within families, but legislating it is not the best way. She urged the committee to oppose this legislation. CHAIRMAN BUNDE thanked Ms. Schmidt for her testimony and asked Nancy Rollins to present her remarks at this time. Number 2221 NANCY ROLLINS testified via teleconference from Kenai in opposition to SSHB 372. She is the parent of two teenagers and works for an organization that provides contraceptive methods and exams to teens without parental consent. She stated it is critical to prevent teen pregnancy and access to prescription contraception is a very important part of the whole picture of prevention of teen pregnancy. She pointed out that teens don't need adult permission or parental consent to have sex and most parents who would be outraged with their children being able to obtain contraception, would also be outraged to know their children were having sex. It's much safer to take birth control pills than it is to become pregnant and most health care providers providing prescription contraception do so after taking a complete medical history and giving good counseling to young people about the different methods of contraception, including not having sex at all. TAPE 98-35, SIDE B Number 0007 MS. ROLLINS continued that many teens talk to their parents before coming into a clinic and oftentimes, they will inform and involve their parents after having the exam and receiving the contraceptives. She urged the committee to oppose SSHB 372 for personal and public health reasons. Number 0068 CHAIRMAN BUNDE asked if it is a possibility that encouraging oral contraception will also encourage unsafe sex resulting in more young women becoming susceptible to STDs. MS. ROLLINS said the organization for which she works also provides, encourages and teaches anyone who is at risk of a sexually transmitted disease to use condoms with every active intercourse. She noted there are conflicting studies about whether or not people using oral contraceptives also use condoms. CHAIRMAN BUNDE thanked Ms. Rollins for testifying and asked Angela Moehring to testify. Number 0235 ANGELA MOEHRING testified via teleconference from Mat-Su on behalf of teenagers in the Mat-Su area. She expressed amazement that this discussion was even taking place when sex education is being taught in middle schools. Children should know about the various forms of contraceptives and not be afraid to talk with their parents or other adults. She is of the opinion that most teenagers don't announce to their parents they are having sex. CHAIRMAN BUNDE asked Jo Campbell to come before the committee to present her testimony. Number 0320 JO CAMPBELL testified she is the mother of a 14-year-old daughter and an educator. She said the testimony relating to the medical aspect of birth control sounds great; but her concern generates from finding birth control pills in her 14-year-old daughter's coat pocket. Her daughter has been educated since birth regarding the family's history of congenital heart disease; however, she was taken to the clinic by one of the junior high school nurses and given birth control pills. Ms. Campbell was unsure why her daughter had been feeling ill, but after discovering the birth control pills, she understood the reason. She said her daughter is not the exception. She has worked with at risk kids for 30 years and the availability of birth control pills does not help these children; parental concern and adult guidance is what helps these kids. Taking the adult guidance away from the birth control issue will only lead to trouble. Every week she works with 15 teenage girls, the oldest is 20 years of age with two children, and she doesn't believe the availability of birth control pills prevents these kids from having babies. Also, the general feeling amongst these teenagers is that birth control pills will protect them from getting pregnant, but the fact is it does not protect them from getting sexually transmitted diseases and a teenage girl and teenage boy who thinks she's perfectly safe to have sex will not use a condom. Her contraceptive choice for her children or any other child would be foam and a condom, which will protect them from a number of things. She believes that availability of oral contraceptives will lead to an increase in venereal diseases. She said she is really confused because her kids can't rent skis on their own, she, in her job, cannot give a child an aspirin, her kids can't get their ears pierced before the age of 18 without parental consent, but yet they can get oral contraceptives and get an abortion without her knowing about it. MS. CAMPBELL said the school nurses have indicated they provide follow-up with these kids, but most children need verbal instruction again and again; generally the paper work given to a child is thrown out without even reading about the maintenance information that's necessary with birth control pills. Birth control pills are high maintenance, requiring regular visits to the doctor and follow-up examinations and most kids will not do that. Her concern is that her daughter was not given a choice to call home at the time she was given the birth control pills; not one adult ever asked if she wished to call her mother. She believes that at some point parents should be allowed to make life choices for their children. Number 0664 REPRESENTATIVE DYSON asked how long it would be before Ms. Campbell would know if her daughter's heart was damaged by the birth control pills. MS. CAMPBELL responded the family's congenital heart disease shows up at different times, depending on a number of things. Her daughter may not even have it, but her older daughter has it, she does and her grandmother has it. She explained, "It could show up when she's 20. So, if she took birth control pills from now until she's 20, her body thinks she's pregnant. What happens is your body thinks it's pregnant all this time, then when you go into labor, that's when you croak - it's a heart, blood thing." Number 0720 REPRESENTATIVE DYSON said that existing state law says under examination and treatment of minors, that the provider of medical or dental services shall counsel the minor, keeping in mind not only the valid interest of the minor, but the valid interest of parent or guardian and the family unit as best the provider presumes them. He asked Ms. Campbell if that was the current practice as she understands it? MS. CAMPBELL said no, based on her involvement with teenagers in the course of her job, she doesn't believe these children are being counseled and second, how many 14-year-old children know their family's medical history or would even bother to fill out the questionnaire properly. REPRESENTATIVE DYSON asked Ms. Campbell if she had any knowledge of children being counseled about the valid interests of the parents or guardians. MS. CAMPBELL responded no, most children do as they are told by adults and in these cases where the future consequences are uncertain, they need to have an adult whether it be a parent, a relative, a teacher or whomever, involved in this big decision. CHAIRMAN BUNDE thanked Ms. Campbell for her testimony and asked Patricia Mark to testify at this time. Number 0930 PATRICIA MARK, representative, Anchorage American Civil Liberties Union (ACLU), testified via teleconference from Anchorage. For clarification she asked if the 13-year-old who received birth control had given the doctor an incorrect medical history or if the doctor didn't ask for one at all. CHAIRMAN BUNDE responded the doctor didn't ask in this case. MS. MARK said the ACLU believes the passage of SSHB 372 would be a bad policy decision. She said the Alaska Constitution unequivocally protects the privacy rights of its citizens, including minors. No decision is more private than the decision of whether and when to bear a child. If a teenager has to notify her parents, she will very likely be discouraged from using the birth control. The ACLU believes this legislation will increase the number of teen pregnancies which will in effect increase the number of abortions, which is a much more dangerous procedure. She said that one-third of teen pregnancies end in abortion and there is no reason to increase the number of abortions performed in the state. She said "Section 1(a)(3) says that a minor child who is the parent of a child can give consent to medical services for the minor child. That kind of seems illogical - why once you become a parent can you give consent for your child - I mean, you're not in any better control of knowing your medical history." It appeared to her this legislation was thrown together in haste and suggested taking some additional time to draft a better bill. Number 1056 CHAIRMAN BUNDE asked where in existing law does it state "under examination and treatment of minors that the provider of medical or dental services shall counsel the minor, keeping in mind not only the valid interest of the minor, but the valid interest of parent or guardian and the family unit as best the provider presumes them." REPRESENTATIVE DYSON responded AS 25.20.025. CHAIRMAN BUNDE asked,"I would really be interested in a reaction from the ACLU or anyone in the legal profession about how that's addressed when we have, in this case I suppose, school nurses escorting teenagers to get birth control, if the doctor does not contact the parent, is the doctor in violation of Alaska Statute?" CHAIRMAN BUNDE next asked Cynthia Moehring to present her remarks. Number 1120 CYNTHIA MOEHRING testified via teleconference from Mat-Su. She has a nine-month-old daughter and doesn't think teenagers should have to get a court order to get birth control bills. She said in this day and age, a young woman is expected to have sex by 16 years of age and the last thing anyone wants is unwanted pregnancies and in order to avoid that, young women should be able to get birth control if that's what they want to do. CHAIRMAN BUNDE clarified this legislation does not address a court order, it requires that a parent be notified if contraceptive drugs or devices are prescribed. Teenagers would still be allowed to use all nonprescription forms of birth control if they so choose. Number 1224 KAREN PEARSON, Health Programs Manager, Division of Public Health, Department of Health and Social Services, testified it is the department's belief the best thing is for very young women to not be sexually active; but addressing the fact this bill deals with contraceptive access, she would direct her comments accordingly. She said the information at the top of the handout came from the 1995 Youth Behavioral Risk Factor Survey which was a survey done with 6,000 young men and women in Alaska. The survey shows that out of 3,866 young women ages 15-17, only 669 were using contraceptives, no young women under 15 years of age indicated use of oral contraceptives, 60 percent of the young women who said they were sexually active indicated the use of a condom. The results of the survey reveal a couple of things: there are a great number of sexually active young women who are not using an oral contraceptive. CHAIRMAN BUNDE clarified for the individuals on teleconference there are 13,422 young women ages 15-17 years of age in the state of which 5,956 have been sexually active, 3,866 are currently sexually active, so only about 25 percent of young women between the ages of 15-17 are sexually active. MS. PEARSON said the department was pleased that no young women under the age of 15 said they were using an oral contraceptive. She said one of the disconcerting things to the department was that according to the Bureau of Vital Statistics, between 1980 and 1995 the number of births to young women under 18 grew from 280 to 415, representing a 67 percent increase over a 15 year period. Simultaneously, the births to 18- 19-year-old women held even and births to 20-29 years olds dropped significantly. This indicates that something is happening with the 16- and 17-year-old young women and efforts need to be made in the area if information and education to prevent that dramatic increase in births to this age group. She remarked there are significant physical risks associated with a pregnancy for a young woman. One significant thing which has not been addressed is that babies born to very young women and a very young partner, are at very high risk for abuse and neglect because the parents do not have the maturity to nurture and care for these children. REPRESENTATIVE DYSON asked what is the age difference between the young girls who get pregnant and their male partners. MS. PEARSON said the staff of the Bureau of Vital Statistics had just compiled that information and she would forward a copy to Representative Dyson. Basically, the statistics show that of young mothers age 13, one father was 1-4 years older, one father was 5-9 years older; in the 14-year-old mother category, 12 fathers were 1- 4 years older, one father was 5-9 years older, one father was 10-19 years older, and one father was more than 20 years older; in the 15-years-old moms category, 4 fathers were the same age, 52 fathers were 1-4 years older, 22 fathers were 5-9 years older, 6 fathers were 10-19 years older, and 1 father was more than 20 years older. REPRESENTATIVE DYSON asked why are some contraceptive method prescription and others aren't? MS. PEARSON thought it had to do with the potential medical benefits; the risks and benefit ratio. Using a condom for instance, basically poses no health risk but any kind of medicinal pharmaceutical requires a dispensing authority. REPRESENTATIVE DYSON said in other words the reason that some devices and methods are prescription is because there's a medical risk from utilizing it. He noted that Ms. Pearson opposed this legislation and asked if she was opposed to the section requiring that a prescriber should make good faith effort to get the medical history. MS. PEARSON replied, "What we believe is that good medical practice says that any prescriber, whether prescribing a contraceptive or any pharmaceutical, will always make good faith effort to get all the history and information to make a good diagnosis." REPRESENTATIVE DYSON reiterated his question of whether she was opposed to putting the requirement into law. MS. PEARSON said she believed it was in existing law which Representative Dyson had previously read. REPRESENTATIVE DYSON said, "It absolutely doesn't say that. What it says in that passage is that they're supposed to counsel the child relationship to the family values and family interest. It doesn't talk about the medical stuff and I want to know why all of you who are in this business are objecting to putting good medical practice into the law." MS. PEARSON deferred that to Dr. Nakamura because she's not a prescriber, but she thought it was in medical practice. REPRESENTATIVE DYSON said, "Then it seems to me that all good medical practitioners would say - that's what good professionals do - putting it into law loses nothing and all that you all really are objecting to is the idea that parents might know what's going on with their kids and that knowledge might preclude the kids going and getting a prescription device which by definition has some danger and by definition gives them no protection against almost all the STDs." MS. CAMPBELL interjected the birth control pills given to her daughter were not prescription; they were a sample and not prescribed by a doctor. CHAIRMAN BUNDE indicated he would continue with public testimony and asked Robin Smith to present her remarks at this time. Number 1660 ROBIN SMITH testified via teleconference from Anchorage. She said according to the American College of Obstetricians and Gynecologists in 1994 an estimated 910,600 U.S. teenagers between the ages of 15-19 became pregnant resulting in 505,000 live births, 276,000 abortions and 128,000 fetal losses. That same year nearly 29,000 women under the age of 15 also became pregnant. A comparison of these statistics with other industrialized countries indicates the U.S. teen pregnancy rate is twice as high as in England, Wales and Canada and more than nine times as high as in the Netherlands and Japan. She said SSHB 372 would punish medical professionals who are trying to provide teens with health care which is obviously needed. This legislation simply does not make sense. Multiple studies have shown that teenage sexual activity is not affected by the availability of contraception. She said, "Just today a mother of two teenage boys told me that her son's 19-year- old friend had impregnated a younger women. His father and future grandfather of the baby has indicated that this is none of his son's concern and it is all her problem." Surely, rather than punishing physicians who provide oral contraceptive, which is the most effective contraceptive against pregnancy, perhaps the father of this teenage boy should be punished for not being responsible and for allowing his teenage son to have sex. Teens will have sex and eliminating access to the most effective form of birth control, even simply by parental notification, will not prevent teens from having sex. Birth control prevents unintended pregnancies and it prevents abortion. Doctor/patient privacy also allows for the treatment of sexually transmitted diseases. She said certainly we want and encourage our children to seek help rather than to hide their problem. Teenage pregnancy hurts everyone; young women are less likely to continue their education, children of teen mothers are more likely to be abused, neglected and not to attain their full potential, and these children are more likely to become teen parents and to continue the destructive cycle. She urged the committee to fund sex education programs, family planning clinics and parenting classes, which will better serve communities than this legislation. CHAIRMAN BUNDE noted the committee is in agreement with a number of the areas addressed by Ms. Smith; certainly the committee does not support teen pregnancy, and certainly wants these young women to have the ability to grow up without the burden of an unwanted pregnancy. One of the challenges he's hearing is the other dangers of having sex. MS. SMITH said her concern is that kids will have sex with or without birth control and if a teen goes to a physician or other health professional to get birth control and finds out that her parents have been notified, that word will get spread amongst the peer groups and none of the kids will go to get birth control to prevent the pregnancies. Instead, they'll continue to have sex at a far greater risk. CHAIRMAN BUNDE agreed that teenagers will have sex no matter what, he agreed that withholding birth control will not keep teenagers from having sex, but the birth control pill is not the only form of birth control. MS. SMITH noted that according to a summary on past surveys of teenage pregnancies, one of the biggest things is that boys don't like to use birth control and condoms are the only form of birth control for boys. REPRESENTATIVE DYSON agreed that most of the social problems with very young girls are a result of very irresponsible males. CHAIRMAN BUNDE asked Andrea Ellenson to present her comments at this time. Number 1950 ANDREA ELLENSON testified via teleconference from Mat-Su. She said, "You were just talking about how not having birth control available would not make a teenager quit having sex, but then again before that you were talking about 12-year-olds and 13-year-olds having sex and how many 12-year-olds know how to put on a condom? That's just going to spread AIDS more and it's just going to make more teenagers pregnant and yet oral contraceptives do not stop sexually transmitted diseases but it does stop the pregnancies - or at least helps to. And not having that available will make it a bigger epidemic in the Valley than it is right now." CHAIRMAN BUNDE thanked Ms. Ellenson for her testimony and asked Dr. Nakamura to come before the committee and present his remarks. Number 1990 PETER NAKAMURA, M.D., MPH, Director, Division of Public Health, Department of Health and Social Services, said one of his responsibilities as the Director of the Public Health Division is to review and help direct health policy to make sure that when issues are brought up that can affect health, less harm and more good is done. And in reviewing SSHB 372, there is no question the intent of the bill is positive; to involve parents with their children. However, in looking at the wording and the way in which the bill is proposed causes him significant concern. He said, "It first says that the provider must obtain records of the client and family. That poses a significant barrier. Yes, it's nice to have as much information as possible, but to try to get the medical records of the client and family is a very major task. You have to get individual consent from each of the adult members of that family in order to obtain their medical records. Very often it's not the same provider that the child encounters that provides the medical care to the other parents. So that provides a significant barrier. To do that, you have to inform the parents, which automatically goes against the reason why the child doesn't consult the parent in the first place. They hope to have their medical encounter in confidence. This ruins that opportunity. Giving a written notice to the parent that the minor has requested contraceptives even is more intrusive and again puts the child in confrontation with the parent if they so choose to proceed with their care. The odds are that knowing this, they will not even encounter the physician and as mentioned before, probably the most significant thing to us is that if this child that is sexually active doesn't have an encounter with the provider, they're not going to get the medical consultation and information that's so critical to this child. Not only getting the information about the risks of pregnancies, but the risks of sexually transmitted diseases and the long-term chronic effects related to it. So, probably to us in the health field, it's very critical to have this child come in and make the encounter with the health provider." REPRESENTATIVE DYSON asked if Dr. Nakamura could suggest language that would be less rigorous, but would still place in law that the medical provider must do their best to get the significant medical history of the child to ensure that child's life is not being put at risk. DR. NAKAMURA replied that good medical practice dictates that a medical provider already makes all efforts possible to get as much information about that patient. He added, "If you put any kind of language or requirements in there that dictates a procedure that will break the confidentiality, and you cannot get this information without breaking this confidentiality, then you provide the kind of barrier that would keep this child from coming in for care." REPRESENTATIVE DYSON said, "So another medical practitioner that jumped my bones about this a couple of months ago, said children are going to die because they are prescribed these devices without it. He said they're dying now and he said that's the way it's got to be because we would rather protect the confidentiality and make sure the kids get these devices and avoid the risk of pregnancy and abortion, but they're going to die. And that's just the medical risk of dealing with this client population." DR. NAKAMURA responded that was pretty extreme. A child will have a greater likelihood of dying if she gets pregnant than she will from taking any contraceptive device. REPRESENTATIVE DYSON said that's correct, but for the few for whom these devices and prescriptions are counter-indicated, the risk is significant and Dr. Nakamura's position is that those children should be subjected to that risk out of ignorance rather than be rigorous about getting the information. DR. NAKAMURA said, "Rigorous about getting the information, I totally agree with and I think you'll find any provider that will be rigorous in trying to get as much information. But relative to the risks even to any individual person, the risks from taking contraceptive medications against the risk of medical complications from pregnancy is much higher on the side of pregnancy - for any individual." REPRESENTATIVE DYSON said that may be true, but what Dr. Nakamura was arguing for is medical ignorance. If there's a chance to get that information to protect that population in jeopardy, Dr. Nakamura is arguing in favor of not going after that information. DR. NAKAMURA said, "See, I don't know how you can get that information and compromise this child's health risks by increasing the risk to pregnancy than by providing the service." Number 2240 DR. NAKAMURA said the five-day waiting period is another significant barrier. He remarked it's quite an intimidating procedure for most children to make the choice to come in to see a physician, much less to come in to see a physician about a service that is not the most comfortable to discuss with someone the child is not that familiar with. To make the child come back five days later to receive the service originally sought, will almost maximize the reality that the child will never come back for that second visit. The consequences of failing to get the contraceptive services .... TAPE 98-36, SIDE A Number 0005 DR. NAKAMURA .... and share the information the child is either interested in becoming sexually active or is active, the majority of children have a significant degree even with the best of parents, but there are a number of parents who do not have the ability to communicate and provide the support necessary, which is evidenced by the 15,000 reports of child abuse and neglect every year in Alaska. If a child is forced to encounter that parent for advice and consultation or even to have that parent notified, it raises the risk to that child of additional violence or confrontation. A law mandating the notification would create that situation. In conclusion, he recognized the positive intent of the legislation, but from a public health perspective it's more counter-productive than a benefit. Number 0200 REPRESENTATIVE DYSON said, "Dr. Nakamura, just like you wish that all the parents were ideal, I wish all the medical practitioners were. Certainly, the information I have is anecdotal, but it doesn't seem to me that the medical practitioners are doing the job of being rigorous about exploring the medical risks and I have yet to find - and I hope I'm very wrong - that the dispensers have sat down and complied with the law and counseled the child about not only their best interests, but their family values and the valid interests of the parents. How can we - you particularly from your responsibility - encourage that and check up on it and find out if it's happening?" DR. NAKAMURA said, "I don't have the answer to that, but I can make a very positive statement that you'll find that those health care providers who take the time to deal with this very difficult subject are some of the best providers out there. They take the time to deal with this very difficult issue and have the information that can be made available to that child - whether the child hears it or not, is a question. But I have a great deal of confidence in them and in the health care profession, I'm not just saying physicians, but those individuals who deal with this very difficult problem." CHAIRMAN BUNDE asked who can write a prescription for oral contraception? DR. NAKAMURA replied a physician, a nurse practitioner or physician assistants working under the direction of a physician. He pointed out that the language in SSHB 372 goes beyond oral contraception; it relates to any medical device. CHAIRMAN BUNDE thanked Dr. Nakamura for his remarks and asked Lana Henley to present her comments. Number 0310 LANA HENLEY testified via teleconference from Mat-Su and agreed with Dr. Nakamura's remarks. Her work at the Services for Young Pregnant Teens brings her in daily contact with teen pregnancies. She doesn't believe that teens are more promiscuous today than when she was a teen; both she and her husband had sexual opportunities as teens, but the services available today were not available at that time. Today's generation is more educated and is more open about sex education. She thinks of herself as a good parent to her teenage daughter and teenage son, but she remembers being deathly afraid of her parents when she was growing up even though she knew she could talk with them and if her children have that same fear of talking to her, she wants them to talk to someone, whether it be a doctor, counselor, nurse or whomever. Taking services away from teens is not the answer; there is a need for more counselors in schools and people who are more educated. CHAIRMAN BUNDE thanked Ms. Henley for her comments. He asked Ron Kreher to come forward to testify at this time. Number 0550 RON KREHER, Program Policy Analyst, Division of Public Assistance, Department of Health and Social Services, said much of the testimony has alluded to many of the medical as well as the social concerns regarding this legislation. His comments would be somewhat more prosaic; i.e., the potential impact this legislation would have on public assistance programs with respect to increasing the number of minor parents receiving public assistance. The division believes this legislation is likely to increase the number of minor parents through teen pregnancies. When the federal government adopted the welfare reform law, quite a bit of research was devoted to the impacts of teen pregnancies and it is known that women under the age of 17 who have children are much more likely to become dependent on public assistance and the costs associated with providing services to minor parents is up to 30 percent higher than adults who have children. Also, it is known that children of teen parents, especially those born out of wedlock, are three times more likely to become public assistance recipients than the average population. He said the division believes there will be significant fiscal impacts as a result of this legislation which is indicated on the division's fiscal note. Number 0655 REPRESENTATIVE PORTER asked how the division had determined that 123 pregnancies would result if this legislation were to pass. MS. PEARSON said, "We took the information that we found basically - part of it's in the original bill analysis, but the figures I gave you for the number of young women who are using oral contraceptives, which was 669, the research says that about 41 percent of young women say that if they had to involve their parents they would not seek contraceptives. So we took that 41 percent - brought that down, that's 274 and then the research also says that sexually active women not using a contraceptive, 90 out of 100 will be pregnant at the end of one year. So we took the 90 percent of the 274; that gave us 246 and if we were just going to go straight across, we would say 246 are going to get pregnant and at that point we no longer had any research, we just made an arbitrary and capricious decision that half of those young women would find some other alternative that would work for them - a less reliable, you know, foam or something like that - and so that's how we came up with the number 123. Everything can be backed by research to the 246, but when we said half of that, that was just our best guess of what would likely happen." CHAIRMAN BUNDE asked Becca Brown to come forward to present her comments at this time. Number 0780 BECCA BROWN testified on behalf of herself and supported much of the testimony that had already been presented. She agrees that SSHB 372 is well-intentioned and that it is intended to benefit teenagers and their parents and to promote good communication among families. However, in the end she thinks it's illogical and there are probably more effective ways to this end of helping teenagers and their families. First, she thinks this legislation presupposes that access to birth control figures into an adolescent's decision to engage in sexual activity. Many studies support her own observations that teenage sexual activity is not affected by the availability of contraception and if it's not available - oh, well, they'll do without and come what may. She has read the most successful deterrent to teenage sexual activity is parental openness to discussion of sexual issues with their teenagers. Unfortunately, she couldn't think of a way to mandate parental openness. Also, she thinks this legislation presupposes that all parents are sensitive, supportive and open-minded and she personally, knows that is not the case. Two years ago she worked in a program in Juneau for at risk ninth graders and attended, as a volunteer, several Alaskan Teen Institutes. She has worked with a lot of teens who do not even have one parent, much less two, living with them who could be considered fully functioning, stable, sober adults, so she doesn't think the parent is always the best person to provide counseling. She agrees that teenagers should get counseling from a responsible adult and she hoped that health care practitioners could help fill that void when the parent is not in a position to provide good counsel. She said many of the students she worked with years ago were abused both physically and/or sexually by their families and in her opinion, it's unreasonable to deny these teenagers, many of whom are sexually active, access to birth control because they're afraid or unwilling to talk to their parents, who may be abusive. As an aside, three of the girls she taught are now mothers and her concern is that many of them were not sober while pregnant. She said unintended pregnancy accounts for over three-fourths of all pregnancies among unwed teenagers. She pointed out some of the consequences of unintended pregnancies are increased abortions, dangerous delays in prenatal care and later on, increases in child abuse and neglect. The consequences for teenager mothers are less of a likelihood to finish high school or college and they are more likely to be poor and on welfare public assistance. She stated her belief that anything done to prevent unintended pregnancies will improve the lives of teenagers and hopefully, their offspring who will come later. Teenagers should be encouraged to delay the start of sexual activity and for those who are sexually active, to promote and encourage the use of birth control. MS. BROWN said another issue is that focus is being placed on some anecdotal evidence about health care practitioners who obviously did not live up to their responsibilities, but it was her belief there were existing laws which cover that issue. It seems illogical to her that promoting access to the pill will increase sexually transmitted disease because most health care practitioners, when prescribing the pill, provide a lot of information on sexually transmitted diseases and require a pap smear which is important for sexually active women in preventing and early detection of cancer. MS. BROWN said in conclusion parents don't have to give their signature of approval when their child has sex, don't have to sign for their child to receive prenatal care once they are pregnant, nor do they have to sign for their child to get invasive procedures such as amniocentesis or to get a Caesarian section. Why then should the parent have to sign for their child to get birth control? Number 1120 REPRESENTATIVE GREEN inquired if there had been a significant number of males in attendance at the youth counseling sessions Ms. Brown had attended. MS. BROWN replied it's about 50/50. The counseling sessions she's been involved with in Juneau are run through the National Council on Alcoholism. REPRESENTATIVE GREEN said there had been previous testimony that sometimes males are not responsive or receptive to the use of condoms and he wondered if there was any difference in the use thereof in the number of males who had attended the counseling sessions as opposed to those who haven't gone through some type of counseling or education program. MS. BROWN said she didn't have any hard statistics, but she certainly hopes so. Number 1188 CHAIRMAN BUNDE thanked Ms. Brown for her testimony. He noted that HB 420 and HJR 58 would be heard at a later meeting. Number 1200 MR. KREHER noted that as part of the federal welfare reform law, states that manage to reduce out-of-wedlock pregnancies by a significant portion without increasing abortions are eligible for (indisc.) bonus from the federal government. The state of Alaska has a relatively good chance in the third or fourth year of this process to be eligible for this bonus. The possibility that out- of-wedlock pregnancies might actually increase if this legislation passed could hamper the state's ability to qualify. CHAIRMAN BUNDE thanked everyone for their participation. ADJOURNMENT CHAIRMAN BUNDE adjourned the House Health, Education and Social Services Standing Committee at 5:02 p.m.