New data capture laws since 1849 governing minors’ legal capacity to consent to sexual health services

A new dataset captures more than 170 years of US state laws governing minors’ legal capacity to independently consent to sexual health services without the involvement of their parent or guardian. The dataset is the largest longitudinal dataset of its kind to date.

The data, published on LawAtlas.org, include state laws from 1849 through 2021 that regulate minors’ legal capacity to independently consent to several specific categories of care, including HIV prevention and treatment and sexually transmitted infection (STI) prevention and treatment, and the minors’ legal right to keep information about their receipt of these services confidential from their parents or guardians.

As of 2021, minors could consent independently to STI/HIV testing and treatment in all 50 states plus the District of Columbia, STI prevention services in 33 jurisdictions, and HIV prevention services in 35 jurisdictions. The largest increase in states allowing minors to consent to STI services occurred during the 1970s. A few states have changed their laws since then, including new limits on capacity to consent.

“The number of states allowing minors to consent independently to STI/HIV services has increased considerably, but these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgements, and neglect of confidentiality concerns,” said Kimberly Nelson, Ph.D., MPH, associate professor at Boston University School of Public Health and School of Medicine and lead researcher on this project.

“Understanding the history, intricate structure, and limitations of these laws is essential to assess their impact on access, to inform clinical practice, to identify areas where additional legal protections are necessary, and, ultimately, to promote sexual health and access to care for US adolescents.”

Pre-pandemic research found that STI cases in adolescents ages 15–24 accounted for approximately half of new STIs in the United States every year.

Guardian consent requirements are a significant barrier to care for minors who are unable or unwilling to involve their parent or guardian when they are seeking STI/HIV services. To address this obstacle, states have enacted statutes granting minors legal capacity to consent to STI/HIV services without their parent or guardians’ consent. Although these state laws are intended to remove barriers to care, research assessing their impact on adolescent health care use is scarce.

“This dataset is an invaluable addition to the resources necessary to support the essential work to facilitate research, practice, and policies that will reduce barriers to STI/HIV care for adolescents and promote adolescent sexual health nationwide,” said Elizabeth Platt, JD, MA, director of research and operations at the Center for Public Health Law Research.