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Take Control!
TAKE CONTROL!
Of Your Reproductive Health
You may be reading this guide because you are facing an unplanned pregnancy. This experience can be very difficult and emotional for many women. You should know that you are not alone; 50% of all pregnancies are unplanned. This guide provides you with basic information that you need to know if you are facing an unplanned pregnancy. In this guide you will find information regarding your rights in accessing reproductive health care, methods to prevent pregnancy, options when you are faced with an unplanned pregnancy and resources for paying for your reproductive healthcare. If you need further support or information, call ACCESS Healthline at 1-800-376-4636.
In this Guide:
Know Your Reproductive Rights
Minors' Rights
Undocumented Immigrants' Rights
Preventing Pregnancy
Your Options
Paying for Care
Know Your Reproductive Rights!
You should be the one who makes decisions about your health! You should be the one who decides when and with whom you have sex, whether you want to have children and when, and how you protect yourself from pregnancy and STI/STDs.
You have the right to make many of these choices on your own and confidentially (where the doctor or clinic cannot tell anyone that you received services), and there are programs that can help you get what you need. In order for you to be able to take control of your life and your health, you have to know your rights!
MINORS' RIGHTS
ABORTION
Laws
According to California laws (California Family Code 6925) a minor (a person who is under 18 years old) can consent to many types of medical care and receive the care confidentially, except sterilization (i.e., getting your tubes tied or a vasectomy) and some mental health treatments. Under some California Health and Safety Codes [123110 (a) and 123115 (a)], a health care provider is not allowed to tell your parents or guardians or ask them for permission for you to receive or ask about any pregnancy-related services. California DOES NOT require parental consent or notification for a minor to seek information about or have an abortion.
Services
Some of the specific services you have the right to receive on your own are:
- pap smears, family planning and birth control, including emergency contraception (to learn more about this check out our preventing pregnancy page) While California Health & Safety Code 123450 denies access to abortion services without parental notification, the California Supreme Court has ruled that this law is unconstitutional.
- testing and treatment for STIs/STDs
- HIV/AIDS testing and treatment
- pregnancy testing and prenatal care
- abortion services
- some outpatient mental health services
** State law requires that parents or guardians of a minor receiving outpatient mental health treatment or counseling be contacted, unless the doctor providing the mental health services says that it’s not ok to inform the parents. There is legislation pending that would allow minors older than 12 to be able to legally consent to their treatment.Paying for Care
If a minor wishes to receive confidential health care coverage to cover the costs of an abortion, she can apply for Medi-Cal Minor Consent Services. All the minor is required to provide are pay stubs if she is employed. An ID is not required. (See our section on How to Pay for Care for more information about this and other programs) Even if the minor has health coverage under her parents, if there is a potential breach of confidentiality she can still apply for Minor Consent Services.
PRENATAL CARE
Laws
Minors can also seek and receive prenatal care without the consent or knowledge of anyone.
Paying for Care
Medi-Cal Minor Consent Services can cover the costs of prenatal care for minors wishing to keep their pregnancies confidential. Again, all the minor is required to provide is pay stubs if she is employed. It is important to note that if a minor is receiving prenatal care coverage, the minor must reapply for the program every month to keep receiving confidential services throughout the pregnancy.
ADOPTION
Laws
According to California adoption laws, minors do not have to get parental consent in order to put their child up for adoption. However, they may need to get the consent of the other parent unless he or she fails to respond to the adoption notice. The only case in which parental consent is needed is if the child is placed in the care of parents and the minor relinquishes gives up his or her any rights to custody.
Paying for ServicesIf you are putting a baby up for adoption you do not have to pay anything to do this. For more information about adoption, check out these organizations:
- Adoption Connection, www.adoptionconnection.org
- PACT, www.pactadopt.org, 800-750-7590
UNDOCUMENTED IMMIGRANTS' RIGHTS
ABORTION AND PRENATAL CARE
Laws
In California, undocumented women have the same rights as other women to access many types of health care. If you are undocumented you especially have the right to seek and receive prenatal care, abortion and family planning services in a confidential manner.
Paying for ServicesLow-income women, regardless of immigration status are eligible for Emergency or Restricted Pregnancy-Only Medi-Cal for Pregnancy. If they are seeking immediate walk-in prenatal care at a participating provider, these women are also eligible for Presumptive Eligibility Medi-Cal. Middle-income women are eligible for AIM and do not have to provide their Social Security Numbers. Undocumented immigrant women are not eligible for Full-Scope Medi-Cal or Minor Consent Services. To learn more about these programs, see our Paying for Care guide.
ADOPTION
Laws
Undocumented immigrants can place their children up for adoption without jeopardizing their immigration status. If theire children are not US citizens, then they may have to go through the international adoption process rather than the usual domestic process.
Paying for Services
There are non-profit organizations in California that help birth mothers, regardless of their documentation status, go through the adoption process. Call us for more information about these services.
Preventing Pregnancy
You have the right to choose if, when, where, with whom and how you have sex and children. If you want to prevent STDs or being pregnant, you have the right to know about all of the medical options that you have, to make your own choices and to take control.
When deciding what birth control you want to use, ask yourself:
- What type(s) of birth control you are interested in using—or NOT using?
- What kinds of birth control have you used in the past?
- What did you like/dislike about that method of birth control? Why did you stop using it?
- How would you feel about getting pregnant right now? How important is it to you that you don’t get pregnant right now?
The chart below provides you basic information about the different methods you can use to prevent pregnancy and gives you a place to start in figuring out what method might be the best for you. Once you think you have an idea of which option you might want to try, do you have access to a doctor or clinic where you can get it? Do you have health insurance that will cover it?
Check out our paying for care guide for information about Family PACT, a program you can use to cover the cost of most family planning services, and to find a provider that accepts Family PACT click here (link to: www.familypact.org). Don’t hesitate to call the ACCESS Healthline at 1-800-376-4636 if you have any questions!
Summary of Birth Control Methods
Resources:
Mayo Foundation for Medical Education and Research, http://www.mayoclinic.com/health/birth-control/, January 25, 2008
UCSF Medical Center, Women’s Health Matters, Birth Control Methods, July 2004
UCSF Medical Center, Women’s Health
|
Method |
What is it? |
How effective? |
Pros |
Cons |
Occasional Side Effects |
|
Non-Hormonal Barrier Methods |
||||||
|
Condoms |
Plastic/latex sheath put on the penis or inside vagina that physically blocks sperm from entering the vagina or uterus. |
Male condom: $0.20-$2.50 Female condom: $2.50-$5.00 |
85 - 98 % (male condom) |
-inexpensive |
-requires partner cooperation |
Rare allergies to latex condoms |
|
Diaphragm |
Placed into vagina before sex and inhibits sperm from entering uterus |
$30 to $50 plus cost of medical exam |
84 – 94 % |
-only has to be used before sex |
-must be inserted properly |
Rare bladder infections |
|
Cervical Cap |
Placed into vagina before sex and inhibits sperm from entering uterus |
starts at about $72 plus cost of medical exam |
84 – 92 % |
-only has to be used before sex |
-must be inserted properly |
Rare bladder infections |
|
Copper T IUD |
Inserted into uterus by clinician, kills and inhibits sperm, and can last up to 10 yrs |
$200 to $300 plus the cost of an office visit for insertion and a follow-up app |
99 % |
-few side effects |
-initial cost |
-occasional cramping |
Hormonal Methods |
||||||
|
Combined Birth Control Pill |
Artificial hormones in pill form that prevent ovaries from releasing egg, thicken cervical mucous and thin uterine lining |
$5-$35 each month plus cost of medical exam |
92-99 % |
-more regular menstrual cycles |
-must take pill daily |
-nausea |
|
Birth Control Patch |
A plastic patch worn on skin that releases artificial hormones which stop ovaries from releasing eggs, thicken cervical mucous and thin uterine lining |
$50 for a month's supply of three patches plus initial exam |
92-99 % |
-only need to reapply once/week |
-must replace patch on schedule |
-headaches |
|
Vaginal Ring |
A small, flexible ring inserted into the vagina skin that releases artificial hormones which stop ovaries from releasing eggs, thicken cervical mucous and thin uterine lining |
$35-$50 each month plus cost of exam |
92-99% |
-only need to reinsert once/month |
-must replace patch on schedule |
-headaches |
|
Progesterone IUD/ “Mirena” |
Small, plastic device that is inserted into the uterus and releases hormones that inhibit sperm and thicken cervical mucous |
$300 to $400 every five years plus the cost of office visit for insertion and a follow-up app. |
99 % |
-very effective |
-clinician must insert and remove |
-irregular or no period |
|
Depo Provera |
Injection of artificial hormones that stop ovaries from releasing eggs, thicken cervical mucous and thins the uterine lining |
$35-$75 for 3 month injection plus cost of medical exam |
97-99% |
-very effective
|
-must be injected by clinician |
-possible weight gain
|
|
Progestin Pill/ “Mini-Pill” |
Pill with hormones that thicken cervical mucous and thins the uterine lining |
$30 to $60 per month plus cost of medical exam |
95-99% |
-more regular menstrual cycles |
-must take at the same time everyday to be effective |
-irregular to no periods
|
|
Emergency Contraception/ “Morning After Pill” |
High dose Progestin hormone pills which can be taken up to 5 days after unprotected sex to prevent pregnancy |
$40- $60 |
89%, depending on when you take it after sex |
-excellent back-up to other BC options |
-limited time frame of effectiveness |
-nausea |
Permanent Methods |
||||||
|
Tubal Ligation |
Surgically blocks passage of egg into the uterus |
varies |
99.5-100% |
-very effective |
-post surgical discomfort |
-Minor surgical and anesthetic risks |
|
Vasectomy |
Surgically blocks passage of sperm out of the penis |
varies |
99.9%-100% |
-very effective |
-irreversible |
-rare and minimal surgical risks |
Liquid Chemical Methods |
||||||
|
Spermicidal suppositories, gels and film |
Sperm killing chemicals placed in the vagina and cervix |
$10-$12 per tube |
71-85% |
-easy to use |
-don’t protect against STIs |
-can irritate skin of vagina or penis |
“Natural” Methods |
||||||
|
Withdrawal |
Removing the penis from the vagina before ejaculation |
No cost |
73-93% |
-inexpensive |
-pre-ejaculation fluid may contain sperm |
-may decrease sexual satisfaction |
|
Abstinence |
Not having sex |
No cost |
100% |
-only sure way to not get HIV, other STIs or to become pregnant |
- not experiencing the physical pleasure associated with sexual intercourse
|
none |
|
Fertility Awareness Method (Natural Family Planning) |
Uses events of menstrual cycle and fertility signs to predict periods of infertility |
$10 for basal body temperature thermometer |
75-95% |
-inexpensive |
-requires careful daily attention to fertility signs and calendar |
none |
Your Options
If you are facing an unplanned, unexpected or unwanted pregnancy, you are not alone and you have options. It is up to you, and only you, to decide what is best for you and your family, and to take control of your reproductive health. This section includes information about your options and things to think about when making your decision. If you want to talk to someone directly about your options, your feelings, your questions or anything else call the ACCESS Healthline at 1-800-376-4636.
This section is intended to give you a brief overview of your options, including abortion, adoption and parenting. You have a right to receive as much counseling on these options as you need and to make your own decision. No counselor should scare you away from certain choices. If you are pregnant it is important that you seek information and medical care immediately.
ABORTION
Abortion ends a pregnancy. There are different methods of abortion. Your medical provider can help advise you on which is right for your individual situation. If you are having trouble finding a provider in your area or need help paying for care, please call ACCESS.
Types of Abortion
Medication Abortions (up to 9 weeks from the first day of your last period)
There are two types of medication abortions: Mifeprex or RU 486 (the abortion pill) and Methotrexate (the abortion shot). For women who choose medication abortion, some prefer it because it may feel more natural, like a miscarriage, or because they would like to go through the abortion process in the privacy of their own home or be able to have any support person there with them.
Surgical Abortions (up to 24 weeks)
- Vacuum Aspiration (4-12 weeks)
This is the most common method used for first-trimester abortions. Women may prefer this method over the medication abortion because the procedure itself only takes about a few minutes, medical staff is present, and it is an option offered later than medication abortion. During a vacuum aspiration, the physician numbs and dilates the cervix and then inserts a hollow plastic tube with an opening in one side of the tip that is connected to a vacuum aspirator. The vacuum aspirator produces gentle suction that empties the uterus.- Dilation and Evacuation (12-24 weeks)
This is a two-day procedure that requires a woman to be at a clinic for several hours. On the first day, the physician inserts a sterile fiber (laminaria) into the cervix which absorbs moisture from the body and expands to enlarge the opening in the cervix. On the second day, the woman returns to the clinic to have the laminaria removed and to complete the procedure. The fetal tissue is removed using small forceps and gentle suction
Surgical abortions are very safe but there are risks just as with any medical procedure. The risks increase the longer you are pregnant and also if you have sedation and general anesthesia. Your medical provider will alert you of any warning signs to watch out for. It is important for you to have an honest dialogue with your provider about your health and medication. It is also important that you are aware of all risks and are prepared to alert your provider of any warning signs you might have after your abortion.
As with any medical procedure, you should consult with your medical provider and be sure that you understand all information given to you and ask any questions that you may have.Source: Our Bodies Ourselves, The Boston Women’s Health Book Collective (2005 and 1998)
PREGNANCY
Prenatal Care
Prenatal care refers to care under a physician during pregnancy used to detect and prevent any problems such as miscarriages, birth defects, and maternal death.
Women are encouraged to schedule an appointment as soon as they know they are pregnant. After the initial appointment, women with low risk pregnancies should expect to see their prenatal care provider once a month for the first 28 weeks, every two to three weeks for 28th to the 36th weeks, and weekly from the 36th week until delivery. Women with high risk pregnancies should expect to see their clinicians more often.
ADOPTION
Adoption permanently and legally places a birthmother’s child with people who will raise the child as their own. If you are considering adoption, there are agencies that can provide you with information and counseling on the choices you have and to help you create an adoption plan.
Consent of Other Parent
The father (or presumed father) must consent to the adoption if the child was born while the parents were married or within 300 days of divorce, if the child’s parents tried to get married but it was not valid for some technical reason, or if the father at some point accepted the child into his home. If none of these cases apply, then the father does not have to consent; however, if a man signed the birth certificate or a form at the hospital with the mother saying he is the father, he must be notified of the adoption.
For more information on adoption and adoption laws:
http://laws.adoption.com/statutes/california-adoption-laws.html
http://www.weblocator.com/attorney/ca/law/c08.htmlPARENTING
If you choose to continue your pregnancy it is important that you seek out medical care immediately.
Please refer to paying for care section for children’s health programs.Resources for Parents:
Women, Infants, and Children Program (WIC) is a nutrition program that helps pregnant women, new mothers and young children eat well and stay healthy.
www.wicworks.ca.gov/
1-800-852-5770 or 1-888-942-9675
Maternal Child and Adolescent Health Program (MCAH) is program where healthy living is promoted for mothers, and their families through programs for reproductive health, family planning, pregnancy, birth defects, infants, children, teens, and human stem cell research.
http://ww2.cdph.ca.gov/programs/mcah/Pages/default.aspx
1-866-241-0395
Paying for Care
Have you ever had trouble getting the health care you need because you do not have insurance or your insurance does not cover what you need? Are you wondering how to pay for a pap smear or prenatal care? Does your insurance not cover abortion?
You have options! There are many programs for which you may qualify that will help you pay for the care you need. See the charts below for basic information and to figure out what programs you might qualify for based on your income.
To apply for most of the programs (specifically the Medi-Cal programs) you have to go to your local social service office to apply in person. Be sure to take as much of the required paperwork as you have with you so that your application can be submitted completely.
You can apply directly for Family PACT and Presumptive Eligibility at a clinic, hospital or doctor’s office that is part of the programs. To find a list of providers near you that offer Family PACT services click here or for referrals to providers where you can enroll in Presumptive Eligibility call us.
If you have any other questions or problems with the processing of your application, call our Healthline at 1-800-376-4636.
Programs that can help you pay for care
You can see a chart that lists the latest federal poverty guidelines at: http://aspe.hhs.gov/poverty/
If you are an single, childless adult between the age of 21-65, please visit the following website to see if you qualify for benefits: http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalEligibility.asp
|
Program |
Client Age |
Income Guidelines |
Residency |
Paperwork Required |
Cost |
Some of the Services Covered |
|
Medi-Cal (Full-Scope) |
Birth-21 and over 65, people in between 21 and 65 have to meet specific criteria to qualify |
100% Federal Poverty Level |
US citizenship or legal permanent residency |
Medi-Cal application, proof of income, proof of citizenship, other supplemental documents as requested |
Share of cost for some clients |
-Complete medical coverage, including all preventive care |
|
Presumptive Eligibility for Pregnant Women |
All |
200% Federal Poverty Level |
Has to live in CA, but does not need to be a citizen or legal permanent resident |
Application at clinic, doctor’s office, or hospital |
None |
-Certain walk-in prenatal care services |
|
Restricted Medi-Cal for Pregnancy |
All |
200% Federal Poverty Level |
Has to live in CA, but does not need to be a citizen or legal permanent resident |
Medi-Cal application, proof of income and assets, proof that you live in California |
None |
-Comprehensive preventive care services |
|
Access for Infants and Mothers |
18 and older |
200-300% Federal Poverty Level |
Current CA residency |
AIM application, proof of income |
1.5% of family income |
Comprehensive health coverage for all medically necessary services the pregnant woman has throughout her pregnancy and for 60 days after her pregnancy ends. The child is covered for two years after birth |
|
Family PACT |
Males up to 60 |
200% Federal Poverty Level |
CA residency |
Client eligibility certification form |
None |
-Contraception |
|
Medi-Cal Minor Consent Services |
Under 21 years old and still living with or financially dependent on parents or guardians |
200 % Federal Poverty Level |
Address in county receiving services,, undocumented women are not eligible |
Application |
None |
-For youth under the age of 12, Minor |
|
Emergency Medi-Cal (also called Restricted Medi-Cal) |
All |
200% Federal Poverty Level |
CA residency |
Application |
None |
-Emergencies, like a broken arm or giving birth |
|
Healthy Families Program |
Under 19 |
250% Federal Poverty Level |
US citizenship or legal residency |
Application |
$4-$17 per child a month; up to $51 |
Complete medical coverage, including all preventive care |
How to Figure Out if you Qualify for Programs
The Federal Poverty Level (FPL) is a poverty threshold developed by the U.S. Census Bureau and issued each year by the U.S. Department of Health and Human Services. The guidelines are used to decide whether a person is eligibile for certain federal and state programs, including many Medi-Cal programs, based on the size of his or her family and how much money s/he makes.
To figure out if you fall under any of the qualifying FPLs count the number of people in your family, or household, and pair that with total monthly or yearly income in your family or household. For example, if you are a single parent, are pregnant and have two other children, you would have a family size of 4. Currently, if you make $3500 a month, or $44100 a year, before taxes, you would fall under 200% of the FPL and just above 185%. Note that for Restricted Medi-Cal for Pregnancy you have to be under 200% of FPL. (There are exceptions on how family size and income are calculated, so if you have questions or you have a complicated situation, call us.)
If you need further information, call ACCESS Healthline at 1-800-376-4636!