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Crystal Lake, was devastated by the news that a 13-year-old girl had been repeatedly sexually assaulted by her 37-year-old junior high school teacher. The teacher eventually was sentenced to 10 years in prison.

But the following the arrest was even more shocking, the teacher had used the title X Federal Family Planning Program at the McHenry County Health Department to shield his crime, and taxpayers were footing the bill. Tired of using condoms, the teacher brought the young girl to a place where he knew she could get birth control drugs without anybody finding out, the federally funded county health department. The teacher knew that title X rules prohibited clinics from notifying parents when issuing birth control drugs to young girls.

When the girl arrived, a clinic worker injected her with a powerful birth control drug, Depo-Provera, a hormonal drug that possesses severe side effects, including excessive bleeding and bone loss. Eighteen months later into the crime, the little girl broke down, told her parents, she underwent intensive therapy and battled anorexia.

The whole argument for providing young girls birth control drugs behind their parents' back is cloaked in the double standards, which Mr. Heisler will bring out. But as a result of what happened in McHenry County, we, in 1998, approved my parental notification bill. The Senate never acted on the provision, however, and it died. But we did get legislation that passed, that became law, that title X clinics are not following, and that is that whenever they have reason to believe that a minor is under the age of consent, these title X agencies have the statutory duty to follow local State laws requiring notification to authorities that a child is indeed being raped. That was the two-part prong of the bill that we got passed. It is quite a story that Mr. Heisler has to tell. Again, I appreciate the opportunity to introduce him and I would ask to be excused.

Mr. BILIRAKIS. Thank you.
Mr. AKIN. Thank you.
Mr. BILIRAKIS. The Chair excuses the gentleman.

Ms. Wuchner?
STATEMENTS OF ADDIA WUCHNER, NORTHERN KENTUCKY

INDEPENDENT HEALTH DISTRICT; RENEE S. JENKINS, ON BEHALF OF THE AMERICAN ACADEMY OF PEDIATRICS; AND JOHN A. HEISLER, COUNTY BOARD, McHENRY COUNTY, ILLINOIS

Ms. WUCHNER. Thank you. Mr. Chairman and members of the Committee, I appreciate this opportunity to be here today to discuss with you the issue of a parent's right to know, especially as it pertains to medical treatment of minor children without their parents' knowledge or notification.

I am a mother of three, a registered nurse, with a background in women's health. I currently serve on the board of directors for the Northern Kentucky Independent District Health Department and Chair the Community on Human Sexuality Education.

Most parents would be shocked to learn that their teenage daughters may walk into one any of the title X federally funded clinics and obtain free birth control, including injectables such as Depo-Provera, emergency contraceptives, the morning after pill, without the knowledge or notification of their parents. They would be shocked because, for centuries, all sorts of rights flowing from the parent-child relationship have been acknowledged and protected by law, among them decisions concerning custody, the education and the medical treatment of their children. Yet today, when it comes to sex and the prevention and treatment of pregnancy and the prevention and treatment of sexually transmitted diseases, is seems neither mother nor father are trusted to know what is best.

The Northern Kentucky Board recently passed a motion to gather community input and review title X and Family Planning Services. This review led them to a vote. But the review led to much more. It led to the highlight of the many strings attached to title X which we will discuss today. For example, Section 8.7 states, “Title X projects many not require the written consent of parents or guardians for provisions of services to minors, nor can the project notify parents or guardians before or after a minor has requested and received title X-funded family planning services."

Section 8.6 states, “Title X projects must offer women and minors with a diagnosis of pregnancy, counseling, which is to include pregnancy termination along with information on prenatal care delivery, infant care and foster care.”

We found title X policies contradicted our health board's commitment in 2000 to under title V funding to fund a model of characterbased abstinence education that included the importance of parental communication. It was apparent to most of us on the board that title X was problematic and would remain so, as it currently exists, because it erodes the parent's right and the parental/child relationship, and it blocks their right to monitor their children's health. It was resolved by the majority of board members that on a local level this may not be the place to deal with this issue of parental notification, but rather it should be addressed at State and at national legislative levels.

Mr. Chairman, committee members, one-third of approximately 5 million women served by the title X programs are U.S. teenagers. In Northern Kentucky, females under the age of 18 represent 24 percent of those came in with parental knowledge, but 75 percent of the young women seen in our clinics are seen without parental notification. The clinics see and treat girls as young as 12 years old. I would like to share with you the day-to-day realities of title X.

Just this year, in one of our Northern Kentucky clinics, a 14year-old girl came in with her boyfriend's mother. Úpon the initial interview, she denied being sexually active, but it was important to her that her boyfriend and his mother like her. The boyfriend's mother wanted the girl to be put on the birth control so that she would not become pregnant when her son had sex with her. Please keep in mind the girl was 14 years old. The adult who brought her into the clinic was not her mother. Following title X guidelines, the 14-year-old's mother could not be notified.

Or what about the 12-year-old who had sex last Thanksgiving holiday and stated she didn't know why she did, she wanted the boy to like her and not get mad. What about her parents? She is only 12 years old. Is putting her on the pill the Government's solution? Perhaps we can prevent her from becoming pregnant, but she will also need to use a condom, and that will only prevent some of the sexually transmitted diseases that she will be exposed to. She is 12 and routinely forgets her homework assignments. A 14-yearold girl, recently seen in a local emergency room with a sexually transmitted infection, gave a medical history of already having five different sexual partners.

Title X specifies that a minor must be treated as an adult when seeking family planning services, yet these are really children at risk, children in engaging in adult behaviors. These high-risk behaviors do not need the cloak of government-funded clinics providing a pill to replace behavioral interventions but rather a true model of health would provide interventions when necessary that assists parents in building a bridge rather than a wedge in the parental and child relationship.

It is in the context of the parent/child relationship that the norms and values of the family are transmitted. A minor cannot legally sign a document or a contract. The school nurse cannot give her an aspirin. She cannot have her ears pierced at the mall without her parents' okay. Yet title X allows this minor to decide and receive family planning services and medications without her parents’ knowledge. This means that your daughter, your granddaughters or any minor female can be put on hormonal medications or given an emergency birth control without notification of her parents or guardians, those most knowledgeable of her health and family health history.

Mr. BILIRAKIS. Please summarize. Ms. WUCHNER. It is irresponsible to move in this direction. Mr. Chairman and members of the committee, a common sense wisdom and sound medical practice would agree that parents have the right to monitor their child's health care and well being. As Government and as a Nation, we must support the first building blocks of our society, the family, by restoring a parent's right to know and monitor their child's health and their well being. Thank you. [The prepared statement of Addia Wuchner follows:] PREPARED STATEMENT OF ADDIA WUCHNER, BOARD OF DIRECTORS, NORTHERN

KENTUCKY INDEPENDENT HEALTH DISTRICT Mr. Chairman and Members of the Committee: I appreciate the opportunity to be here today to discuss the issues of a “parent's right to know”, especially where it pertains to medications or medical treatment and care, in this case, adolescent reproductive health and the distribution of hormonal birth control agents and devices to minors without parental knowledge or notification.

I am a registered nurse with a background in women's health. I currently serve on the Board of Directors of the Northern Kentucky Independent District Health Department and Chair the Human Sexual Education Committee. I was appointed to the Board and serve as the designee of Judge Executive Gary Moore of Boone County, Kentucky. The Health District provides services for a four county region.

Most parents would be shocked to learn that their teenage daughter may walk into Ikone of these federally funded clinics and obtain free contraceptives, including injectables such as Depo-Provera, and emergency contraceptives (the morning after pill) without their knowledge or notification.

They would be shocked because, for centuries, all sorts of rights flowing from the parent-child relationship have been acknowledged and protected by law, among them decisions concerning custody, education and medical care. Yet today, when it comes to sex, the prevention and treatment of pregnancy, and the prevention and treatment of sexually transmitted diseases, the federal government tells us that neither Mother nor Father knows best.

The rights of parents to address and provide for their children's medical care has been undermined by controversial guidelines transforming parent's right to know into a privacy issue.

Children need two decades, more or less, of love, education, training, discipline and experience to be able to function independently of parents and make sound decisions concerning their lives. Throughout this formative period, parents have the right and duty to guide their children well. This last proposition should hardly be controversial. Ask any mother and father who've had to provide a school nurse with written permission just to see that their child gets a midday dose of Tylenol ®. Background on Recent Title X Federal Funding Issues and Northern Kentucky Inde

pendent District Health Department: Earlier this year the Board passed a motion to gather community input and review the policies of Title X funded Family Planning Services and the medical and scientific information available on all FDA approved contraceptives and birth control methods currently provided under the Family Planning Services.

A public caucus was held on the issues of the “Impact of Title X” on May 9, 2002, and on June 19, 2002 the Board met to vote on whether we would continue to accept or reject the Federal Title X funding of Family Planning Services.

As the issues were manipulated under the microscope of the press, political, religious, ethical and moral debates, and at great length, they became emotionally charged with accusations that some Board members do not care about poor women. The actual facts of why the Board was taking a look at Title X funded Family Planning and the birth control medications and devices that are dispensed through the program became, at times, publicly clouded. Our responsibility to the Northern Kentucky community impelled us to ask several questions: What is Title X's impact on health of women and adolescent females? What are the ramifications of Title X funding? What benefits could be attained by discontinuing the status quo and promoting women's health, absent of Title X?

While researching the medical and scientific information on birth control methods and devices, our Title X review also highlighted the many “strings” attached to accepting Title X funding from the federal government. These requirements (strings) are laid out in the Program Guidelines for Project Grants for Family Planning Services set forth by the United States Department of Health and Human Services, Office of Public Health and Population Control.

The Program guide begins by defining the wording of the document and just what is meant when the words “must” and “may” are used. Section 1.1 Definitions states, “Throughout this document the word “must” indicates mandatory program policy”.

For example: • Title X projects may not require the written consent of parents or guardians for

provision of services to minors. Nor can the project notify parents or guardians before or after a minor has requested or received Title X funded family planning services. (reference Section 8.7 Program Guidelines for Project Grants for Fam

ily Planning Services) • Title X projects must offer women and minors with a pregnancy diagnosis, coun

seling which is to include pregnancy termination along with information on prenatal care and delivery, infant care, foster care... (Reference Section 8.6 Program Guidelines for Project Grants for Family Planning Services)

BOARD ACTIONS.
Title X Blocks parents' right and responsibility to monitor their children's health

In 2000, the Northern Kentucky Independent District Health Board took a fresh look at the efficacy and coherence of its adolescent sexuality programs and chose to support Character Based Abstinence Education. The Board was farsighted in recognizing both the power of an abstinence focus and that the 20th-century model of contraceptive education was ineffective. However, Title X remains a product of its times, and its requirement to provide contraceptive services to adolescents without parental notification contradicted our Health Board's year 2000 stated intention to focus on character_based abstinence education, including parental communication.

The fact is that Title X blocks parents' rights and responsibilities to monitor their children's health. When minors seek contraceptive information, they must be informed about all birth control methods, treated for medical conditions and sexually transmitted infections and have medication

prescribed and dispensed to them with out their parents' knowledge or consent. This became an issue that greatly disturbed Board Members and the community.

Board members researched, studied, pondered, and sought public input. We found ourselves constrained by the fact that you could not reject part of Title X and still receive funding for services. We were bound to the structure and guidelines set forth by the Programs Guidelines of the Project. On June 19, the twenty-seven members present at the Board meeting voted 14 to 13, with the Chair casting a tie breaking vote, to reject a motion that would have discontinued the Department's acceptance of close to $220,000 in Title X and related funding.

Two issues/concerns were prevalent in discussions with Board members. First, there was concern that if we rejected the funding there would not be another service in place at this time to adequately provide family planning services to low income women. Second, and of most concern to the majority of the Board members, was the treatment of children and adolescents without parental knowledge.

The Judge Executive, Steve Pendery from Campbell County, resolved that the local level may not be the place to deal with the issue of parental notification but, rather, it should be addressed at a State and National Legislative level. While Judge Pendery felt he needed to vote to retain the Title X funding for practical reasons, in the press the next morning Judge Pendery concluded that the Board is not as divided as it seems; “We're a lot closer on this issue than the vote makes it sound.”

I voted with the support of my Judge Executive, Gary Moore, to discontinue the Health Department's collaboration with Title X funding and to look for other sources of funding to support a model of Family Planning Services not restricted by the constraints of Title X. On June 20, Judge Pendery's designee sent a letter to Board members requesting that we move forward with letters to all legislators in Kentucky asking for their help in changing the Title X requirements regarding girls under the age of 18 receiving birth control without their parents' knowledge.

It was apparent to most of us on the Board working on this issue that Title X would remain problematic as it currently exists because it erodes parental rights and the parent-child relationship. Title X and Parent's Right to Know

Mr. Chairman and Members, I know you are well aware that Title X of the Public Health Service Act was established as a federal program in 1970. For many years it has offered low-income women certain “reproductive health” services, including family planning as well as “non-directive” pregnancy counseling and referrals on all "options, including termination of pregnancy.

One-third of the approximately five million women served by the program are teenagers. Unmarried teens may qualify for free services regardless of their parents' income, knowledge of or consent to care. Currently, a teenager may walk into any Title X clinic and receive free prescription contraceptives, including injectables, i.e., Depo-Provera, or emergency contraceptives (the morning after pill) without her parents' knowledge or consent. Congressmen, one of these young girls may easily be your daughter or granddaughter.

To date, our Northern Kentucky clinics' statistics show that of the clients seen and treated this year, looking at numbers for females under the age of 18, only 24% came in with parental knowledge or consent. Approximately 75% of the young women seen in our clinics are seen without parental notification. The clinics have seen and treated girls as young as 12 years old. Example Case:

Just this year, in one of our Northern Kentucky clinics, a 14-year-old girl came in with her boyfriend's mother. Upon initial interview, she denied being sexually active at that time, but it was important to her that her boyfriend and his mother like her. The boyfriend's mother wanted the girl put on some form of birth control so she would not become pregnant when her son had sex with her. Please keep in mind the girl was 14 years old. The adult who brought her in to the clinic was not her mother. The 14-year-olds' mother was not notified. This is the reality of the strings attached to Title X.

Under the auspices of Title X, providers of women's and adolescent health services have fallen into disaster control mode, leaving proactive mediation and behavioral interventions on the back burner. We abet unhealthy practices by offering birth control to sexually active teens, especially young women who are the population at the greatest risk for Human Papillomavirus (HPV) and other STDs. These behaviors of young people need parental awareness, so that they may support and give guidance and dialog that respects the norms and values of the family. A true health model would then provide intervention when necessary that assists parents in parenting, building a bridge rather than a wedge in the parent-child relationship. These high risk behaviors do not need the cloak of government funded clinics providing a “pill” to replace behavior interventions, rather the situation calls for more support for parental communication.

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