For adolescents, part of transitioning to adulthood includes learning how to navigate relationships, sexuality, sex, and reproductive health. Being in foster care means navigating these same experiences in addition to other barriers and unique challenges. For example, they may be less likely to have access to healthy relationship models as well as adequate sexual and reproductive health information and services. They are more at risk of sexual exploitation, vulnerabilities which are exacerbated for youth who may identify as LGBTQ+. They may not know how to book a sexual health appointment, not be comfortable asking their caregiver to help them book one, or struggle to get transportation to such an appointments.

This makes it much more difficult for foster youth to access to contraceptives. In California alone, 26% of young women in foster care will become pregnant by 17. Despite teen pregnancy declining overall, it is increasing for youth in care; teens in foster care are 2.5 times more likely to become pregnant than their non-foster care peers, and 20.7% of pregnant foster youth never receive prenatal care. Unintended pregnancy can significantly impact a youth’s ability to access and complete school, obtain and maintain employment, and financially support themselves.

It is vital that young people in foster care be given full control of their bodies and reproductive decisions. In fact, it is the law in CA that foster youth receive comprehensive sexual health education twice before graduation, once in middle school, and once in high school. Part of sexual autonomy requires an understanding of comprehensive sexual health information; the capacity to engage in consensual sexual activities when they choose to; knowledge of their reproductive rights; and access to healthcare that includes birth control options and sexually transmitted infection treatment and prevention. These services need to be delivered in a trauma-informed way given the trauma that young people in foster care have already experienced.

How to advocate

There are many different ways a CASA can actively support their youth’s reproductive health needs, both behind-the-scenes and directly with their youth. Check out some of our ideas below!

Behind-the-scenes:

Check to see if your youth’s social worker is providing developmentally appropriate sexual health information to them, regularly informing them of their reproductive rights, helping them make appointments, and providing transportation to and from those appointments. Social workers are required by law to do all of the above.

Check to see if your youth’s social worker is ensuring that the youth receives Comprehensive Sexual health Education (CSE) one time in middle school, and one time in high school. In July 2017 California adopted a new law requiring comprehensive sexual health education (CSE) for youth in foster care (SB89). This also includes new training requirements for caregivers, social workers, and judges. A CASA can play a big part in ensuring their youth’s team is complying with this law.

Research appropriate services, from clinics to community-based organizations providing reproductive and sexual health support and education for adolescents. See the “Partner Organizations” and “Resources/Links to Learn More” below as a starting point.

Contact your youth’s school to learn when and how it disseminates reproductive and sexual health information to its students. In California, there is a mandate for all public middle and high schools to provide comprehensive sexual health education (CSE). Not sure if that is happening at their school? Given the Foster Youth Liaison at their school or school district a call to find out.

Be careful about what you share in the court report. A youth’s reproductive and sexual health choices are private, and unless they explicitly state that they want you to share something with the team or in your court report, refrain from doing so. This includes birth control choices, romantic relationships, pregnancy, and STDs.

With your youth:

Provide them with one of these age-appropriate guides that cover their sexual and reproductive health rights:

Tweens

Middle adolescents

Transitional aged youth

Know Your Sexual and Reproductive Health Rights flyer (This flyer can be shared with youth 10-12 years and older. Talk with your Case Supervisor if you have questions)

Let them know that you can be a 100% judgement-free resource for information or support around their sexual and reproductive health.

Talk to them about appropriate resources that they could access. See our “Resources” section below to learn more, and also use the guides linked above.

Ask them if there is someone they would feel comfortable talking to/being supported by when it comes to their reproductive and sexual health. It is completely normal if they do not feel 100% comfortable speaking with you about this subject. If not, make sure to connect them with someone, whether that be a family friend, caregiver, or professional either on their team or at a relevant agency, who they do feel comfortable speaking to instead.

Don’t be afraid to bring up the subject of safety around things like consent. Even for youth who are at a very young age, conversations around personal space, normal relationships, and how to speak up when you may be uncomfortable can be incredibly powerful and important to have. As with the point above, if they do not feel comfortable speaking about these subjects with you, connect them with someone else.

If appropriate, help them set up medical appointments and access care as needed. They have a legal right to access most reproductive and sexual healthcare at any age, which includes the right to transportation.

Engage with your youth about the qualities of a healthy relationship.

Expecting and Parenting Youth - How to advocate

There is considerable legislation in California meant to reduce teen pregnancy rate and improve the overall sexual and reproductive health outcomes for our young people. Despite these laws, youth in foster care are still experiencing poorer health outcomes as related to their peers not involved in the system.

Youth in foster care have less access to birth control and comprehensive health education than their peers not involved in the system, and female youth experience higher pregnancy rates than their non-system involved peers
Almost 50% of females in the California foster care system will have been pregnant at least once by the age of 19
One if five pregnant youth in foster care (or 20.7%) never receive prenatal care and many youth will experience either a stillbirth or a miscarriage
The overrepresentation of LGBTQIA+ youth as well as youth of color in the foster care system, makes improving access to appropriate healthcare a racial justice imperative

Despite these alarming statistics, there are a lot of ways that CASAs can support their young people who are either expecting or are parenting their own children. Advocacy strategies for supporting expecting and parenting youth (EPY) are driven by the youth’s voice and choice in regards to their reproductive health and pregnancy status.

Engaging with youth in reproductive health and pregnancy conversations
Supporting EPY with pregnancy testing
Supporting EPY through pregnancy
Supporting EPY through the birth process
Supporting EPY post birth
Supporting EPY through adoption process
Supporting EPY to raise
Supporting EPY through pregnancy termination

If a youth shares their pregnancy status with their CASA, it is imperative that advocates remain open minded and provide a judgement free atmosphere for youth to process and make choices about their reproductive health and family planning. As one’s pregnancy status is considered protected health information, the advocate is not allowed to share this information without first gaining the youth’s consent.

Engaging with youth in reproductive health and pregnancy conversations:

Advocates must be mindful to use a strengths based approach when discussing reproductive health and pregnancy with their young person. EPY might feel judged when discussing these topics with others, and CASAs are meant to support youth in exploring their options in a safe and supportive environment. When engaging with youth, advocates should remember:

Thank your youth for trusting you with their story!
Ask the youth if they have any other trusted adults with whom they feel comfortable sharing their pregnancy status

Supporting youth with pregnancy testing:

All youth in foster care have the right to access pregnancy testing. If a youth mentions they might be pregnant, advocates can support youth in obtaining a pregnancy test either at a pharmacy, a clinic or a doctor’s office.

Obtain and use female or male birth control and protection options, including condoms.
Access to pregnancy testing and prenatal care.
Receive an abortion.
Access services that may be needed due to a rape or sexual assault.
Confidentiality with their doctor around what services they choose to access or considering accessing.
Transportation to appropriate services by their social worker, group home staff, or caregiver.
At the age of 12 and older, foster youth can access healthcare services to prevent, test, and treat sexually transmitted infections and HIV.

Supporting youth through pregnancy and birthing process:

All youth in foster care have the right to access prenatal care.

WIC provides nutritional services during pregnancy and also for the newborn ages 0-5.
The average cost to maintain health and safety standards before childbirth is $2,000. Advocates should work with their young person to ensure that the youth has all they need for when the baby is born.
Beginning January 01, 2022, all pregnant youth in foster care will be eligible to receive an expectant parenting payment three months prior to their expected due date. This payment totals $2,700 and is available to all pregnant youth in care, regardless of placement type.

**Supporting youth post birth: **

CASAs should support youth in contact their PSW within 30 days of birth to ensure that their baby is added to the youth’s MediCal insurance. It is important to note that the newborn is only on the MediCal plan for 30 days.

CASAs can also support youth in accessing childcare and understanding, Early Childhood Education.

Supporting youth through pregnancy termination:

All youth in foster care have the right to receive an abortion.

Pregnancy can be a vulnerable and emotional experience for foster youth. Pregnancy for a foster youth can bring up many mixed emotions. It can be seen as an opportunity to create a loving family of their own or as a chapter in their life they are not ready for.

CASAs should continue to meet their youth where they are at without any judgement and look to support their youth with any decision they make. CASAs should advocate according to their youth's decision and ensure they have access to appropriate care and resources.

In general, for youth younger than 18 in California, youth do not need parental consent nor permission from anyone, to terminate a pregnancy. If there are concerns about or information disclosed regarding physical or sexual abuse, the police or child abuse authorities will be contacted, who may then alert parents or caregivers. If a youth is 12 years old or older and there is no concern for physical or sexual abuse, they must provide written consent before the healthcare provider could alert others.

For foster youth younger than 18 in California, youth have the right to decide whether they want to continue with the pregnancy or to end it. The youth’s assigned PSW must provide referrals to healthcare services if the youth were to decide to terminate the pregnancy. Upon birth, the child will not become part of Dependency and the youth will have parental rights to live with and care for their newborn.

Supporting Parenting Youth

As an advocate, you may support a youth who is pregnant or parenting a young child of their own. As young parents, youth will need support to ensure the appropriate services and resources are obtained to best care for their child. A major part of understanding the type of care needed for a child, is understanding their developmental needs as they grow. Services and Resources such as childcare, early education programs, special need services, etc. if your youth is an expecting parent or a young parent already, please consider reviewing the ECE section, as they may first need support with finding childcare to continue to pursue their own education or employment.

Appropriate language

Talking about sex, sexual health, and sexuality can be tricky to navigate with your youth. You may be concerned about their caregiver’s value system or religion. However, remember that your youth has a right to access reproductive and sexual health services regardless of their placement situation or dynamics. You may also be worried that your youth will not be comfortable talking with you about these subjects. Ultimately, part of supporting your youth’s knowledge and understanding of their rights and available services is by non-judgmentally and sensitively bringing this subject up with them.

The way in which you will want to approach this subject with your youth will need to be age- and developmentally appropriate. Please reference the handy one-page guides listed above in the “How to Advocate” section for ideas on how to navigate this conversation based on your youth’s age. You should even consider handing the colorful guide to your youth both as a resource and conversation starter!

In conversation, ask your youth open-ended questions like,

What does a loving and healthy relationship look like to you?

When you think about safety when it comes to sex and sexual health, what comes to mind?

How would you define consent?

Do you know what your rights to services are? I’d love to share that with you if you aren’t sure.

Is there someone you would feel comfortable speaking with about these things if not me?

Legal rights

Foster youth have the legal right to be informed in an age and developmentally appropriate manner of sexual and reproductive health services that are available to them. At any age, foster youth have the right to:

Obtain and use female or male birth control and protection options, including condoms.

Access to pregnancy testing and prenatal care.

Receive an abortion.

Access services that may be needed due to a rape or sexual assault.

Confidentiality with their doctor around what services they choose to access or considering accessing.

Transportation to appropriate services by their social worker, group home staff, or caregiver.

Additionally, at the age of 12 and older, foster youth can access the following healthcare services:

Healthcare to prevent, test, and treat sexually transmitted infections and HIV.

Mental health counseling.

Additional Resource: Consent Laws

Resources/links to learn more

Resources for Expectant and Parenting Youth in Foster Caree Provides $2,700 to pregnant minor and non-minor dependents 3 months prior to their expected due date. Provides $900 per month to foster youth who are custodial parents. Provides a childcare voucher or payment and assistance with finding a subsidized childcare placement.

Teen Health Consent Laws This chart shows what minors may consent to legally related to sexual and reproductive healthcare:

Age Appropriate, Medically Accurate Sexual Health Facts

Teen Health Rights

Resources for Supporting Pregnant and Parenting Teens

Know Your Sexual and Reproductive Health Rights (brochure)

Consent to Medical Treatment for Foster Children

What is a healthy relationship? What is safe sex? What does consent look like?

Los Angeles Reproductive Health Equity Project for Foster Youth

CASARC: Child and Adolescent Support, Advocacy & Resource Center compassionate, comprehensive services that support healing for children and families who have experienced sexual abuse, physical abuse, severe neglect, or exposure to violence

Rape Treatment Center medical providers with specialized training in survivor-centered care.

Resources for Expecting and Parenting Youth

Money for Pregnant Minors and NMDs

San Francisco Nurse Home Visiting Program A public health nurse meets with youth to discuss questions or concerns, and helps guide youth to:

take steps for a healthy pregnancy
prepare for your baby
become a confident parent and help your baby learn and grow
support your family’s health
help your family connect to community resources
get needed supplies (baby crib, diapers, etc.)

All pregnant and postpartum women who live in San Francisco are eligible and encouraged to enroll as early in pregnancy as possible to get an early start on a healthy pregnancy and healthy baby.

California CASA Conversations: Pregnant and Parenting Teens and Young Adults

Resources for Teen Parents in Foster Care

[Safe and Sound][30] [30]: https://safeandsound.org

Center for Youth Wellness

SF Office of Early Care and Education

Good Samaritan Family Resource Center

YWCA Early Childhood Education

Planned Parenthood

Health Connected Clinic Locator

Homeless Prental Program

Know Your Rights: Abortion Access in California

Your Rights as a Pregnant or Parenting Youth Under 18 in CA