Why it’s so easy for the US to cut children’s access to healthcare: ‘There’s no right to these programs’ | Health policy

EVery academic year, the midwife Lisa Isman meets tens of eighth year for an annual visit to the clinic where she works. Students first meet in the office waiting room, where neon green sofas, romantic novels for young adults and brochures on solitude and sexual well-being greet them. During the tour of the INGDOMSMOTTAGNING – Swedish for the “Young Clinic” – the students of this suburb of Stockholm, in Sweden, will take a look at the various examination rooms, will meet advisers in clinic and will visit the “Kondomeria” of the Clinic, a cupboard decorated with conservatives posed as action figures and in stock with a variety of brands.

The required school tour is an opportunity for Isman and his colleagues to explain to students that, from 12 to 22 years old, it is their clinic. And “they can decide for themselves” to make an appointment, with or without the involvement of their parents, says Isman.

At the youth clinic – one of the 300 spaces of this type across the country – adolescents and young adults can make appointments or come at times of appointments to discuss puberty, periodic pain, contraception, abortion, anxiety, depression and various other health problems.

Young access to health care is guaranteed, says ISMAN, because “in Sweden, the [UN Convention on the Rights of the Child] Now becomes a law, we are therefore obliged to follow the law ”.

Children’s right to health care is not also protected in the United States. A fact that experts say they appear in the federal budget currently in debate, which would see significant reductions in programs that help low -income children allow food and health care, such as Medicaid, the Health Insurance Program (CHIP) and the additional Nutritional Assistance Program (SNAP).

“There is no right to these programs,” said Jonathan Todres, a leading children’s rights expert and law professor at Georgia State University College of Law. “Medicaid, chip, those who support millions of children, but they do not establish a right. Thus, at any time, the government can choose to reduce these programs. ”

Medicaid and Chip offer health coverage for two out of five American children, while Snap provides meals to one in five. The current budget would reduce $ 863.4 billion from Medicaid and Chip, and 300 billion dollars of snap, over the next decade. Although children under the age of 18 represent around 22% of the American population, Tombes notes that expenditure for young people represent only 10% of the federal budget.

“The right to health care is essential and is very threatened in the United States at the moment for children and adults,” said Elizabeth Barnert, pediatrician and professor at the University of California in Los Angeles. Because children do not vote, she fears that they are often forgotten in politics, but says that the health ramifications of poor access to health care “are permanent and generational”.

In 1989, the UN adopted the Convention on the Rights of the Child – a treaty recognizing the human right of children to, among other things, play, live without violence and receive health care. In the years that followed, each member country of the United Nations would adopt the Convention – which makes it the most widely ratified of the body treaties – except the United States. Although the United States signed the treaty in 1995, it never submitted it to the Senate for ratification.

“I think that for many people”, this fact “becomes even more confusing when they learn that the United States has had a greater impact on the writing of [the convention] That any other country, “said Tades, who notes that the Convention was written during the Republican administrations of Ronald Reagan and George HW Bush.” ​​The American stamp is everywhere in this treaty. »»

The reason why the United States has long hesitated to ratify the Convention, as a result, is multilayer.

“Historically, the United States has always been slow to join human rights treaties. It is generally very active in the creation of human rights treaties, but more careful when it comes to taking legal obligations,” said TDES, noting that the United States has taken 40 years to decide to ratify the genocide agreement. He adds that the United States often beware that such treaties can challenge its sovereignty.

Another reason why he identifies is a “much broader cultural war” with regard to the rights of parents and children in the United States, which, according to him, is based on an inaccurate understanding of children’s rights.

The parental rights movement in the United States is perhaps better known today for its conservative efforts to prohibit teachers from discussing sexuality and gender identity in schools. But supporters have long campaigned for parents’ rights to determine what their children learn, by removing their children from schools integrated in the 1950s into the leading coalitions in order to avoid the sex education program in the 1990s.

Although republican administrations were very involved in the drafting of the Convention on Children’s Rights, conservative social groups quickly came to oppose it. In 1999, the Home School Legal Defense Association, a defense group of Christian defenders focused on the rights of parents who educate their children at home, wrote that “war was declared on parental rights in America” ​​when the United States government sent the United Nations Convention to the Senate.

He declared that ratifying the treaty would be “a direct attack on parents’ rights to choose the form of education and the content of education for their children” and that the Convention “would intervene spanking”, would give “children the right to listen to rock music” and to create a right to private life which “would invalidate all the laws on the notification of parents concerning abortion”.

At the ISMAN clinic in Stockholm, she said, “We have parents now that they don’t want their daughters to come to our youth clinic because we are talking about things they don’t want their daughters to know,” said Isman, who estimates that around 90% of clinical patients are women. “You must try to find ways to speak to these parents and try to find ways for children who are not allowed to come here. How to reach them? “

Isman and his midwifery colleagues could spend a day helping a young adult to choose a birth control method or plan an abortion. In the corridor, her colleagues as a social worker and psychologist could filter adolescents to sail in their mental health for abuse by asking them if they have already been spanked or prevented from taking prescribed drugs. Both are services that are often difficult to access – even illegal – in the United States.

Although Sweden has implemented the United Nations Convention in a way that allows children to access contraceptive and sexual health advice, including sometimes abortion care, without parental consent, Tadres does not imagine that the United States would do the same, and says that the Convention leaves the application of each country which would ratify it. He believes that controversial health debates that have an impact on a small number of children, such as the abortion and affirmative sex care, have distracted the largest areas where most parents would support that their children have access to health care.

“Of the majority of problems, the interests of parents and the rights of children align. If you ask parents, what do they want for their children? They want their children to be safe. They want to be able to take their child to a good doctor when the child needs it, they want the child to receive quality education, “said Tadre. He adds that human rights laws “are designed to protect children and families against abuse by governments”.

For Barnert, a right to health care means “that each child can satisfy their urgent and emergency needs and that each child has access to appropriate preventive care based on evidence”.

It finds the human rights framework of the United Nations Convention particularly useful because it considers “many obstacles which are not health care itself which interferes with the capacities of patients to obtain health care”, such as the cost of transport or parking, which can take working time, by feeling safe in the office of a doctor, regardless of immigration status or access to unusual care, like vaccines.

It is unlikely that the United States will soon ratify the Convention on the Rights of the Child, said Tadre. Or, that if he does, he will implement it in the same way as Sweden. But in the meantime, a handful of cities, including Portland, Oregon, and Santa Cruz, California, have adopted acts of rights for children. And with children’s access to health care on blocking this year, it may be time to determine whether this access should be protected as a right.

This story is part of a reporting scholarship sponsored by the association of Health Care Journalists and supported by The Commonwealth Fund