Every school year, midwife Lisa Isman meets dozens of eighth graders for an annual tour of the clinic where she works. Students gather first in the office’s waiting room, where neon green couches, young adult romance novels and pamphlets on loneliness and sexual wellness greet them. On the tour of the Ungdomsmottagning – Swedish for “youth clinic” – the students in this suburb of Stockholm,Sweden, will take a peek at the different exam rooms, meet clinic counselors, and pay a visit to the clinic’s “kondomeria”, a cupboard decorated with condoms posed like action figures and stocked with a variety of brands.
The required school tour is an opportunity for Isman and her colleagues to explain to students that, from ages 12 to 22, this is their clinic. And “they can decide for themselves” whether to book an appointment, with or without their parents’ involvement, Isman says.
At the youth clinic – one of 300 such spaces across the country – teenagers and young adults can schedule appointments or come to walk-in hours to discuss puberty, period pain, contraception, abortion, anxiety, depression, and a variety of other health concerns.
Youth access to healthcare is guaranteed, Isman says, because “in Sweden, the [UN Convention on the Rights of the Child] is now becoming a law, so we are obliged to follow the law”.
Children’s right to healthcare is not similarly protected in the US. A fact experts say is apparent in the federal budget currently under debate, which would see significant cuts to programs that help low income children afford food and healthcare, like Medicaid, the Children’s Health Insurance Program (Chip) and the Supplemental Nutrition Assistance Program (Snap).
“There’s no right to these programs,” said Jonathan Todres, a leading expert on children’s rights and law professor at Georgia State University College of Law. “Medicaid, Chip, those all support millions of children, but they don’t establish a right. So at any time the government can choose to cut these programs.”
Medicaid and Chipprovide health coverageto two in five US children, while Snapprovides mealsto one in five. The current budget would cut $863.4bn from Medicaid and Chip, and $300bn from Snap, over the next decade. Although children under the age of 18 make up about 22% of the US population, Todres notes that spending on youth only amounts toabout 10%of the federal budget.
“The right to healthcare is critical and it’s very much under threat in the United States right now for children, and for adults,” said Elizabeth Barnert, a pediatrician and professor at the University of California, Los Angeles. Because children don’t vote, she fears they are often forgotten in policy, but says the health ramifications of poor access to healthcare “are lifelong and generational”.
In 1989, the UN adopted the Convention on the Rights of the Child – a treaty recognizing children’s human right to, among other things, play, live free from violence and receive healthcare. In the ensuing years, every UN member country would adopt the convention – making it the most widely ratified of the body’s treaties – except the US. Although the US signed the treaty in 1995, it never submitted it to the Senate for ratification.
“I think for many people” that fact “becomes even more puzzling when they learn that the United States had a larger impact on the drafting of [the convention] than any other country,” said Todres, who notes the convention was drafted during the Republican administrations of Ronald Reagan and George HW Bush. “The US stamp is all over this treaty.”
The reason the US has long been reluctant to ratify the convention, he believes, is multilayered.
“Historically, the US has always been slow to join human rights treaties. It is typically very active in the creation of human rights treaties, but more cautious when it comes to taking on legal obligations,” Todres said, noting that the US took 40 years to decide whether to ratify the Genocide Convention. He adds that the US is often wary that such treaties might challenge its sovereignty.
Another reason he identifies is a “much broader culture war” around parents’ and children’s rights in the US, that he believes relies on an inaccurate understanding of children’s rights.
The parental rights movement in the US is perhaps today best known for conservative efforts to ban teachers from discussing sexuality and gender identity in schools. But proponents have long campaigned for parents’ rights to determine what their children learn,from withdrawing their children from integrated schoolsin the 1950sto beginning homeschool coalitions in an effort to avoid sexual education curriculumin the 1990s.
Although Republican administrations were highly involved in drafting the children’s rights convention, conservative social groups quickly came to oppose it. In 1999, the Home School Legal Defense Association, a Christian advocacy group focused on the rights of parents who homeschool their children,wrotethat “war was declared on parental rights in America” when the US government sent the UN convention to the Senate.
It said ratifying the treaty would be a “a direct attack on parents’ rights to choose the form of education and content of education for their children” and that the convention would “outlaw spanking”, give “children the right to listen to rock music” and create a right to privacy that would “invalidate all parental notification laws concerning abortion”.
At Isman’s clinic in Stockholm, she says: “We do have parents now that they don’t want their girls to come to our youth clinic because we talk about things they don’t want their girls to know about,” said Isman, who estimates about 90% of the clinic’s patients are female. “You have to try to find ways to talk to those parents and also try to find ways for those kids that are not allowed to come here. How do we reach them?”
Isman and her fellow midwives might spend a day helping a young adult choose a method of birth control or schedule an abortion. Down the hall, her social worker and psychologist colleagues might screen teens navigating their mental health for abuse by asking if they’ve ever been spanked or prevented from taking prescribed medications. Both are services that are often difficult to access – or even illegal – in the US.
Although Sweden has implemented the UN convention in a way that allows children to access contraceptive and sexual health counseling, including sometimes abortion care, without parental consent, Todres doesn’t imagine the US would do the same, and says the convention leaves enforcement up to each country that ratifies it. He believes controversial health debates that impact only a small number of children, like abortion and gender-affirming care, have distracted from the larger areas where most parents would support their children having access to healthcare.
“On the majority of issues, parents’ interests and children’s rights align. If you survey 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 a quality education,” said Todres. He adds that human rights laws “are designed to protect children and families from abuses by governments”.
For Barnert, a right to healthcare means “that every child can have their urgent and emergency needs met, and that every child has access to appropriate evidence-based preventive care”.
She finds the human rights framework of the UN convention particularly useful because it considers “a lot of barriers that aren’t the healthcare itself that interfere with patients’ abilities to get healthcare”, like the cost of transportation or parking, being able to take time off of work, feeling safe going to a doctor’s office regardless of immigration status or accessing non-politicized, evidence-based care, like vaccines.
It’s not likely the US will ratify the convention on the rights of the child anytime soon, Todres says. Or, that if it does so, it will implement it the same way Sweden has.But in the meantime, a handful of cities, includingPortland, Oregon, andSanta Cruz, California, have adopted children’s bills of rights. And with children’s access to healthcare on the chopping block this year, it might be time to consider whether that access should be protected as a right.
This story is part of a reporting fellowship sponsored by the Association ofHealthCare Journalists and supported bythe Commonwealth Fund