Minnesota Considers Stripping Teens of All Health Decisions, Eliminating Judicial Bypass

Robin Marty

Tucked into a bill proposed on Friday is a stipulation that teens cannot consent to any health procedure, removing access from abortion, birth control and STI screenings.

The Minnesota Republicans are continuing their assault on health care, now coming after local teens in an attempt to remove their ability to get abortions, birth control, or even a screening and treatment if they have a concern about STI’s.  And if the teen has been raped, there would be almost no chance at a judicial bypass.

As Rachel Nygaard reports at Minnesota Progressive Project:

MN GOP’s bill, SF 1017, moves Minnesota from a ‘parental notification’ state to a ‘parental consent’ state – meaning that for a minor to obtain an abortion, they must obtain permission from their parents. There is an exception for incest, though only when raped by a relative nearer than a first cousin by blood and the victim would be forced to go in front of a judge and prove that incest occurred. The incest exception would NOT include step parents, step siblings or guardians and there is no exception for rape by a stranger. This bill effectively removes the judicial bypass mechanism implemented by Minnesota’s parental notification law, which enabled minors to obtain permission from a judge. This bill would not only force rape and many incest victims to confront their assailants to obtain permission for an abortion, they would have to obtain their permission for mental health counseling and other medical treatment.

SF 1017 will prevent youth from seeking health care services by removing the right to confidentiality. This right has been a cornerstone to improving the health of American teens.  

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Anti-abortion activists believe that forcing children to talk to their parents for permission to get birth control keeps parents in the loop about their child’s well-being.  Instead, it makes for teens who engage in riskier behavior and avoid treatment when they do eventually get sick.  And to force a teen girl to prove to a judge that she was raped by a closely related blood relative to have an abortion?  Or even worse, deny her an abortion if she was raped by a step-family member unless she tells another parent in order to get access?

The anti-choice say they want to protect children.  How is this protecting them?

Investigations Abortion

Anti-Choice Activists, Using Bogus Legal Threats, Trick Teens Into Signing Away Abortion Rights

Sharona Coutts

Providers throughout the country have told Rewire that a document produced by Life Dynamics has been used to deceive and intimidate both patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Last February, AJ, a single mother in Mississippi, found herself at the back of an abortion clinic in Memphis, Tennessee, where two police officers threatened to charge her with fetal homicide.

It was yet another unexpected turn in a week of surprising events for AJ, whose name we have agreed to conceal for the sake of her family’s privacy.

Days earlier, AJ had received the kind of news that most parents of teenagers hope never to hear. Her 17-year-old daughter, a student at Lake Cormorant High School, texted her to say she thought she was pregnant.

Mother and daughter discussed the realities of raising a baby as a single teen in a low-income household. Initially, AJ’s daughter said that she wanted to have an abortion, but she cried when they went to the clinic, so AJ took her home. After more conversations, the daughter again decided to have an abortion, and AJ scheduled an appointment at CHOICES, a clinic in Memphis, half-an-hour’s drive across the border from their home in Mississippi.

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As they sat in the clinic waiting room, her daughter was distracted, texting on her phone with a woman in Hernando, Mississippi, whom AJ did not know. The woman had—to AJ’s consternation—been trying to persuade AJ’s daughter not to have an abortion. Her messages kept flashing up on her daughter’s phone. It’s wrong to have an abortion. God is not going to forgive you for this.

“Her mind was solely made up with the procedure that the clinic was going to do,” AJ recalled, “but when she had someone up in her ear telling her, don’t do this—I think the lady did really get in her head.”

Now AJ found herself being stared down by two police, with nervous clinic staff telling her they were unable to provide her daughter’s abortion at that time.

“The police explained that someone had called them saying that my daughter was there unwilling to have the procedure done,” AJ recalled in an interview with Rewire. “So when the police talked to me, they said that if I had forced her to do it they were going to bring fetal homicide charges against me. So we left, and came home.”

AJ was shaken by the encounter, and it would take several weeks and significant legal wrangling before she could make sense of how events had spiraled from what should have been a simple medical appointment into a serious brush with the law.

With assistance from her lawyer, over the course of the next few days, AJ would learn that in addition to the anonymous phone calls that had been made to the clinic while she and her daughter waited for her procedure, people unknown to AJ had faxed her daughter’s personal information—her name, medical information, and even her social security number—to countless numbers of doctors, police, and other strangers in at least two states, without AJ’s knowledge or consent. She would discover that her daughter had been picked up from school and driven across the state border by a person that AJ did not know. And before the saga was resolved, AJ would even find out that an attorney she’d never heard of had purported to represent her daughter, and had sent threatening letters to the abortion clinic, directly interfering with her daughter’s medical treatment.

A Rewire investigation has found that at the center of the drama that unfolded in AJ’s life was a document produced by Life Dynamics, the prominent anti-choice group that is based in Denton, Texas, which receives the majority of its funding from the fracking billionaires Dan and Farris Wilks. The Wilks brothers are also the main backers of Sen. Ted Cruz’s presidential campaign.

The document is a bogus “notice” that tricks women into believing they have signed away their legal rights to receive an abortion. Providers throughout the country have told Rewire that this document has been used for years to deceive and intimidate both patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

In AJ’s case, the tactic did not work. But her story is an illustration of the intrusive and dishonest techniques used by anti-choice activists to deprive women of their constitutional rights. Abortion providers familiar with the document worry that, for each of the women who ultimately receive the care they desire, countless more may be too intimidated to try.

School Employees Introduce Student to Anti-Choice Activist

The involvement of anti-choice activists in AJ’s daughter’s life began with an innocent conversation between the daughter and a teacher at her school in early February 2015. Rewire was not able to speak directly with the daughter, but confirmed many of the details of AJ’s account with documentation provided by AJ’s attorney, Latrice Westbrooks. Rebecca Terrell, the executive director at CHOICES in Tennessee, also confirmed that the incident involving the police occurred in February last year.

When the daughter confided to her teacher that she was pregnant, the teacher informed another school staff member, and that staffer then contacted a third woman—a stranger to AJ’s daughter, and not a member of school staff—who arranged to meet the girl after school. To this day, AJ has been unable to learn this woman’s identity.

On February 19, the unknown woman drove AJ’s daughter—a minor—across state lines to Millington, Tennessee, where they visited a clinic called Confidential Care for Women, which is a crisis pregnancy center.

Crisis pregnancy centers have a long track record of providing false information to women. Their names and marketing materials are designed to trick the public into thinking that these centers provide abortion when, in reality, they are run by anti-choice groups who deliberately mislead women, and stall for time, in the hopes of diverting them from accessing abortion care. These centers have been the focus of numerous investigations by congressional committees, cities, and independent investigators who have all caught them lying to women about the risks of abortion procedures, as well as misleading them on the types of services crisis pregnancy centers actually provide.

While AJ’s daughter was at Confidential Care for Women, staff performed an ultrasound and had her sign a document titled, “Patient Notice of Intent.”

As AJ would eventually discover, it was that document that created astonishing difficulties in attempting to secure her daughter’s medical care.

The notice is a boilerplate document drafted in small-print, ersatz legalese.

It states:

I have decided to continue my pregnancy to term. However, I am being subjected to coercion by others that is meant to compel me to terminate my pregnancy against my will.

The document then says that if the person who signed it is “brought” to a health-care facility to obtain an abortion, their presence would be a result of “threats, intimidation, force or threats of force.” It also threatens civil and criminal action against “all participating members of the healthcare facility’s medical staff and non-medical support staff” for a laundry list of 15 offenses, including wrongful death, sexual assault, child abuse, and fetal homicide.

The form lists Sheila Williams as the “contact person at the pregnancy center.” In a telephone interview with Rewire, Williams, who said she is the “client services person” at Confidential Care for Women, confirmed that her center continues to have patients sign these notices of intent, but declined to say why, other than that they are “self-explanatory.” Williams repeatedly sought to learn the identity of the patient who was the subject of our call; we declined her requests.

Crucially, the document claims “it is probable that a person or persons whose objective is to prevent me from either withholding or withdrawing my consent for an abortion will accompany me to this facility.”

That last claim appears to be what prompted police to threaten AJ with charges of fetal homicide if her daughter obtained an abortion.

(Read a redacted copy of the document here.) 

“They said they would bring legal actions against me,” AJ told Rewire. “They were saying there’s nothing I can do because if she’s a teenager and she doesn’t want to have an abortion, it’s wrong for me to force her to have it. And I wasn’t forcing her, I was just letting her know what it’s really going to be like to have a baby.”

Deceptive Form Produced by Group Tied to Fracking Billionaires

The form is copyrighted to Life Dynamics, a Texas-based group dedicated to ending legalized abortion in the United States. Life Dynamics is known for its ongoing anti-choice activities. Over the years, the organization has sent DVDs to thousands of lawyers across the country, urging them to sue abortion providers. And through its “Spies for Life” program, it seeks to enlist the public as spies on abortion clinics, and unsubtly encourages activists to trawl through abortion providers’ trash.

According to the most recent available public tax filings, between 2011 and 2013, Life Dynamics received the majority of its funding from Dan and Farris Wilks—the Texas fracking billionaires—via the Thirteen Foundation, one of the vehicles they use to make charitable contributions. While the brothers have scattered their wealth throughout the fundamentalist Christian world, the other major current beneficiary of their largesse is the presidential campaign of Republican Sen. Ted Cruz.

A spokesperson for Life Dynamics declined to answer our questions for this story.

Lawyers told Rewire that the type of document signed by AJ’s daughter would not have any legal force, especially when signed by a minor.

But that hasn’t stopped anti-choice groups from using the documents, according to multiple providers from different regions of the country, who said they are familiar with these phony notices.

Vicki Saporta, president and CEO of the National Abortion Federation, told Rewire that providers all across the country have contacted her group about these forms. She ticked off states in which clinics had shared them with her recently: Arkansas, Georgia, Kentucky, and Maryland to name a few. Terrell from CHOICES in Memphis told Rewire that her clinic receives multiple such forms every year, and Lori Williams, clinic director at Little Rock Family Planning Services in Arkansas, said her clinic also regularly receives these forms.

The forms are frequently given to minors, who later report that they were coerced into signing them by people such as their boyfriend’s parents, who oppose abortion for their own religious or political reasons.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Saporta and multiple providers told Rewire that the tactic frequently fails, as long as a girl or woman makes it to a clinic. Staff are well trained when it comes to the informed consent process, and support their patients to make their own decisions, whether or not that results in an abortion. In this particular case, CHOICES faced the unusual situation that police were present while a patient was seeking care, and according to Terrell, there was confusion as to who had called the police.

What worries providers are the girls and women who never come to the clinic, believing they have signed their rights away.

“The ones who do come and say that they do want to obtain an abortion, the clinics do their own informed consent process and take the time to ensure that the woman is not being in any way coerced,” Saporta said. “You don’t know about how many women don’t come to the clinic to attempt to obtain care.”

Single Mom Faces More Legal Threats From Anti-Choice Activists

After returning home from that visit to the clinic, AJ and her daughter spent the next few days discussing her daughter’s options. At one point, her daughter appeared to vacillate, saying she might want to continue her pregnancy. AJ talked with her about what that would entail—what it would mean for her daughter’s social life, for her studies, and for her future. She also explained the financial reality of having a baby: AJ was already struggling to support herself and her daughter by working 64 hours per week between two jobs as a card dealer at local casinos.

Ultimately, the 17-year-old decided that she wanted to terminate her pregnancy, and AJ made another appointment at CHOICES, for February 21, 2015.

But when they arrived, CHOICES staff again told AJ they could not perform the abortion. Minutes before, the clinic had received a threatening legal notice from an attorney in Tupelo, Mississippi, named Stephen M. Crampton, who claimed to be representing AJ’s daughter.

“Be advised that this office represents [REDACTED], age 17,” the fax read. “Her mother is transporting her to your clinic as I write.” Crampton purported to put the clinic on “legal notice that any procedure you administer would be against [REDACTED’s] wishes and her constitutional right to choose, and you will face legal consequences if you choose to ignore her stated choice.” (Emphasis in original.)

Crampton named Cathy Waterbury as the employee at Confidential Care who had faxed through the notice of intent to CHOICES. Waterbury has since left Confidential Care, according to Williams, but she is listed in federal tax filings as the chief officer of a Tennessee nonprofit, Heart to Heart, which describes its mission as “abortion alternatives.” Heart to Heart is based in Millington, Tennessee—the same town listed on the notice as Confidential Care’s address. The documents also list the same phone number for both Confidential Care and Heart to Heart. We attempted to contact Waterbury through publicly listed phone numbers, but were unable to reach her.

AJ had never heard of Williams, Crampton, or Waterbury. This brought to five the total of unknown adults who had interfered with AJ’s daughter’s health decisions without AJ’s knowledge, in addition to the two school staffers. AJ would later learn that Crampton had been in contact with her daughter while she was wrestling with her decision about whether to continue her pregnancy.

The involvement of an unknown attorney in her child’s health decisions would be troubling enough, but Crampton is not just any neutral lawyer, seeking to do his client’s bidding. Based on his online profiles, Crampton is in fact special counsel to the Thomas More Society, a Chicago-based nonprofit law firm that represents anti-choice extremists, including David Daleiden, the activist who has recently been indicted by a Texas grand jury for his role in creating the deceptive attack videos against Planned Parenthood last summer. Neither Crampton nor the Thomas More Society responded to our requests for comment.

For all the strangers that AJ could identify who had been given sensitive information about her daughter’s health, the document that Confidential Care had AJ’s daughter sign indicated that—contrary to what their name would suggest— they could have disseminated it to an almost infinite number of third parties.

In addition to the legal threats it contained, the notice of intent also included a section that permitted Confidential Care to “immediately forward copies of this document to the following”:

  1. Every abortion clinic or other abortion provider to which I might be taken;

  2. Every law enforcement entity (police department, sheriff’s department, district attorney’s office, etc.) with jurisdiction where I might reside and those with jurisdiction where the abortion might be performed; and

  3. My legal counsel and/or the legal counsel representing the Pregnancy Center.

AJ learned that Confidential Care had already faxed a copy of the notice to CHOICES, apparently on the same day that her daughter had visited Confidential Care. AJ does not know who else received a copy.

That was particularly worrisome because the document did not just inform all recipients of AJ’s daughter’s pregnancy, but it also contained the girl’s full name, her full address, and even her date of birth and her social security number.

Williams, of Confidential Care, was unapologetic about distributing this private information about a minor to third parties. “I am fully aware of what we sent out,” she told Rewire.

When pressed on the fact that this case involved a minor—who was not legally competent to sign such a document—Williams pointed to language in the document that asserts that the minor gives permission to the pregnancy center to “provide this document to every city, county or state social service agency responsible for the protection of underage children with jurisdiction where I reside and those with jurisdiction where the abortion might be performed.”

Williams then asked again for the patient’s name, saying, “I have concerns for patient confidentiality.”

Williams declined to answer questions about whether she and her center are bound by federal patient privacy laws. She said that someone else from her organization would answer those questions, but we never heard back from any other Confidential Care representative.

Abortion providers say that when they receive these notices, they almost always contain this level of personal information—a practice that disturbs Vicki Saporta of the National Abortion Federation.

“It’s particularly unconscionable that they indiscriminately send out patient information,” she said. “If she had concerns about patient confidentiality then she would not be having the patient sign the form to begin with and sending it all over town in violation of the patient’s confidentiality.”

At this point, AJ decided she needed a lawyer. She contacted Latrice Westbrooks, who knew she had to act fast because AJ’s daughter’s pregnancy was approaching the end of the first trimester, and mother and daughter were concerned that it might soon become more difficult for her daughter to obtain an abortion at a local clinic.

Despite multiple phone calls, Crampton never replied to Westbrooks. Ultimately, she had to draw up legal paperwork to prove to the clinic that Crampton was not AJ’s daughter’s legal representative, and that the document the girl had signed was not legally binding. As soon as the clinic was satisfied that it was legally able to do so, staff provided AJ’s daughter with her abortion.

Westbrooks says the clinic’s cautious response was understandable, given the threats they had received and the general atmosphere of intimidation currently surrounding abortion care, especially in the South. However, she says that the tactics used by the various anti-choice activists are alarming.

“My main concern here is that a minor was taken advantage of, and that school officials took the decision out of the hands of the parent and guardian and took it upon themselves to make a health-care decision on their behalf,” Westbrooks told Rewire. “It’s important for people to know that they have a choice to change their mind—whether it’s to keep their child or terminate their pregnancy—and not to let someone force them into making any kind of health-care decision.”

Westbrooks said that her client does not currently plan to take legal action against the school; neither the school nor the district replied to Rewire’s requests for comment.

While AJ’s daughter eventually obtained the care she wanted, AJ says the situation took a toll on her. Throughout the course of less than a month, AJ found herself threatened by police, and ensnared in a web of anonymous strangers who sought to impose their own ideological views on her daughter’s life.

“I’m truly a strong person,” she told Rewire, “but that really got the best of me.”

Analysis Human Rights

Zika Increases the Already Grave Dangers of Being Young and Female in El Salvador

Kathy Bougher

The Zika virus, its potential link to microcephaly and other complications, and the inadequate government responses to it so far all bring into sharper focus the threats girls and women already face in the country.

Read more of our articles on the Zika virus here.

The arrival of the Zika virus is not the only threat to young women’s health and human rights in El Salvador. The virus, its potential link to microcephaly and other complications, and the inadequate government responses to it so far all bring into sharper focus the grave situation girls and women already face in the country. Such danger, highlighted in both government reports and the work of activists on the ground, includes sexual violence, a lack of access to medical care, and gang activity.

El Salvador’s health ministry recently recommended that because of the virus, women contemplating pregnancies should take measures to postpone their pregnancies for at least two years. However, as Rewire reported, feminists responded that the recommendation is inadequate. It does not address the realities in El Salvador, they said, a country where 31 percent of all pregnancies registered with the El Salvador Ministry of Health in 2014 occurred among girls and women ages 10 to 19. Because of a number of societal restrictions, many of these girls may not have a choice in whether to put off pregnancy. 

A November 2015 report from the United Nations Population Fund (UNFPA) and the Salvadoran Ministry of Health (MINSAL) gives the most up-to-date details so far about this large segment of the population, especially where issues of relationships, pregnancies, and reproductive rights are concerned. Although the report was released before news of Zika became widely recognized, it describes interconnected systems of coercion and abuse any strategies to address the virus must take into account.

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The UNFPA and MINSAL report stemmed from two stark figures in a National Health Survey in 2014: One out of every three women ages 20 to 49 in the survey had a pregnancy before the age of 18. One out of four lived in a relationship with a man, married or unmarried, before the age of 18.

These numbers, notes Minister of Health Violeta Menjívar in the 2015 report’s introduction, reflect the environment young women must often navigate in El Salvador:

The relationships as well as the early pregnancies are the result of circumstances beyond the control of the girl and the adolescent, and they impede her from making key decisions about her life adequately. The situation of violence in the family and in the society places girls and adolescents in situations in which their rights are violated. The relationships and pregnancies before age 17 are a product of the social violence that they suffer daily, and which is not taken on as such by the society or the State. 

Using interviews with girls between the ages of 10 and 17 who had a live birth in 2012 at a Ministry of Health facility, the authors of the 2015 report attempted to flesh out the stories behind those statistics. The majority of the relationships, it found, were “not among peers,” meaning an age difference of three years or less. Rather, two-thirds of the girls had a male partner at least four years older at the time they gave birth, and 18 percent had a partner at least 10 years older.

This, the report states, creates “very unequal power” in the relationships, which leaves the girls and young women with “very little margin with which to make decisions about their lives.”

The study recognizes the problematic and conflicting laws in the country that criminalize some of these relationships but legalize others. For unmarried individuals, for example, any sexual relation with a minor younger than 15 years old is a crime. But there are still laws in effect in the penal code, it says, that “permit marriage under the condition that the girl or adolescent is pregnant or [they] have children in common, and there exists the express permission of the parents or guardians.”  

The study also shows that “one of every ten relationships was formalized through marriage, including some with girls ages 10 to 12.”

The report also highlighted the inadequate medical services many of the girls received. In the case of the 10-to-12-year-old group, 20 percent had no postpartum care, even though, as the report says, they are the most vulnerable to obstetric complications. Half the girls and young women who gave birth in 2012 were not using contraceptives at the time of the study in 2015. By that time, 29 percent had already had a second pregnancy or were pregnant.

Girls and adolescents with histories of sexual violence, as self-reported in the interviews, comprised 37 percent of the interviewees overall, but two-thirds of girls ages 10 to 12 in 2012. One out of five of the girls who were 10 to 12 years old in 2012 had their first sexual relation with a family member, which constitutes the crime of aggravated sexual aggression. Though the report did not discuss individuals’ experience with the justice system, feminist groups that collect data on violence against women say that few police reports are ever filed of crimes like these—and if they are, there is rarely any follow-up.

“Sexual aggressions committed against girls and adolescents take place in an environment of social permissiveness around assaults, abuse and deception, fed by neglect, violence and poverty,” wrote Menjívar in her introduction.

“The fact that a girl of 10, 11 or 12 years of age is pregnant or finds herself in a relationship, that she leaves school, that she does not have access to services to protect her, et cetera, should be considered a national priority especially, when the persons who should protect them, and the institutions that should guarantee their rights, permit that these rights be violated,” she continued.

Right now, local health educators say that combating this problem is not a national government priority—and their own community-based work reinforces the report’s conclusions. Zuleyma Lovo, psychology student and leader from the activist group Jóvenes Voceras y Voceros en Derechos Sexuales y Reproductivos, gave workshops in rural communities and in middle schools on sexual and reproductive health—until increasing gang violence caused the program to be suspended in late 2015.

In an interview with Rewire, she affirmed the frequent incidents of violence and sexual abuse among the students she knew, and the many young girls who lived with older men:

At the school we asked for anonymous written comments, and in addition to questions about our talks, the girls would tell us about the physical, sexual, and emotional violence they experienced at home. Many think they can escape it by leaving home and living with a man, almost always a man who is older. But, the same dynamics repeat themselves, the violence, the abuse, the control.

This coercion extends to the control of pregnancy planning. “The men decide whether or not the women can use contraceptives. The men almost never agree to use condoms,” she said.

“Then the Ministry of Health arrives and tells women to abstain or to keep from getting pregnant,” she added.  

This is not the only situation, advocates say, in which adolescents have difficulty accessing contraceptives. Lovo, and Noel Gonzalez, health educator and national director of Voceros y Voceras, described the difficulties the young people they serve face when attempting to obtain birth control available at no cost from local health centers operated by the government. Such clinics are the providers for the majority of poor people, both urban and rural; those who can pay for private pharmacies tend to have more options.

Gonzalez explained that the centers are directed to offer “youth-friendly” services, but that is rarely the case. Frequently, Gonzalez said, the young people he’s interacted with are met with “judgmental, prejudice-laden treatment and a lack of confidentiality” from the time they walk in the door. When young people do request contraceptives, he said, they are often told, “You’re too young. It won’t matter. You’re just going to get pregnant, anyway.” As a result, Gonzalez said, “many never go back.”

Clinics, Gonzalez said, often have limited supplies of certain kinds of birth control. “They only have the three-month injections, which have more side effects for young women,” noted Gonzalez. In its 2014 report On the Brink of Death: Violence Against Women and the Abortion Ban in El Salvador, Amnesty International found that “these clinics have … been associated with provision of fewer options and poorer levels of service for young women including denial of services and discriminatory treatment.”

And if that contraception fails, Lovo noted, women have few options: Abortion is 100 percent illegal in all cases in El Salvador. “Pregnant women who are abused or whose partners deserted them might be considering interrupting their pregnancies, but they are afraid to talk about it because of the strong religious biases against abortion,” she said.

All this is worsened, Lovo explained, by the threat of gang violence, which shut down her project in 2015. “They murdered a woman leader in one community, and we can’t go back there,” she said.  

El Salvador, by many rankings, is one of the most dangerous countries in the world. Contributing factors are complex, but gangs and organized crime play large roles.

Gangs claim territories, which makes access to some health clinics a dangerous matter. Gonzalez elaborated, “The gangs stop you and ask you for your [identification], and if you live in the area of a rival gang, they won’t let you into their area. That can be where the clinic is.” A young person with the resources can take a bus to a distant clinic, but most don’t have that option.  

Working as a health promoter is also dangerous: Some, Gonzalez said, have been murdered by gangs as they move from one community to another. He also explained that gangs kidnap or threaten to kidnap young women from their families and rape them, which has caused families to relocate within the country or to leave the country in order to protect their daughters. Some health clinics are reluctant to report rapes when women come to them for fear of reprisals from gangs.  

Violence and poverty work together to curtail school attendance, including access to sexual education. Rates of students who leave their school out of fear have doubled in the past five years. In some cases, schools have closed as families flee to other regions of the country or leave the country altogether. Lovo noted that independently run sexual education programs such as hers have been effective but small, and limited by safety concerns.

Various projects and programs to improve matters have been written at the ministerial level and partially implemented, but have not met their goals. A proposed law on sex education in the schools has stalled in various committees.

The potential risks and impacts of the Zika virus interact with and exacerbate the chronic dangers of being young and female in El Salvador. Any efforts to deal with Zika need to recognize those contexts, and to work on making the country safer for girls and women beyond the threat of the virus alone.