Ensuring California Youth in Foster Care Receive Gender Affirming and Reproductive Health Care

teen girl smiling and talking to adult

February 2023

All youth deserve the right to healthy relationships, healthy sexual development, and bodily autonomy to ensure they can lead thriving lives and create the futures they envision for themselves. But youth in foster care often face systemic barriers that make access to sexual health education and care challenging, leading to poor reproductive and sexual health outcomes and experiences, including high rates of unintended pregnancy and sexually transmitted infections. The Supreme Court’s 2022 Dobbs decision to cut people off from reproductive care as well as state attacks on gender affirming care only further undermine efforts to provide foster youth with the information and access they need to make informed decisions about their health. And foster youth are clear: They want trusted information about sex, health, and puberty, and access to the health care needed to ensure they can thrive in adolescence and adulthood.

California is one state listening to the voices of youth. Recently, California issued a directive to counties affirming both that youth have a right to receive the sexual, reproductive, or gender affirming health care they want and need regardless of the Dobbs decision and that the state has a responsibility to step in and help California kids in foster care get that care even if they live outside of California. 

Learn more about how California is leading the way to ensure foster youth have bodily autonomy and healthy sexual development in our Q&A by health team lead Rebecca Gudeman.

What does it mean for foster youth that California has stated it will provide them sexual, reproductive, or gender affirming health care? 

Youth in foster care want and need bodily autonomy and access to healthy sexual development – just like all children and people. California has been a national leader in setting a standard for the sexual and reproductive health education and services we believe youth should have and deserve. So when the state takes children into its care, the state has a legal and moral responsibility to address their health needs, including sexual and reproductive care, as well as  their physical and mental health needs. 

Making it clear that the state of California – and by extension its 58 counties – will provide California foster youth sexual, reproductive, or gender affirming health care no matter where they live, acknowledges this responsibility. It also builds off of years of work by youth-led projects, advocates, and coalitions, including the Reproductive Health Equity Project collaborative coordinated by the National Center for Youth Law. Our collective policy and education goals have been to ensure California youth in care have access to comprehensive age-appropriate sexual health and relationship education, dismantle unique barriers that youth in care face to timely access to sexual and reproductive health services, foster development of culturally-relevant and trauma responsive care, and educate, enable and empower key adults to play the role of a trusted adult mentor. The letter to California counties affirming the state’s responsibility is a major milestone in our policy and education journey for youth, and sets precedent for other states on how to best serve youth in foster care.

Why is California making this announcement now, 6 months after the Supreme Court’s Dobbs decision?

While California leaders, including Governor Gavin Newsom, have been clear about protecting reproductive care rights for all people, the devastating reach of the Dobbs decision doesn’t stop at state lines. And that is especially true for California foster youth who can be placed in out-of-state homes or situations and may be in a state that has restricted access to health care services that would be available to youth in California.  

California is the first state to draw a line and say we will help foster youth get the health care they want, including in a state where access to abortion or gender affirming care is being taken up by hostile state legislatures or courts. California’s letter to counties makes it clear that it is the state’s legal duty to intervene and get those kids care, whether it be supporting transportation, providing funding for care, changing their placement or other forms of assistance that might be needed.

What can youth partners in other states do to follow California’s lead and support youth’s healthy reproductive care?

Healthy sexual development and access to sexual and reproductive care and gender-affirming care is something every human deserves and cannot be taken for granted in the US or any state. And healthy reproductive care is about more than access to safe abortions. Sexual and reproductive health incorporates access to comprehensive, medically accurate sexual health education, consistent, preventive care like annual health screenings, the right to consent to care and to confidentiality in that care, the full range of contraception options, as well as pre and postnatal care from inclusive and affirming providers – among other things. 

It is also important to lift up that while the Dobb’s decision certainly has drastically cut off access to abortion and reproductive care in many states, many in marginalized communities already faced almost impossible barriers to real sexual and reproductive health care access, including youth in foster care and youth who identify as LGBTQ and/or as BIPOC. Too often the right to reproductive care was just ink on a piece of paper thanks to racism, homophobia, transphobia, and structural barriers in our systems. Dobbs has only made things worse. 

Partners in other states can start to help youth by taking stock of what is available in their state to support healthy sexual development. It’s imperative state leaders, including policymakers, health educators, and school educators, come together and listen to the voices, information, and work of youth to shape policy and curriculums. Engaging a youth advisory board comprised of young people with a diverse array of lived experiences to actively participate in and shape policy and advocacy efforts is essential. Building local and state capacity to empower youth by providing trauma-informed and culturally relevant education, training, and resources directly to foster youth, caregivers, community-based health providers, social workers, and judges is also what states must prioritize.

Whether you’re a youth, caregiver, health provider, child welfare leader, or advocate, the Reproductive Health Equity Project can guide you on how to get started and help youth in your state have access to the sexual health development and bodily autonomy they need.

Eager to learn more? Join us for a free virtual conference on Thursday, February 16, 9 am - 5 pm (PST). “Thinkings Outside of the Systems: Reimagining healthy sexual development for youth in foster care.” Register today and don't miss out.