The field of health has numerous consent and capacity criteria and contrasts significantly with rights afforded to children in other areas. The legal drinking and smoking age are fixed and consistent across the region.
The legal minimum ages at which children and adolescents can access services, and are allowed to give independent informed consent to medical interventions and treatment, are higher than in many of the other domains. This includes sexual and reproductive and mental health services.
This is most strikingly seen in the limited and restricted ability of children and adolescents to consent to medical treatment, access confidential advice, and request an abortion independently. The field of health has numerous consent and capacity criteria and contrasts significantly with rights afforded to children in other areas. The legal drinking and smoking age are fixed and consistent across the region.
Also within the health domain is the legal access to substances such as tobacco and alcohol, as well as the access to harm reduction services. The forthcoming CRC General Comment No. 20 recommends that “in view of the degree of risk and harm associated” with the consumption of alcohol and tobacco the minimum age limit should be 18 years” (Para. 44).
Nearly all countries in the region comply with this recommendation, with only Bosnia and Herezegovina allowing smoking at the age of 15. Kazakhstan has set an even higher legal drinking age at 21, and in Uzbekistan, both alcohol and tobacco may only be sold to those above the age of 20. On the access to harm reduction services, little information could be found.
For adolescents, another key area within the health domain are sexual and reproductive health services. In the CEE/CIS region, abortion is legal in all countries and all countries have set a minimum legal age for abortion with the exception
of Azerbaijan and Moldova. The lowest age is 14 years in both Georgia and Ukraine. Georgia is a particularly unique example as it not only has the lowest minimum age for abortions, but that it also does not require parental consent.
The Georgia Law on Patient Health Rights (last amended in 2015) stipulates in Article 40 that,
[i]nformation about a minor’s health status may be withheld from parents or legal representatives when … a minor patient aged 14 to 18 who, in the opinion of a medical care provider, can evaluate his/her health condition correctly and who referred to the doctor for treatment of sexually transmitted diseases or drug addiction, or for taking advice on non-surgical methods of contraception or for artificial termination of pregnancy.
In seven other countries (see the table at the end of the section for details), the age is 18 years, meaning that children are prohibited from having an abortion. The majority of these countries are from the Central Asian sub-region. Six countries have set the age at either 15 or 16 years, and seven countries have set a minimum age but require parental consent, consent by the father, proof of capacity, or the permission of a court or parents. An interesting regulation is found in Bosnia, where “requests for the termination of pregnancy of a minor pregnant woman must be submitted by one of the parents or the guardian on her behalf if she has not reached the age of 16 or does not earn a living through work” (CRC State Report by Bosnia and Herzegovina CRC/C/11/Add.28, 2004, para 230, 231).
Thus, a minor must be 16 years to have an abortion without parental consent or she must be employed. If she is not employed, she cannot take this decision independently below the age of 16. Additionally, a child between 14-16 years can
refuse an abortion, even if her parents want one, but will not be allowed to have one if her parents do not consent: “Despite a request by parents, the termination of pregnancy of a person who has reached the age of 14 cannot be carried
out without her own consent.”
The age at which children can access independent medical advice on contraception is less clear, with five countries being unclear and no data found for a further five countries. Where minimum ages are set, they vary across the region from 10 years in Armenia to 18 years in Kazakhstan, Macedonia and Moldova. The lack of availability of independent family planning advice contrasts with the lower age of consent across the region. Furthermore, there is often a marriageable age that is often lower than 18 years, meaning that a married individual may not be able to accept contraception advice or have access to abortions without consent or additional proven capacity.
Where information on independent access to confidential testing and treatment of sexually transmitted infections (STI) could be obtained, it is usually aligned with other minimum ages in the health domain, with the exception of Armenia, where STI testing is possible at the age of 14.
Two key questions in the field of health are: a) the access to confidential health advice, and b) the consent to treatment. Across the CEE/CIS region, the ability of children and adolescents to independently consent to b) medical treatment
varies significantly (see table at the end of the section for details). In seven countries, children under the age of 18 cannot make independent health choices, always needing parental or guardian approval (Bulgaria, Romania, Macedonia,
Armenia, Azerbajan, Turkey and Tajikisztan). In two countries, the age is 18 for consent to complex procedures with possible adverse consequences for the child, but lower otherwise. These two countries are Kazakhsztan, where the general
age for independent health decisions is 16, and Russia, where children that show competence can receive independent treatment at the age of 15. Georgia and Turkemistan specify that emancipated minors can make independent health choices,
even though the general age to make complex independent medical decisions is set higher. Hence, in these two countries, the right to independent health decisions is tied to majority (which can be attained earlier), rather than a fixed
The lowest age at which a child can make independent health choices are in Belarus and Uzbekistan, at 14 years. In Croatia, Kyrgysztan and Moldova, the age is set at 16. In Montenegro and Serbia, the age is set at 15 with the additional need for the child to prove capacity. Overall there is no clear regional pattern, except that all Central Asian countries do not allow children to make independent health choices.
For those countries of the region for which data regarding access to independent medical advice is available, the average age to access medical advice is above 15, and it would be higher if not for the notable exception of Serbia. The Serbian
Law on Patients’ Rights ensures that confidential counselling is provided to any child that is capable for reasoning, irrespective of age and without parental consent if that is in the best interest of the child. It is the only law of
this type in the region. Apart from Serbia, access to independent medical advice is often as high as for medical interventions (see table at the end of the section).
Age at which children/adolescents can seek independent medical advice
During our consultation adolescents felt strongly capable to exercise their participatory rights in health, such as seeking medical advice alone without a parent/or guardian, if they wanted.
Overall, 62% of respondents “agreed” or “strongly agreed” that they were capable enough to speak to a doctor independently, with capability increasing as the age of the respondent increased. From the age of 14, more than half of respondents from each age group felt that they could speak to a doctor independently.
“I am capable enough to:” “talk to a doctor by myself without my parents/guardians” by age
How much do you agree with the following statement? “A young person your age should be able to seek medical advice by themselves without their parents/guardians, if they want to” by age
From what age can a young person seek medical/health advice by themselves?
Did a doctor ever refuse to give you medical advice because your parents/guardians were not with you in the room? by gender, general health status, and existence of long-term health problems
Did you ever avoid seeking medical advice because your parents/guardians had to be with you in the room? by gender, general health status, and existence of long-term health problems
The top medical issues that respondents wanted to seek advice for (but did not because their parents had to be in the room) were: mental health, sexual issues (e.g. pregnancy, avoiding diseases), and sexual orientation. In particular, females selected mental health as the issue for which they avoided seeking advice more often than males, whereas males selected sexual orientation more often than females.
What were you seeking medical advice for? (Top 3) by gender
Few felt capable to make their own decisions about medical treatment (such as injections) in a general sense, but the majority felt strongly about giving consent before receiving medical treatment specifically. On average, only 30,7% of respondents “agreed” or “strongly agreed” that they were capable enough to make their own medical decisions, while 68,6% “agreed” or “strongly agreed” that they should always give consent prior to receiving a medical treatment.
"I am capable enough to": “make my own decisions about medical treatments I could receive (e.g. injections).”
How much do you agree with the following statement? “A young person your age should always give consent to a doctor before receiving any medical treatment (e.g. injections)“ by age
A doctor wants to give a young person medical treatment (e.g. injections). From what age can a young person refuse to receive treatment?
Did you ever have a medical treatment that you did not want, but were forced to by your parents/guardians or doctor? by gender, general health status and existence of long-term health problems
*As many laws have several exceptions and considerations, the most widely applicable ages were used in the consultation. This is to ensure that ages would be easy to understand by adolescent participants for the sake of discussion. For more on the legal minimum ages used in the consultation, please see our Methodology.
**Names have been changed to protect the privacy and confidentiality of focus group participants. For more on ethical considerations when conducting research with adolescents, please see our Methodology.