Categories
Abortion Public Health

Lament over Unplanned Pregnancy

The prevention of unwanted pregnancy is more important than ever for the well-being of the family.

  Antero Myhrman, Born Unwanted

One of my strongest memories from medical school was a delivery I assisted with. This was the mother’s fifth child and a quick birth. I proudly held up the newborn boy to show him to his mother. She turned her head away and cried.

I don’t remember the names of the mother or baby, who would be about 44 years old now. How his life has gone is only conjecture, but the likelihood is that his path has not been an easy one.

We generally assume that all adults are cut out to be parents, but that is not true. Forced parenthood can have unhappy consequences for the adults, and especially for the children. This column examines the outcomes of children of unwilling parents. Next month’s column will include the words written by a person who, herself, was born unwanted.

The biggest and best analysis of children born unwanted was done in Czechoslovakia at a time when women had limited access to legal abortion. An American psychologist, Dr. Henry David, collaborated with Czech counterparts. Czech women had two chances to request an abortion in the 1960s. The first chance was at a local clinic. If the woman were turned down, she could apply again at a regional level, the last resort for a legal abortion. Unfortunately, the many advantages of adoption were not considered in this study.

One of the Czech psychologists had a list of women who had been twice denied for the same pregnancy. Because of the excellent record keeping of that country, the children born to these women with unwanted pregnancies could be followed for many years. They were carefully matched to children who were desired—same age, same socioeconomic class, same school etc. All the families lived in Prague, the country’s capital.

These people, both those who were unwanted before birth and the “normal” controls, were examined and tested at age 9, in adolescence and again in their early 20s. The investigators also looked at records, interviewed parents and spoke with teachers.

The two groups of people ended up significantly different despite growing up in very similar circumstances. Compared to the people who resulted from pregnancies that were planned (or at least accepted), those born unwanted did not fare so well in life.

Specifically, the babies who had been unwanted were not breastfed as long, and did not achieve as well in school even though their intelligence tests were as good as the more desired children. They were more likely to be less social and more disruptive and hyperactive, and were more likely to have criminal records. When asked as adolescents, the children who had been unwanted believed their mothers showed less maternal interest than did the control group.

The young adults in their 20s were asked how they felt about their lives. Again there was a significant difference, with the people who were unplanned being less satisfied with their lives, with their love relationships, with their own mental health and with their jobs. It is interesting that their sexual debut was at an earlier age and they had more sexual partners than control people. Thus, these people were more likely to beget another generation of unwanted pregnancies.

There are exceptions to the general rule, fortunately. Dr. David’s research found three groups of women who requested abortions but were denied. Some had temporary motivation for wanting to abort, such as financial reasons. These women usually accepted the pregnancy and both mother and child did well. For other women the pregnancy resulted from a poor relationship, and they did not do so well with childrearing. The third group of women apparently realized from the beginning that they would not be good parents, and the study, unfortunately, bore this out. Both the women and their children did not fare well.

The Czech study was of women who were denied legal abortion. Those who were allowed to have abortion must have had even more compelling reasons to not parent. If they had been forced to bear their unwanted kids, presumably these children would have had even more severe problems.

What does this mean? A person resulting from an unplanned, unwanted pregnancy starts off life with a handicap, like the baby I delivered in medical school. This can have consequences for society, too. There is a controversial theory, popularized in Freakonomics, that the downturn in serious crime in the USA noted in the early 1990s was due to the decrease in unwanted pregnancies after the legalization of abortion in 1973.

An unwanted pregnancy can be devastating. Sometimes things work out well, but delivering and raising an unwanted baby may be traumatic for the parent(s), and scar the child.

© Richard Grossman MD, 2012

 

Categories
Medical Public Health Reproductive Health Women's Issues

Update on Abortion

Many years ago I worked for three weeks in Swaziland, South Africa. A memory still haunts me.

Most mornings we saw one or two young women through the emergency ward. Almost all of these women were from surrounding communities, were “visiting an auntie” and they hadn’t eaten breakfast. All were carrying early pregnancies and reported bleeding. Indeed, on examination there was blood and the cervix had started to open.

Bleeding and cervical dilatation in pregnancy usually ends up as a miscarriage, and can lead to a serious infection unless a D&C is done to empty the uterus.

Another doctor told me this pattern had been happening for a long time. We surmised that some doctor in this city was using instruments to make it appear that these patients were about to miscarry. It would be easy to instrument the cervix, tell the young woman to go to our hospital in the morning—and to skip breakfast. “I hope all goes well tomorrow at the hospital. And have your boyfriend wear a condom next time,” I can imagine that doctor saying.

In Swaziland abortion is only legal to save a woman’s life. The physician who opened the cervix was taking a big risk, allowing him to charge an outrageous fee.

Don’t laws that prohibit abortion decrease its frequency? No, apparently not. Norway, known for its excellent medical statistics, found that the incidence of abortion did not rise when it was legalized in 1978. This finding was borne out by a recent article in the world’s premier medical journal, Lancet.

The study looked at all the world’s countries. 84 have liberal abortion laws; the remaining nations (like Swaziland) prohibit abortion, with few or no exceptions.

Outlawing abortion does not prevent women from terminating unwanted pregnancies. Where it is illegal, however, women are subjected to unsafe procedures and risk their health and very lives. Surprisingly, this study found the incidence of abortion is higher in places where it is outlawed. This may be because these are also places where women are not esteemed, and where contraception is difficult to obtain.

Wherever laws permit safe abortion, two observations are made. Maternal mortality from unsafe abortions decreases drastically, and women are treated with more respect.

More surprises are to be found in another research paper from England. It is an exacting review of the psychological effects of abortion. Although many studies in this field are of poor quality, the researchers found 44 high quality studies.

To reduce the possibility of bias and to ensure transparency, the reviewers sent out a request for comments. Several anti-abortion (as well as pro-choice) organizations responded, and their comments influenced the final report.

The questions the multi-faceted panel of experts set out to answer are: How prevalent are mental health problems in women who have an induced abortion? What factors cause poor mental health outcomes after an abortion? Are mental health problems more common in women who have an abortion compared with women who deliver an unwanted baby?

The report’s findings are summarized:

•            Unwanted pregnancies are associated with an increased risk of mental health problems, and the rate of problems is the same whether women had an abortion or gave birth.

•            The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.

•            There are additional factors associated with an increased risk of mental health problems specifically related to abortion, such as pressure from a partner to have an abortion and negative attitudes towards abortions in general.

The study recommends:

“…it is important to consider the need for support and care for all women who have an unwanted pregnancy because the risk of mental health problems increases whatever the pregnancy outcome. If a woman has a negative attitude towards abortion, shows a negative emotional reaction to the abortion or is experiencing stressful life events, health and social care professionals should consider offering support, and where necessary treatment, because they are more likely than other women who have an abortion to develop mental health problems.”

We are lucky in La Plata County to have wonderful assistance for women carrying unintended pregnancies. The Pregnancy Center supports women who plan to deliver, while Planned Parenthood provides access to safe, compassionate abortions. I am concerned, however, that the people who demonstrate outside Planned Parenthood may not provide accurate information to women who are considering abortion. The demonstrators may have a negative influence on those women who are at risk for mental health problems.

© Richard Grossman MD, 2012