The Best Intentions Unintended Pregnancy and the Well-Being of Children and Families (1995) / Chapter Skim
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Consequences of Unintended Pregnancy
Consequences of Unintended Pregnancy
Pages 50-90
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From page 50... ...
The second section considers the fact that unintended pregnancy is more common among Unmarried women and women at either end of the reproductive age span (Chapter 2) demographic attributes which themselves carry increased medical or social risks for children and/or their parents.
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From page 51... ...
but also by a decline in hospital emergency room admissions because of incomplete or septic abortions, conditions that are more common with illegally induced abortions (Institute of Medicine, 19751. Given the long-standing reliance on abortion to resolve many unintended pregnancies, it is important to consider available information about the major medical and psychological risks that this procedure may pose (Centers for Disease Control and Prevention, Reproductive Epidemiology Unit, 1994; Frye et al., 1994; Lawson et al., 19941.
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From page 52... ...
Later complications that have been investigated include possible negative effects on subsequent pregnancy outcomes, particularly low birthweight, midtrimester spontaneous abortion, and premature delivery. The vast majority of abortions performed in this country are first-trimester vacuum aspiration procedures.
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From page 53... ...
The risk of mortality is higher, however, for nonwhite women, women 35 years of age and older, and for women of higher parity. The increased risk of both morbidity and mortality with increasing gestational age underscores the health risks averted by early rather than late abortion.
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From page 54... ...
Most of the 250 studies dealing with the psychological effects of induced abortion suffer from substantial methodological shortcomings and limitations (Council on Scientific Affairs, 1992; Adler et al., 1990; Gold, 1990; Koop, 19891. In light of these problems, former Surgeon General C
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From page 55... ...
Although many of these unintended pregnancies are resolved by abortion, an appreciable number result in live births (see Table 2-21. Therefore, in assessing the consequences of unintended pregnancy, it is useful to review the available data on the extent to which these demographic attributes themselves carry increased risks for children and their parents.
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From page 56... ...
Moreover, teenage mothers are more likely to be single parents or, if they are married, to experience marital dissolution (Hayes, 19871. Indeed, the proportion of teenagers who are single parents has increased substantially over the years.
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From page 57... ...
com., 1994~. Published results from these investigators find that the negative effects associated with teenage childbearing are much diminished when the mother's prepregnancy characteristics are accounted for.
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From page 58... ...
based on p~Uc use Ales Tom me National Longitudinal Survey of Your, 1979-1988 dam, under Comract ~1-HD-92919 Tom me National Institutes of Realm. eel of early cbil~e~g OD He best ~ social ~ eco-~c well-be~ of cbUdren; ibis eel ~ over ~ Move Be irons ells of background disa~-ages.
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From page 59... ...
Several studies have indicated that very young adolescent mothers are underweight and give birth to smaller babies because of poor diets and inadequate or no prenatal care (Stevens-Simon and White, 1991~. Similarly, the greater incidence of illness and injury in infants of adolescent mothers is more likely due to environmental factors such as poverty, poor health habits, and insufficient supervision than to the age of the mother per se (Stevens-Simon and White, 19911.
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From page 60... ...
Risks to the fetus and infant of a woman over age 40 include spontaneous abortion, chromosomal defects, congenital malformations, fetal distress, and low birthweight. Although the chances of miscarriage for a woman under age 25 are only 1 in 400, after the age of 35 the rate jumps to 40 in 100 pregnancies (Hotchner, 19901.
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From page 61... ...
Childbearing by Single Women Births resulting from unintended pregnancies are often conceived out of wedlock and the infants are born to unmarried women. More than 40 percent of infants born after Unintended conception begin life with unmarried parents.
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From page 62... ...
i, Children raised by single mothers exhibit different patterns of home leaving and family formation. They leave home earlier than children in two-parent families (Kiernan, 1992; Thornton, 19911; they are more likely to become teenage parents and unmarried parents (Haveman and Wolfe, 1994; Wu and Martinson, 1993; McLanahan, 1988; McLanahan and Bumpass, 1988~; and, if they are married, are more likely to divorce (McLanahan and Bumpass, 19881.
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From page 63... ...
1~ EFFECTS OF INI~NDEDNESS A number of investigators have studied whether children born as a result of unintended pregnancies (both mistimed and unwanted) are at greater risk of various poor outcomes, such as low birthweight, than are children born as a result of intended pregnancies.
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From page 64... ...
This means that a selection bias is built in from the outset that is, the sample is composed entirely of women already in prenatal care; those who are not in care, for whatever reason, are excluded. Thus, results cannot be generalized to those with late prenatal care or none at all.
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From page 65... ...
But with mistimed pregnancy, the distinction can be determined that the ill effect is caused by the slimed, then there is some reason to hope that by helping ir pregnancies better (which usually means postponing of the problem would decrease. If, on the other hand, the associated with mistimed pregnancy, it is more likely that , of pregnancy would not affect the risk of the ill effect reviewing studies on the effect of intention status on t is important (1)
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From page 66... ...
Women who have mistimed or unwanted conceptions tend to initiate prenatal care later in pregnancy and to receive less adequate care (Figure 3-3) than women who have intended the pregnancy.
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From page 67... ...
~ ~ ~ any Unintended pregnancy is associated with Insu#1Iclen1 pa[ticipe110n In prenatal care 67 FIGURE 3-3 Studies of prenala1 care attainment: odds ratios or rel~ive risks of index care by pregnancy intendedness. All rates displayed in this Agure were developed by me Co~iNee on unimended Pregnancy Tom me p~Nsbed research except Dose far me DePersio study, which had already calculated me rues.
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From page 68... ...
. When factors associated with both planning status and prenatal care initiation are controlled, the effect of mistimed or unwanted conception remains elevated, but its effect is reduced and sometimes no longer statistically significant (see tables in Appendix D)
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From page 69... ...
Adjustment for factors related to both pregnancy planning and smoking tend to reduce the estimates of effect, but planning status remains a significant factor in most studies. These are probably underestimates of the true effect, because of misclassification bias resulting from underreporting of smoking and alcohol consumption.
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From page 70... ...
In the United States and Norway, some studies have failed to find an increased risk of low birthweight for closely spaced births (Klebanoff M, 1988; Erickson and Bjerkedal, 19781. However, a recent prospective study suggests that white infants conceived within three months of a previous pregnancy and black infants conceived within nine months of a previous pregnancy are at greater risk of preterm delivery and low birthweight (Rawlings et al., 19951.
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From page 71... ...
All rates displayed in this figure were developed by the Committee on Unintended Pregnancy from the published research except those for the DePersio study, which had already calculated the rates.
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From page 72... ...
estimated that a decade later the reduced incidence of low birthweight and preterm births among black infants in 1977 was mostly associated with the availability of family plam~g clinics which helped women to avoid a birth unintended at conception. More recent estimates of the impact of family planning and abortion services on low birthweight and infant mortality suggest continued benefit (Meter and McFarlane, 19941.
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From page 73... ...
The authors hypothesize that this critical developmental skill is lagging because "significant adults, particularly the mother may be less available" to the children (Baydar and Grady, 1993:141. In the most extreme examples of unwanted conceptions children born after women were denied abortions various social development problems and relationship problems have been documented among children in Sweden (Forssman and Thuwe, 1981, 1966; Blomberg, 1980; Hook, 1975, 1963)
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From page 74... ...
Its effects can be surprisingly farreaching, contributing, for example, to the problem of insufficient child care in the United States. Child care is a major burden, largely for women, often beginning with teenagers who stay home from school to care for their infants and children (who are often the result of unintended pregnancies)
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From page 75... ...
, and, regardless of marital status at birth, women who give birth following an 'unintended conception are more likely to suffer from postpartum depression as well (Salmon and Drew, 1992; Najman et al., 1991; Condon and Watson, 19871. They may also be at greater risk of experiencing domestic violence.
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From page 76... ...
The importance of preconception care derives from the notion that if a woman or couple is actively planning or intending-a pregnancy, there are new and important opportunities to improve outcomes for both the mother and her baby by identifying and managing risks before conception. Most women enter prenatal care several weeks into the pregnancy, even with the most earnest attempts to initiate care after missing one, and sometimes two, menstrual periods.
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From page 77... ...
A number of authorities and professional groups have published recommendations for the content of preconception care (Cefalo and Moos, 1995; March of Dimes Birth Defects Foundation, 1993; Jack and Culpepper, 1990; Public Health Service Expert Panel on the Content of Prenatal Care, 19891. These recommendations have a high degree of commonality and for the most part focus on optimizing the woman's health and identifying pregnancy risks and negative habits that may influence fetal development.
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From page 78... ...
Early start of prenatal care offers the opportunity to initiate surveillance for malformations through ultrasound and other techniques. Such surveillance may reduce the incidence of births with malformations among those parents who elect induced abortion; for those who continue the pregnancy, early diagnosis offers
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From page 79... ...
For many of the women who might benefit the most from preconception care, such as those with a history of poor health maintenance or abuse of alcohol or drugs, it remains only a theoretical benefit that is rarely available and perhaps not even understood. 1~ DEMOGRAPHIC IMPLICATIONS OF REDUCING UNFRIENDED PREGNANCY This section suggests how the profile of the childbearing population in the United States would change if unintended pregnancies were eliminated altogether.
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From page 80... ...
CONCLUSION The data and perspectives presented in this chapter demonstrate that unintended pregnancy has serious consequences. These consequences are not confined only to unintended pregnancies occurring to teenagers or unmarried women and couples; in fact, unintended pregnancy can carry serious consequences at all ages and life stages.
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From page 81... ...
With an unwanted pregnancy especially, the mother is more likely to seek prenatal care after the first trimester or not to obtain care. She is more likely to expose the fetus to harmful substances by smoking tobacco and drinking alcohol.
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From page 82... ...
Finally, a recalculation of what the childbearing population in the United States would look like if unintended pregnancy did not occur (unwanted conceptions eliminated and mistimed ones redistributed) shows that a larger proportion of children would be the product of intended conceptions born to married women, thereby improving the life circumstances of children and contributing to the well-being of future generations.
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From page 83... ...
Byrd T Correlates of Prenatal Care Initiation Among Low-Income Hispanic Women.
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From page 84... ...
Brunnquell D An at-risk approach to the study of child abuse.
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From page 85... ...
Variations in infant mortality rates among counties of the United States: The roles of public policies and programs. Demography.
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From page 86... ...
Preconception Care. In New Perspectives on Prenatal Care.
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From page 87... ...
Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet.
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From page 88... ...
Prenatal prediction of child abuse and neglect: A prospective study. Child Abuse Negl.
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From page 89... ...
1995;85:65-70. Public Health Service Expert Panel on the Content of Prenatal Care.
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From page 90... ...
Low income negro mothers-their decision to seek prenatal care. Am J Public Health.
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