Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences
[Journal of Youth Adolescence DOI 10.1007/s10964-006-9094-x
ORIGINAL PAPER Priscilla K. Coleman
Received: 14 April 2005 / Accepted: 6 June 2005
_C Springer Science+Business Media, Inc. 2006]
Abstract. Using data from the National Longitudinal Study of Adolescent Health, various demographic, psychological, educational, and family variables were explored as predictors of pregnancy resolution.
Only 2 of the 17 variables examined were significantly associated with pregnancy resolution (risk-taking and the desire to leave home).
After controlling for these variables, adolescents who aborted an unwanted pregnancy were more inclined than adolescents who delivered to seek psychological counseling and they reported more frequent problems sleeping and more frequent marijuana use.
No significant differences were observed for cigarette smoking, frequency of alcohol use, and problems with parents based on alcohol use after the controls were instituted; however without controls, significant associations were observed, underscoring the importance of the use of psychological and situational controls in studies of the consequences of abortion. The information derived from this study is potentially useful to parents and professionals who provide guidance to adolescents regarding pregnancy resolution.
The teen pregnancy rate in the United States has steadily dropped over the last few decades, presumably due to a combination of social programs focusing on sex education and abstinence (Santelli et al., 2004).
Nevertheless, adolescent pregnancy and childbirth rates are higher in the U. S. than in all other developed countries across the globe (Singh and Darroch, 2000), with approximately 10% of adolescents becoming pregnant each year and 60–65% choosing to give birth (AGI, 1999; Henshaw, 1998).
Adolescents are typically unprepared emotionally, cognitively, and financially to assume the role of parent and as a result both the adolescent and her child are at an enhanced risk for adverse developmental and behavioral outcomes (Dubow and Luster, 1990; Klepinger et al., 1999; Miller and Moore, 1990; Zabin and Cardona, 2002).
Rather than take their lives on the difficult path of early parenthood, many adolescents either decide to abort or are pressured by others to terminate their pregnancies (Henshaw and Kost, 1992).
More specifically, in 1974, 29% of pregnant adolescents opted to abort (Moore, 1989), in the mid 1980’s 42% of adolescent pregnancies ended in abortion (Moore, 1989), and more recently, the rate has been reported to be approximately 35–40% (AGI, 1999; Henshaw, 1998).
Because childbirth and abortion are so common among contemporary U.S. adolescents, the purpose of this study is to compare adolescent psychological and behavioral outcomes associated with each choice after controlling for demographic, educational, psychological, and family variables that discriminate between the two options.
Unintended pregnancy delivered
The majority of adolescent pregnancies are unintended (75%–86%; AGI 1994; Henshaw, 1998; Squires, 1995) and unintended pregnancy is widely recognized as a stressful life event for most women regardless of their age (Adler and Dolcini, 1986; Cohen and Roth, 1984; Olson, 1980).
Further, based on the available correlational evidence, researchers have tended to conclude that unintended pregnancy carried to term poses a serious risk factor for compromised maternal health (Brown and Eisenberg, 1995; Joyce et al., Springer J Youth Adolescence 2000).
Unintended pregnancy has specifically been shown to be associated with late prenatal care (Braveman et al., 2000; Hulsey, 2001; Mayer, 1997; Pagnini and Reichman, 2000), substance use (Hellerstedt et al., 1998; Kost et al., 1998), and depression (Leathers andKelley, 2000).
However Joyce et al. (2000) challenged the integrity of many of the studies used as the basis for the conclusion that unintendedness produces negative maternal outcomes. In particular, they note that the evidence for a causal model is weak, as many of the previous studies neglected to control for potentially confounding socio-demographic, individual difference, and family factors related to pregnancy intendedness.
Pregnancy resolved through abortion
Previous research indicates that a minimum of 10% of women who opt for an abortion will suffer from serious negative psychological consequences (Adler et al., 1990;Lewis, 1997; Zolese and Blacker, 1992).
Among women who are adversely impacted by an abortion, a number of mental health problems have been documented including anxiety (Cougle et al., 2005; Franco et al., 1989), depression (Cougle et al., 2003; Reardon and Cougle, 2002; Thorp et al., 2003), sleep disturbances (Barnard, 1990), and substance use/abuse (Coleman et al., 2002a; Reardon and Ney, 2000; Yamaguchi and Kandel, 1987).
Nearly 25% of U.S. abortions are performed on women under age 20 (AGI, 1996) and younger women may be particularly vulnerable to experiencing post-abortion difficulties (Franz and Reardon, 1992; Osofsky and Osofsky,
1972).
One attempt to explain a possible heightened risk for post-abortion emotional difficulties during adolescence focuses on pressure exerted by others. When women are supported in their decisions to abort by significant people in their lives, post-abortion adjustment tends to be more positive (Moseley et al., 1981; Shustermamn, 1979).
However, when women feel forced into abortion by others or by life circumstances, negative post-abortion outcomes become more common (Lemkau, 1988).
Adolescents are generally much less prepared to assume the responsibilities of parenthood and are logically the recipients of pressure to abort.
Further, as suggested by Lemkau (1988), the risk for post-abortion adjustment difficulties may be higher for adolescents, since they are more inclined than more mature women to engage in denial of the pregnancy and delay in decision-making, leading to the use of procedures entailing more physical and emotional risk.
Studies comparing resolution of pregnancy through abortion versus delivery
As common as adolescent pregnancy is in our society, it is surprising that few relative risk studies have been conducted to ascertain whether unintended pregnancy resolved through abortion or delivery is associated with greater risk to adolescent psychological well-being. Data from two small scale investigations, which unfortunately did not include assessments of pregnancy wantedness suggested that abortion and delivery in adolescence were associated with similar levels of psychological distress (Anthanasiou et al., 1973; Zabin et al., 1989). A couple more recent large-scale studies have revealed that abortion when compared to delivery is associated with significantly more mental health problems (Coleman et al., 2002b; Cougle et al., 2003; Reardon et al.,
2003) and higher rates of substance use (Coleman et al., 2002a; Hope et al., 2003). However, the age range in these studies was broad and pregnancy wantedness was again not determined.
One analysis of the National Longitudinal Study of Youth (NLSY) (Reardon and Cougle, 2002) revealed that women who aborted a first pregnancy were significantly more likely to be at risk for clinical depression compared to women who carried a first unintended pregnancy to term. This difference was observed even after controlling for age, income level, race, and a psychological measure taken prior to the women’s first pregnancies. In a second study using data from the NLSY, Reardon and colleagues recently reported that women who aborted when compared to those who carried to term were twice as likely to use marijuana and reported more frequent use of alcohol after controlling for age, race, marital status, income, education, and prior psychological well-being (Reardon et al., 2004).
Predictors of pregnancy resolution
A significant limitation of the few available relative risk studies is failure to control for a sufficient number of demographic and psychosocial variables associated with the choice to abort. As noted by Coleman and colleagues (2002a), an abortion history is really a package variable defined by numerous personal and situational factors leading up to the decision to abort while also carrying the potential to cause problems. Adolescents who obtain abortions may be more likely to have certain personality traits or they may experience more strained relationships with their parents than adolescents who decide to carry to term. One or more of these variables as opposed to the abortion itself may be the critical element(s) related to differences observed in psychological health among adolescents who choose abortion as opposed to childbirth.
Unfortunately, research pertaining to predictors of pregnancy resolution is rather limited for women in general and for adolescents in particular. A couple small-scale studies have been conducted to identify a profile of women likely to undergo an abortion. For example, Bradley’s (1984) Canadian study of women who had recently given birth revealed that those with a history of abortion were more likely to describe themselves as self-reliant, independent, rebellious, and to enjoy being unattached or unconnected to other people, places, and things. Similarly, two additional studies have shown the choice to abort to be associated with an independent personality (Bailey et al., 2003; Miller, 1992). Although the above studies involved women of various ages, an association between an outgoing personality type and the choice to abort may logically be expected to emerge in a sample that is exclusively focused on adolescents, because outgoing adolescents, who undoubtedly spend a great deal of time with peers and/or are involved in numerous activities outside the home are unlikely to want to be tied down with an infant. Rebelliousness is another variable that is likely to be a predictor of the choice to abort in an exclusively adolescent sample, because adolescents who are inclined to defy parents, go against conventions, take risks, etc. would seem less inclined to want to assume a traditional female role, requiring responsibility that would hinder their ability to engage in thrill-seeking, possibly unlawful behavior. Within the construct of rebelliousness, an orientation to risk-taking is a particularly important variable to explore as a predictor of the choice to abort, because it is also highly likely to be associated with variables indicative of negative adjustment that have been examined as correlates of abortion (e.g., mental health problems and substance use.)
If risk-taking is definitively identified as a predictor of the choice to abort, studies investigating psychological correlates of abortion should control for this potentially powerful third variable. In the current study, an outgoing personality (independent, assertive) and a tendency toward risk-taking were examined as predictors of the choice to abort.
The results of a recently conducted study revealed that women whose parents were critical, demanding, and not very nurturing were more inclined to choose abortion over childbirth (Coleman et al., 2005). The authors speculated that these findings may indicate that on a deeper level the choice to abort in some situations may be grounded in internalized parental criticisms, anxiety associated with close relationships, and/or expectations of failure in parenting. As applied to adolescence, one might expect an association between less close relationships with parents and the choice to abort for more concrete reasons, such as fear that parents will not provide the psychological and practical assistance likely to be needed if the pregnancy is continued.
In the current study, several variables related to the level of general emotional support provided by both parents were investigated as predictors of the choice to abort among adolescents.
Studies designed to identify predictors of the decision to abort vs. deliver in adolescence have tended to focus on demographic factors.
One recent large scale effort by Zavodny (2001) revealed that abortion was associated with higher educational attainment of the woman’s mother and the choice to abort in adolescence tends to also be associated with academic success and high educational aspirations of the adolescent
(Carlson et al., 1984; Eisen et al., 1983; Henshaw and Silverman, 1988).
The association between variables suggestive of an individual or family commitment to education and the choice to abort is logical, because the responsibilities inherent in having a child may significantly alter educational plans, or if the plans are retained, render them mo
re difficult to pursue. In the present study, in addition to examining a variable related to educational aspirations (intended college attendance), two additional education variables (one behavioral, whether or not the respondent has ever been suspended and one emotional, whether or not the adolescent is happy at school) were examined.
The choice to carry to term tends to be made more frequently by adolescents who consider themselves highly religious (Henshaw and Silverman, 1988), have mothers who had their first child before age 20 (Evans, 2001), are raised in single parent homes (Tomal, 2001), and experience support from family members for the pregnancy (Bailey et al., 2003).
Taken together, the variables previously identified as predictors of the choice to carry to term suggest a profile of an adolescent exposed to values and/or family norms that are supportive of the birth option. In an effort to replicate some of these earlier findings, the present study involved an examination of adolescent religiosity and parental marital status as predictors of pregnancy resolution. Limitations imposed by reliance on secondary data precluded consideration of the level of familial support for carrying the pregnancy to term as a predictor of pregnancy resolution.
This study involved analysis of two waves of data from the National Longitudinal Study of Adolescent Health (Add Health) in pursuit of two objectives. The first objective was to explore numerous demographic, educational, psychological, and family factors as possible correlates of pregnancy resolution. The second objective was to examine psychological and behavioral outcomes among individuals who aborted or delivered during adolescence after the effects of potential confounds were statistically removed.
P. K. Coleman
Human Development and Family Studies, Bowling Green State University, 16D Family and Consumer Sciences Building,
Bowling Green, OH 43403, USA
Acknowledgements This research is based on data from the National
Longitudinal Study of Adolescent Health (Add Health), directed by J.
Richard Udry, Kenan Professor of Maternal and Child Health and Sociology
and a fellow of the Carolina Population Center at the University
of North Carolina at Chapel Hill. Funding for the study is provided by
NICHD and 17 other federal agencies.
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Other research articles by Dr. Priscilla Coleman:
Coleman, P. K., Reardon, D. C., & Cougle, J. (in press). Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology.
Cougle, J., Reardon, D. C., & Coleman, P. K. (in press). Generalized anxiety associated with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders.
Coleman, P. K., Reardon, D. C., Strahan, T., & Cougle, J. (in press). The psychology of abortion: A review and suggestions for future research. Psychology and Health.
Reardon, D. C., & Coleman, P. K. (in press). Letter to the editor pertaining to a study published in AJOG by Gissler, Berg, Bouvier-Colle, and Buekens entitled "Pregnancy-associated mortality after birth, spontaneous abortion or induced abortion in Finland, 1987-2000." American Journal of Obstetrics and Gynecology.
Rue, V. M., Coleman, P. K., & Reardon, D. C. (in press). The context of elective abortion and traumatic stress: A comparison of U. S. and Russian Women. Medical Science Monitor.
Reardon, D. C., Coleman, P. K., & Cougle, J. (2004). Substance use associated with prior history of abortion and unintended birth: A national cross sectional cohort study. American Journal of Drug and Alcohol Abuse, 26, 369-383.