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Coleman PK. The Turnaway Study: A Case of Self-Correction in Science Upended by Political Motivation and Unvetted Findings. Front Psychol 2022; 13:905221. [PMID: 35783786 PMCID: PMC9247501 DOI: 10.3389/fpsyg.2022.905221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
This review begins with a detailed focus on the Turnaway Study, which addresses associations among early abortion, later abortion, and denied abortion relative to various outcomes including mental health indicators. The Turnaway Study was comprised of 516 women; however, an exact percentage of the population is not discernable due to missing information. Extrapolating from what is known reveals a likely low of 0.32% to a maximum of 3.18% of participants sampled from the available the pool. Motivation for conducting the Turnaway Study, methodological deficiencies (sampling issues and others), and bias are specifically addressed. Despite serious departures from accepted scientific practices, journals in psychology and medicine have published dozens of articles generated from the study's data. The high volume of one-sided publications has stifled dialogue on potential adverse psychological consequences of this common procedure. Following a critical analysis of the Turnaway Study, an overview of the strongest studies on abortion and mental health is offered. This comprehensive literature comprised of numerous large-scale studies from across the globe has been largely overlooked by scientists and the public, while the Turnaway Study dominates the media, information provided to women, and legal challenges involving abortion restrictions. In the final section of this article, literature reviews by professional organizations are considered, demonstrating that the biased science characterizing the Turnaway Study is aligned with a pervasive and systemic phenomenon wherein deriving reliable and valid results via careful attention to methodology and scrutiny by the scientific community have been supplanted by politics.
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Affiliation(s)
- Priscilla K. Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, United States
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Nweke M, Ukwuoma M, Adiuku-Brown AC, Ugwu P, Nseka E. Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis. WOMEN'S HEALTH 2022; 18:17455057221118773. [PMID: 36039898 PMCID: PMC9434669 DOI: 10.1177/17455057221118773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postpartum depression (PPD) is a common mental health challenge in
resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates
will aid prediction, early detection, and pre-emptive interventions. This review
aimed to systematically synthesize and stratify PPD correlates in sub-Saharan
Africa. The review was structured as per the Preferred Reporting Item for
Systematic Reviews and Meta-Analyses. We included studies that reported the
correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search
Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of
PPD constituted the primary outcome. A random effect model was fitted to
estimate the pooled correlation coefficient per correlate. The clinical
relevance of correlates was stratified based on strength of correlation (r) and
recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6%
of participants had completed at least secondary education. The correlates of
PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8;
r = 0.212 (confidence interval (CI): 0.11–0.31), poor social support (PSS)
(rw = 1.9; r = 0.250 (0.133–0.361)), unwanted pregnancy (UP) (rw = 1.6;
r = 0.279 (CI: 0.14–0.41); I2 = 95.89), and maternal age (MA)
(rw = 0.96; r = 0.27 (CI: 0.154–0.37)), among others. A cumulative risk weight
of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive
interventions should be instituted. The stratification of risk PPD factors and
computation of risk stability index are useful in identifying the clinical
significant risk factors. The provision of critical risk point will simplify
early detection thus facilitating cost-effectiveness. Of the correlates of PPD
in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and
pre-emptive interventions for women with high risk weight may be a reasonable
strategy both in the short and long term.
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Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, Evangel University Akaeze, Ebonyi State, Nigeria
| | - Maryjane Ukwuoma
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ada C. Adiuku-Brown
- Department of Obstetrics and Gynaecology, College of medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Princewill Ugwu
- Department of Physiology, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Elizabeth Nseka
- Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu, Nigeria
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Salinas V, Jorquera-Samter V. Gender differences in high-school dropout: Vulnerability and adolescent fertility in Chile. ADVANCES IN LIFE COURSE RESEARCH 2021; 49:100403. [PMID: 36695116 DOI: 10.1016/j.alcr.2021.100403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 06/17/2023]
Abstract
The original concerns about the consequences of adolescent fertility assumed that pregnancy is a turning point, which altered teens' life trajectories in terms of school progress, human capital accumulation and labor force participation, placing them on a path of vulnerability. However, several years of research have shown that teenagers who become pregnant are not a random sample of the population, but a selective sample, more likely to have limited socioeconomic resources and other characteristics that made them a vulnerable group to begin with. This paper studies the association between adolescent fertility and high school dropout in Chile taking that selectivity in consideration. We analyze the dropout of teen men and women, considering their socioeconomic status, sociodemographic characteristics, and characteristics of their sexual debut. Data comes the VIII Chilean Survey of the Youth, a nationally representative survey of people 15-29 years old applied in 2015. In order to deal with selectivity issues, we use a combination of propensity score weighting techniques and adjusted generalized linear models for estimating the effect of teen parenthood on high school dropout (ATT), for men and women separately. Our best estimates of the effect of teen parenting on the probability of high school dropout is 16-18 percent for women and ten percent for men, which implies that the educational setback of parenthood for women is about twice as high as the setback of men. These findings suggest the need of policies and interventions aimed both to reduce adolescent fertility, but also to facilitate the high school completion of those who already are parents.
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Affiliation(s)
- Viviana Salinas
- Pontificia Universidad Católica de Chile & Millennium Nucleus for the Study of Life Course and Vulnerability, Chile.
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Amongin D, Benova L, Nakimuli A, Nakafeero M, Kaharuza F, Atuyambe L, Hanson C. Trends and determinants of adolescent childbirth in Uganda- analysis of rural and urban women using six demographic and health surveys, 1988-2016. Reprod Health 2020; 17:74. [PMID: 32456705 PMCID: PMC7249638 DOI: 10.1186/s12978-020-00925-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/17/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women. Methods We estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey. Results Among these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant decline occurred (− 16.0 pp., p < 0.001). First childbirth < 18 years of age declined by − 13.5 pp. (p < 0.001) between 2000/01 and 2016. There was no change over time in the percentage of adolescents 18–19.9 years of age having first childbirth. Among rural residents, childbirth < 18 years declined from 43.8% in 1988/89 to 32.7% in 2016 (− 11.1 pp., p < 0.001), in urban it declined from 28.3 to 18.2% (− 10.1 pp., p = 0.006). There was an increase over time in the percentage of women, both rural and urban, who wanted to delay their first pregnancy. Independent determinants of reporting an adolescent childbirth in both urban and rural residents were: no education/incomplete primary and younger age at first sex. Additional determinants for rural women were residence in Eastern region, Muslim religion, and poor household wealth index. Conclusion In the 30-year period examined, adolescent childbirth in Uganda declined from highs of 7 in 10 to approximately 5 in 10 women, with more wanting to delay the pregnancy. The decline started after the 2000/01 survey and affected predominantly younger adolescent childbirth < 18 years among both rural and urban residence women. Efforts need to be intensified to sustain the decline in adolescent pregnancies. Targeted and specific strategies for urban and rural areas might be required.
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Affiliation(s)
- Dinah Amongin
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Department of Health Policy Planning and Management, Makerere university School of Public Health, Kampala, Uganda.
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Frank Kaharuza
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,Dept of Global Public Health, Karolinska Institutet, Solna, Sweden
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Affective and Substance Abuse Disorders Following Abortion by Pregnancy Intention in the United States: A Longitudinal Cohort Study. ACTA ACUST UNITED AC 2019; 55:medicina55110741. [PMID: 31731786 PMCID: PMC6915619 DOI: 10.3390/medicina55110741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Psychological outcomes following termination of wanted pregnancies have not previously been studied. Does excluding such abortions affect estimates of psychological distress following abortion? To address this question this study examines long-term psychological outcomes by pregnancy intention (wanted or unwanted) following induced abortion relative to childbirth in the United States. Materials and Methods: Panel data on a nationally-representative cohort of 3935 ever-pregnant women assessed at mean age of 15, 22, and 28 years were examined from the National Longitudinal Survey of Adolescent to Adult Health (Add Health). Relative risk (RR) and incident rate ratios (IRR) for time-dynamic mental health outcomes, conditioned by pregnancy intention and abortion exposure, were estimated from population-averaged longitudinal logistic and Poisson regression models, with extensive adjustment for sociodemographic differences, pregnancy and mental health history, and other confounding factors. Outcomes were assessed using the Diagnostic and Statistical Manual, Version 4, American Psychiatric Association (DSM-IV) diagnostic criteria or another validated index for suicidal ideation, depression, and anxiety (affective problems); drug abuse, opioid abuse, alcohol abuse, and cannabis abuse (substance abuse problems); and summary total disorders. Results: Women who terminated one or more wanted pregnancies experienced a 43% higher risk of affective problems (RR 1.69, 95% CI 1.3–2.2) relative to childbirth, compared to women terminating only unwanted pregnancies (RR 1.18, 95% CI 1.0–1.4). Risks of depression (RR 2.22, 95% CI 1.3–3.8) and suicidality (RR 3.44 95% CI 1.5–7.7) were especially elevated with wanted pregnancy abortion. Relative risk of substance abuse disorders with any abortion was high, at about 2.0, but unaffected by pregnancy intention. Excluding wanted pregnancies artifactually reduced estimates of affective disorders by 72% from unity, substance abuse disorders by 11% from unity, and total disorders by 21% from unity. Conclusions: Excluding wanted pregnancies moderately understates overall risk and strongly understates affective risk of mental health difficulties for women following abortion. Compared to corresponding births, abortions of wanted pregnancies are associated with a greater risk of negative psychological affect, particularly depression and suicide ideation, but not greater risk of substance abuse, than are abortions of unwanted pregnancies. Clinical, research, and policy implications are discussed briefly.
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Pereira J, Pires R, Canavarro MC. Decision-making trajectories leading to termination of an unplanned pregnancy: specificities among adolescent and adult women. J Reprod Infant Psychol 2019; 37:242-255. [PMID: 30664356 DOI: 10.1080/02646838.2019.1566596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To describe the decision-making trajectories leading to termination of an unplanned pregnancy and to explore the differences according to women's age. Background: Although decision-making regarding abortion has been conceptualised as a multiphase event, the different trajectories leading to termination of an unplanned pregnancy remain unexplored. Methods: In this cross-sectional study, 422 women (248 adolescents, 174 adults) who had an abortion were recruited. Data were collected through self-report questionnaires at 16 Portuguese healthcare services. Results: Eight decision-making trajectories leading to termination of an unplanned pregnancy were identified according to the sequence: consideration (or not) to continue the pregnancy, conceal (or not) the decision from the family, the main decision-maker, and reasons for abortion. The most frequent trajectory included women who did not consider its continuation, did not conceal the reproductive decision from their family, were the main decision-maker and referred as reasons for abortion 'education/job would be more difficult to continue'. Adolescents more frequently not considering pregnancy continuation, not concealing the decision from their family and referred as reasons for abortion the prioritisation of their academic plans and immaturity; or considering its continuation, but were pressured into abortion by their parents. Adults more frequently (not) considering pregnancy continuation, concealed the decision from their family and reported economic reasons for abortion; or considering its continuation, but were pressured into abortion by their partners. Conclusion: Our study may contribute to more informed intervention by healthcare providers involved in supporting women's decisions, highlighting the need to promote an informed, weighted, developmentally adapted and free decision-making process.
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Affiliation(s)
- Joana Pereira
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Raquel Pires
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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8
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Gomez AM. Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health. Psychol Med 2018; 48:294-304. [PMID: 28625180 DOI: 10.1017/s0033291717001684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Twenty states currently require that women seeking abortion be counseled on possible psychological responses, with six states stressing negative responses. The majority of research finds that women whose unwanted pregnancies end in abortion do not subsequently have adverse mental health outcomes; scant research examines this relationship for young women. METHODS Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed. Population-averaged lagged logistic and linear regression models were employed to test the relationship between pregnancy resolution outcome and subsequent depressive symptoms, adjusting for prior depressive symptoms, history of traumatic experiences, and sociodemographic covariates. Depressive symptoms were measured using a nine-item version of the Center for Epidemiologic Studies Depression scale. Analyses were conducted among two subsamples of women whose unwanted first pregnancies were resolved in either abortion or live birth: (1) 856 women with an unwanted first pregnancy between Waves 2 and 3; and (2) 438 women with an unwanted first pregnancy between Waves 3 and 4 (unweighted n's). RESULTS In unadjusted and adjusted linear and logistic regression analyses for both subsamples, there was no association between having an abortion after an unwanted first pregnancy and subsequent depressive symptoms. In fully adjusted models, the most recent measure of prior depressive symptoms was consistently associated with subsequent depressive symptoms. CONCLUSIONS In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.
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Affiliation(s)
- A M Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California,Berkeley, Berkeley, CA,USA
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Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med 2016; 4:2050312116665997. [PMID: 27781096 PMCID: PMC5066584 DOI: 10.1177/2050312116665997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/22/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. METHOD Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. RESULTS After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30-1.62; p < 0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13-1.37; p < 0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0-11.3) of the prevalence of mental disorders examined over the period were attributable to abortion. CONCLUSION Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.
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Diaz CJ, Fiel JE. The Effect(s) of Teen Pregnancy: Reconciling Theory, Methods, and Findings. Demography 2016; 53:85-116. [DOI: 10.1007/s13524-015-0446-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Although teenage mothers have lower educational attainment and earnings than women who delay fertility, causal interpretations of this relationship remain controversial. Scholars argue that there are reasons to predict negative, trivial, or even positive effects, and different methodological approaches provide some support for each perspective. We reconcile this ongoing debate by drawing on two heuristics: (1) each methodological strategy emphasizes different women in estimation procedures, and (2) the effects of teenage fertility likely vary in the population. Analyses of the Child and Young Adult Cohorts of the National Longitudinal Survey of Youth (N = 3,661) confirm that teen pregnancy has negative effects on most women’s attainment and earnings. More striking, however, is that effects on college completion and early earnings vary considerably and are most pronounced among those least likely to experience an early pregnancy. Further analyses suggest that teen pregnancy is particularly harmful for those with the brightest socioeconomic prospects and who are least prepared for the transition to motherhood.
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Affiliation(s)
- Christina J. Diaz
- School of Sociology, University of Arizona, Social Sciences Building, Room 400, Tucson, AZ 85721, USA
| | - Jeremy E. Fiel
- School of Sociology, University of Arizona, Social Sciences Building, Room 400, Tucson, AZ 85721, USA
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11
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Murphy Tighe S, Lalor JG. Concealed pregnancy: a concept analysis. J Adv Nurs 2015; 72:50-61. [PMID: 26370358 DOI: 10.1111/jan.12769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Abstract
AIM/DESIGN A concept analysis of concealed pregnancy was undertaken using Walker and Avant's framework to examine the attributes, characteristics and uses of the concept in maternity care. BACKGROUND Understanding the concept of concealed pregnancy is critical as failing to do so adds the risk of maternal and neonatal morbidity and mortality. Reviewing the literature and selected empirical referents indicated that concealed pregnancy has been predominantly viewed through a biomedical lens. Confusion exists around the definitions of denied and concealed pregnancy. DATA SOURCES A systematic search of five bibliographic databases using keywords from the years 1960-2014. METHODS Walker and Avant's framework was used to guide the concept analysis. A thematic analysis of reviewed papers identified the main characteristics of concealed pregnancy. RESULTS Concealed pregnancy was conceptualized as a process and the critical attributes are secrecy, hiding, daytime story, staying away and avoidance. This process involves avoidance and if this includes failing to access healthcare can lead to catastrophic outcomes such as maternal and neonatal death. Antecedents, attributes and consequences of concealed pregnancy are also identified. CONCLUSIONS Understanding the concept of concealed pregnancy and its antecedents, attributes and consequences may assist in risk identification of women who conceal a pregnancy. This concept analysis has identified a need for further exploration of the coping styles and psychosocial processes involved in women concealing and revealing a pregnancy.
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Affiliation(s)
| | - Joan G Lalor
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
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Mann ES, Cardona V, Gómez CA. Beyond the discourse of reproductive choice: narratives of pregnancy resolution among Latina/o teenage parents. CULTURE, HEALTH & SEXUALITY 2015; 17:1090-1104. [PMID: 25953108 DOI: 10.1080/13691058.2015.1038853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite the fact that the US teenage birth rate has declined dramatically in recent years, teen births among Latinas are higher than any other racial/ethnic group. Most studies focus on the causes and consequences of early motherhood among Latina teenagers, neglecting other important dimensions of the issue. This study examines how Latina/o teenage parents living in California narrate their experiences with unintended pregnancy resolution. Qualitative analysis reveals three central themes. First, participants expressed shock upon learning they or their partner was pregnant, followed by acceptance about their impending parenthood. Second, participants' views of abortion and adoption largely foreclosed these options as pathways by which to resolve their unintended pregnancies. Third, participants recounted numerous stories of the messages they received from parents, other family members and male partners that were frequently directive regarding how to resolve their pregnancies. These findings have implications for young people's reproductive health and rights, and for reproductive justice more broadly.
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Affiliation(s)
- Emily S Mann
- a Department of Health Promotion, Education and Behavior , Arnold School of Public Health, University of South Carolina , Columbia , USA
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13
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Pregnancy resolutions among pregnant teens: termination, parenting or adoption? BMC Pregnancy Childbirth 2014; 14:421. [PMID: 25524615 PMCID: PMC4276101 DOI: 10.1186/s12884-014-0421-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 12/10/2014] [Indexed: 11/30/2022] Open
Abstract
Background Teenagers are unprepared to face or to deal with an unexpected pregnancy. Adolescents do not necessarily possess the cognitive ability needed to clearly evaluate such a situation or to determine how to resolve their pregnancy. This study seeks to shed light on what pregnant adolescents consider when coming to a decision about what to do about their pregnancy. Methods In-depth interviews were conducted among a purposive sample of Hong Kong Chinese women recruited from a Maternal and Child Health Centre, who had a history of being pregnant in their teens and out of wedlock. Interviews were conducted to explore the considerations surrounding their decision on how to resolve their pregnancy. Results A total of nine women were interviewed. An analysis of the interview transcripts revealed that to arrive at a decision on what to do about their pregnancy, pregnant teens took into consideration their relationship with their boyfriend, their family’s advice or support, practical considerations, their personal values in life, and views on adoption. Conclusions The results of this study results highlighted that during this life-altering event for adolescents, an open discussion should take place among all of the parties concerned. A better understanding of each party’s perspective would allow for better decision making on the resolution of the pregnancy. Health professionals or social workers are there to help pregnant adolescents, romantic partners, and family members make informed choices on how to resolve the pregnancy.
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14
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Harris LF, Roberts SCM, Biggs MA, Rocca CH, Foster DG. Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study. BMC Womens Health 2014; 14:76. [PMID: 24946971 PMCID: PMC4080695 DOI: 10.1186/1472-6874-14-76] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 06/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Examining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups. METHODS The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months. RESULTS Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time. CONCLUSIONS Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.
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Affiliation(s)
- Laura F Harris
- University of California Berkeley, University of California San Francisco, Joint Medical Program, 570 University Hall #1190, Berkeley, CA 94720, USA
| | - Sarah CM Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
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Peltzer K, Shikwane E, Matseke G. Psychological Distress and Associated Factors Among a Sample of Pregnant Women in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2011.10820489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Karl Peltzer
- Human Sciences Research Council, Pretoria, South Africa, University of Limpopo, South Africa
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16
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The association between prepregnancy parental support and control and adolescent girls' pregnancy resolution decisions. J Adolesc Health 2013; 53:413-9. [PMID: 23763966 PMCID: PMC3755627 DOI: 10.1016/j.jadohealth.2013.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 04/24/2013] [Accepted: 04/24/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the influence of prepregnancy parental support and control on adolescent girls' pregnancy resolution decisions. METHODS Data from the National Longitudinal Study of Adolescent Health were analyzed. Girls whose first pregnancy reported in wave IV occurred after wave I and before age 20 were included (n = 1,107). Participants self-reported pregnancy disposition (abortion, ectopic or tubal pregnancy, miscarriage, stillbirth, live birth) for each pregnancy; responses were dichotomized as abortion versus other. Girls' perceptions of parental support and control were measured at wave I. Controls were included for wave I age, age at pregnancy, year at the end of pregnancy, race/ethnicity, and parent characteristics (i.e., education, religious affiliation, age at first marriage, and educational expectations). Weighted multivariable logistic regression models were performed. RESULTS Approximately 18% of girls reporting a teen pregnancy reported having an abortion. In crude analyses, parental support was marginally negatively related to abortion (odds ratio [OR] = .83, p = .06) and parental control was significantly negatively related to abortion (OR = .78, p = .02). In multivariable analyses, higher parental control was significantly negatively related to abortion versus other pregnancy outcomes (adjusted OR .80, 95% confidence interval .66-.98). Perceived parental support was unassociated with pregnancy resolution decisions. The only other factor associated with abortion decisions was parent education: odds of choosing abortion versus other pregnancy outcomes were significantly higher for adolescent girls whose parents had a bachelor's degree or greater versus those with lower educational attainment. CONCLUSIONS Pregnant adolescents with less educated parents or parents exercising greater control were less likely to have an abortion.
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17
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Fergusson DM, Horwood LJ, Boden JM. Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence. Aust N Z J Psychiatry 2013; 47:819-27. [PMID: 23553240 DOI: 10.1177/0004867413484597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There have been debates about the linkages between abortion and mental health. Few reviews have considered the extent to which abortion has therapeutic benefits that mitigate the mental health risks of abortion. The aim of this review was to conduct a re-appraisal of the evidence to examine the research hypothesis that abortion reduces rates of mental health problems in women having unwanted or unintended pregnancy. METHODS Analysis of recent reviews (Coleman, 2011; National Collaborating Centre for Mental Health, 2011) identified eight publications reporting 14 adjusted odds ratios (AORs) spanning five outcome domains: anxiety; depression; alcohol misuse; illicit drug use/misuse; and suicidal behaviour. For each outcome, pooled AORs were estimated using a random-effects model. RESULTS There was consistent evidence to show that abortion was not associated with a reduction in rates of mental health problems (p>0.75). Abortion was associated with small to moderate increases in risks of anxiety (AOR 1.28, 95% CI 0.97-1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI 1.05-5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% CI 1.13-13.55; p<0.05), and suicidal behaviour (AOR 1.69, 95% CI 1.12-2.54; p<0.01). CONCLUSIONS There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.
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Affiliation(s)
- David M Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
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Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, San Francisco, USA
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Yogalingam K, Kelleher C, Bourke A, Boduszek D, McGee H, Morgan K. Experiences of crisis pregnancy among Irish and non-Irish adults living in Ireland: findings from the Irish Contraception and Crisis Pregnancy Survey 2010 (ICCP-2010). Ir J Med Sci 2013; 182:633-8. [PMID: 23558849 DOI: 10.1007/s11845-013-0943-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Using nationally representative data, this paper investigates the experience of crisis pregnancy (CP) among Irish and non-Irish adults living in Ireland in 2010. AIMS To generate a detailed profile of Irish and non-Irish adults living in Ireland who have had an experience of CP and to investigate the differences in the experiences of CP between Irish and non-Irish adults. METHOD A national cross-sectional telephone survey methodology recruited 3,002 adult (18-45 years) participants (69 % response). Descriptive statistics and Chi-square analysis were used to compare the differences between the Irish (n = 334) and non-Irish sample (n = 57) with an experience of CP. RESULTS The majority of respondents with an experience of CP had a higher education level and were aged between 18 and 25 years. Significant differences, in terms of outcome of CP, were also found between groups; with more Irish respondents choosing parenthood over abortion, compared with their non-Irish counterparts. CONCLUSION This paper presents a unique profile of Irish and non-Irish adults living in Ireland with an experience of CP. Enhanced promotion of longer-acting contraceptives to all younger adults, and targeted awareness raising of post-abortion services among the non-Irish community, is recommended.
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Affiliation(s)
- K Yogalingam
- Division of Population Health Sciences, Department of Psychology, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Thorp JM. Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later. SCIENTIFICA 2012; 2012:980812. [PMID: 24278765 PMCID: PMC3820464 DOI: 10.6064/2012/980812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/15/2012] [Indexed: 06/02/2023]
Abstract
During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.
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Affiliation(s)
- John M. Thorp
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
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21
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Asamoah BO, Agardh A. Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana. Reprod Health 2012; 9:10. [PMID: 22867435 PMCID: PMC3453516 DOI: 10.1186/1742-4755-9-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/23/2012] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The fight against maternal deaths has gained attention as the target date for Millennium Development Goal 5 approaches. Induced-abortion is one of the leading causes of maternal deaths in developing countries which hamper this effort. In Ghana, alcohol consumption and unwanted pregnancies are on the ascendancy. We examined the association between alcohol consumption and maternal mortality from induced-abortion. We further analyzed the factors that lie behind the alcohol consumption patterns in the study population. METHOD The data we used was extracted from the Ghana Maternal Health Survey 2007. This was a national survey conducted across the 10 administrative regions of Ghana. The survey identified 4203 female deaths through verbal autopsy, among which 605 were maternal deaths in the 12 to 49 year-old age group. Analysis was done using Statistical software IBM SPSS Statistics 20. A case control study design was used. Cross-tabulations and logistic regression models were used to investigate associations between the different variables. RESULTS Alcohol consumption was significantly associated with abortion-related maternal deaths. Women who had ever consumed alcohol (OR (adjusted) 2.6, 95% CI 1.38-4.87), frequent consumers (OR (adjusted) 2.6, 95% CI 0.89-7.40) and occasional consumers (OR (adjusted) 2.7, 95% CI 1.29-5.46) were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. Maternal age, marital status and educational level were found to have a confounding effect on the observed association. CONCLUSION Policy actions directed toward reducing abortion-related deaths should consider alcohol consumption, especially among younger women. Policy makers in Ghana should consider increasing the legal age for alcohol consumption. We suggest that information on the health risks posed by alcohol and abortion be disseminated to communities in the informal sector where vulnerable groups can best be reached.
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Affiliation(s)
- Benedict O Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Victoria, Australia
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22
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Gil-Lacruz AI, Gil-Lacruz M, Bernal-Cuenca E. Socio-Economic Determinants of Abortion Rates. SEXUALITY RESEARCH AND SOCIAL POLICY 2012; 9:143-152. [DOI: 10.1007/s13178-011-0056-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
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Conrad D. Deprivation-based inequalities in under-18 conception rates and the proportion of under-18 conceptions leading to abortion in England, 1998-2010. J Public Health (Oxf) 2012; 34:609-14. [PMID: 22615419 DOI: 10.1093/pubmed/fds031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 1999, the UK Government launched a strategy to reduce teenage pregnancy and geographical inequalities in teenage conception rates. This study investigates how associations between deprivation and under-18 conceptions, along with subsequent abortions, since changed as teenage pregnancy rates fell. METHODS A data set was constructed from local authority Indices of Multiple Deprivation (IMD) scores and routine data on under-18 conception rates and the proportion of under-18 conceptions leading to abortion from 1998 to 2010. Correlation analysis (Pearson's r) was used to measure the association between each period of conception and abortion data and the relevant version of the IMD. Changes in these correlations over the period were tested for statistical significance. RESULTS There remained a strong association between IMD and under-18 conception rates from 1998 (r = 0.782, P< 0.0001) to 2010 (r = 0.817, P< 0.0001) with no statistically significant change. A statistically significant decrease occurred in the inverse association between IMD and the proportion of under-18 conceptions leading to abortion from 1998 (r = -0.501, P< 0.0001) to 2010 (r = -0.332, P< 0.0001) CONCLUSIONS While under-18 conceptions fell from 1998 to 2010, inequalities in rates between the most and least deprived local authorities remained undiminished. At the same time, abortion became an increasingly common outcome of under-18 conceptions.
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Affiliation(s)
- David Conrad
- Department of Public Health and Policy, Whelan Building, The University of Liverpool, Liverpool L69 3GB, UK.
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24
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Steinberg JR, Trussell J, Hall KS, Guthrie K. Fatal flaws in a recent meta-analysis on abortion and mental health. Contraception 2012; 86:430-7. [PMID: 22579105 DOI: 10.1016/j.contraception.2012.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 03/21/2012] [Accepted: 03/28/2012] [Indexed: 01/19/2023]
Abstract
Similar to other reviews within the last 4 years, a thorough review by the Royal College of Psychiatrists, published in December 2011, found that compared to delivery of an unintended pregnancy, abortion does not increase women's risk of mental health problems. In contrast, a meta-analysis published in September 2011 concluded that abortion increases women's risk of mental health problems by 81% and that 10% of mental health problems are attributable to abortions. Like others, we strongly question the quality of this meta-analysis and its conclusions. Here we detail seven errors of this meta-analysis and three significant shortcomings of the included studies because policy, practice and the public have been misinformed. These errors and shortcomings render the meta-analysis' conclusions invalid.
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Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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25
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Coleman PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009. Br J Psychiatry 2011; 199:180-6. [PMID: 21881096 DOI: 10.1192/bjp.bp.110.077230] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians. AIMS To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome. METHOD After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios. RESULTS Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour. CONCLUSIONS This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, 16 D FCS Building, Bowling Green State University, Bowling Green, Ohio 43402, USA.
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26
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Canário C, Figueiredo B, Ricou M. Women and men’s psychological adjustment after abortion: a six months prospective pilot study. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.592974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Halldén BM, Lundgren I, Christensson K. Ten Swedish midwives' lived experiences of the care of teenagers' early induced abortions. Health Care Women Int 2011; 32:420-40. [PMID: 21476161 DOI: 10.1080/07399332.2010.535937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This phenomenological hermeneutic study of 10 Swedish midwives illuminates the internal conflicts of values that arise when midwives' professional and personal belief systems clash in encounters with teenagers. Midwives may react emotionally in situations where teenagers ignore advice on contraception by rejecting the use of contraceptives and preferring early abortions as a contraceptive method. The results strengthen the suggestion that caregivers need support in reflecting on how to deal with conflicts of values that may otherwise hinder them in communicating effectively with teenagers and encounter their life-worlds and in challenging their individual assumptions on the shortcomings of using contraceptives.
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Affiliation(s)
- Britt-Marie Halldén
- Division of Reproductive and Perinatal Health Care, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
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28
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Steinberg JR, Becker D, Henderson JT. Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2011; 81:193-201. [PMID: 21486261 PMCID: PMC3076612 DOI: 10.1111/j.1939-0025.2011.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines the risk of depression, suicidal ideation, and lower self-esteem following an abortion versus a delivery, with and without adjusting for important correlates. Using the National Comorbidity Survey, we tested how first pregnancy outcome (abortion vs. delivery) related to subsequent major depression, suicidal ideation, and self-esteem. Models controlling for risk factors, such as background and economic factors, prepregnancy violence experience, and prepregnancy mental health, as well as a model with all risk factors, were examined. When no risk factors were entered in the model, women who had abortions were more likely to have subsequent depression, OR=1.53, 95% CI [1.05-2.22], and suicidal ideation, OR=2.02, 95% CI [1.40-2.92], but they were not more likely to have lower self-esteem, B=-.02. When all risk factors were entered, pregnancy outcome was not significantly related to later depression, OR=0.87, 95% CI [0.54-1.37], and suicidal ideation, OR=1.19, 95% CI [0.70-2.02]. Predictors of mental health following abortion and delivery included prepregnancy depression, suicidal ideation, and sexual violence. Policies and practices implemented in response to the claim that abortion hurts women are not supported by our findings. Efforts to support women's mental health should focus on known risk factors, such as gender-based violence and prior mental health problems, rather than abortion history.
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Affiliation(s)
- Julia R Steinberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA.
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29
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Conduct disorder symptoms and subsequent pregnancy, child-birth and abortion: a population-based longitudinal study of adolescents. J Adolesc 2010; 34:1025-33. [PMID: 21146202 DOI: 10.1016/j.adolescence.2010.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 10/15/2010] [Accepted: 11/11/2010] [Indexed: 12/28/2022]
Abstract
Research on teenage pregnancy and abortion has primarily focused on socio-economic disadvantage. However, a few studies suggest that risk of unwanted pregnancy is related to conduct disorder symptoms. We examined the relationship between level of conduct disorder symptoms at age 15 and subsequent pregnancy, child-birth and abortion. A population-based, representative sample of Norwegian adolescent girls (N = 769) was followed from early adolescence until their mid-20s. Even with control for socio-demographic and family variables, conduct disorder symptoms at age 15 were strongly associated with pregnancy in the 15-19 age group, and a weaker association persisted in the 20-28 age group. Similar results were obtained for abortions, but here a strong relationship with conduct disorder symptoms was found even after age 20. After adjustment, no significant association between conduct disorder symptoms and subsequent child-birth was observed. More targeted preventive programmes aimed at girls with conduct disorder symptoms may be warranted.
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30
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Warren JT, Harvey SM, Henderson JT. Do depression and low self-esteem follow abortion among adolescents? Evidence from a national study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:230-5. [PMID: 21126298 PMCID: PMC5234489 DOI: 10.1363/4223010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT A 2008 report by the American Psychological Association found no evidence that an induced abortion causes mental health problems in adult women. No conclusions were drawn with respect to adolescents because of a scarcity of evidence. METHODS Data from the National Longitudinal Study of Adolescent Health were used to examine whether abortion in adolescence was associated with subsequent depression and low self-esteem. In all, 289 female respondents reported at least one pregnancy between Wave 1 (1994-1995) and Wave 2 (1996) of the survey. Of these, 69 reported an induced abortion. Population-averaged lagged logistic regression models were used to assess associations between abortion and depression and low self-esteem within a year of the pregnancy and approximately five years later, at Wave 3 (2001-2002). RESULTS Abortion was not associated with depression or low self-esteem at either time point. Socioeconomic and demographic characteristics did not substantially modify the relationships between abortion and the outcomes. CONCLUSIONS Adolescents who have an abortion do not appear to be at elevated risk for depression or low self-esteem in the short term or up to five years after the abortion.
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Affiliation(s)
- Jocelyn T Warren
- Department of Public Health, Oregon State University, Corvallis, USA.
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31
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To SM, Chu F. An interpretative phenomenological analysis of the lived experiences of young Chinese females in the course of unintended pregnancy. Int J Adolesc Med Health 2010; 21:531-43. [PMID: 20306765 DOI: 10.1515/ijamh.2009.21.4.531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research in the West has increasingly recognized the importance of understanding the perceptions and experiences of young pregnant females; however, limited studies are available in Chinese societies. This paper investigates the experiences of 10 young pregnant Chinese females living in Hong Kong. Through the use of individual interviews and the method of interpretive phenomenological analysis, the researchers were able to explore how the research participants made sense of their personal and social worlds. This research strategy also adds a cultural perspective in analyzing their stories in the context of Hong Kong. Recurrent themes identified in their stories revealed their thoughts, feelings, and actions in encountering the unintended pregnancy. The themes can be grouped into four categories, namely 1) pregnancy resolution: self-determination vs. significant others' influences; 2) emotional experiences after the termination of pregnancy: sense of relief vs. sense of guilt and sadness; 3) identity of young pregnant females: self-perception vs. others' perceptions and 4) pursuing an intimate relationship: love vs. sex. The findings provide a knowledge base for an understanding of the perspectives of young pregnant women and open up valuable reflections and discussions about adolescent pregnancy in Chinese societies. Implications can also be drawn for intervention, prevention, and research.
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Affiliation(s)
- Siu-Ming To
- Hong Kong Institute of Educational Research, Faculty of Education, Chinese University of Hong Kong, Hong Kong, PRC.
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32
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Adamczyk A. Understanding the effects of personal and school religiosity on the decision to abort a premarital pregnancy. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2009; 50:180-195. [PMID: 19537459 DOI: 10.1177/002214650905000205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although much research has examined the relationship between religion and abortion attitudes, few studies have examined whether religion influences abortion behavior. This study looks at whether individual and school religiosity influence reported abortion behavior among women who become pregnant while unmarried. Hierarchical Logistic Models are implemented to analyze two waves of data from the National Longitudinal Study of Adolescent Health. Findings show that personal religiosity is unrelated to reported abortion behavior. However, conservative Protestants appear less likely to obtain abortions than mainline Protestants, Catholics, and women of non-Christian faiths. Regardless of personal religious affiliation, having attended a school with a high proportion of conservative Protestants appears to discourage abortion as women enter their twenties. Conversely, women from private religious high schools appear more likely to report obtaining an abortion than women from public schools.
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Affiliation(s)
- Amy Adamczyk
- Department of Sociology, John Jay College of Criminal Justice, 899 10th Ave., Suite #520, New York, NY 10019, USA.
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Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res 2009; 43:770-6. [PMID: 19046750 DOI: 10.1016/j.jpsychires.2008.10.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/19/2008] [Accepted: 10/21/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.
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34
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Factors that adolescent males take into account in decisions about an unplanned pregnancy. J Adolesc 2008; 32:995-1008. [PMID: 18950852 DOI: 10.1016/j.adolescence.2008.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 07/28/2008] [Accepted: 08/23/2008] [Indexed: 02/08/2023]
Abstract
Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447-458], and extends the findings of that study. Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partner's pregnancy. Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as 'well-balanced' (80.6%), and the two minority groups as 'unwilling/unready' (10.9%) and 'family-centred' (8.5%). Group membership was strongly predictive of the males' final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.
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You say “regret” and I say “relief”: a need to break the polemic about abortion. Contraception 2008; 78:87-9. [DOI: 10.1016/j.contraception.2008.04.116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 04/24/2008] [Indexed: 11/24/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:596-605. [DOI: 10.1097/gco.0b013e3282f37e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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