Minors' behavioral responses to parental involvement laws: delaying abortion until age 18

CONTEXT

Prior research on the effect of laws mandating parental involvement in minors' abortions has failed to examine an important behavioral response to such laws: Older teenagers may delay an abortion until age 18; for some, this may mean terminating a pregnancy after the first trimester.

METHODS

Statewide data were obtained on abortions in Texas in 1997-2003. Analysis of relative rate ratios with narrowly defined comparison groups was used to evaluate the association between Texas's parental notification law and the occurrence of second-trimester abortions among minors who have responded to the law by delaying abortion until age 18.

RESULTS

In the four years after the law went into effect, the proportion of abortions obtained at age 18 increased by six percentage points among minors who conceived at age 17 years and eight months, and by 13 points among those who did so at 17 years and nine months. As a result, the second-trimester abortion rate of these groups combined increased by 21%; by contrast, there was no evidence of an increase in this rate among younger minors, for whom delaying the abortion until age 18 was not feasible.

CONCLUSIONS

Some minors postpone abortion until the second or even third trimester of pregnancy to circumvent parental notification requirements. Given the greater costs of and medical risks associated with late-term abortions, policymakers should not ignore this behavior.

Post-abortion and post-partum psychiatric hospitalization

Confusion persists regarding relative psychological risks associated with term deliveries and induced abortions. One reason for the scarcity of comparative findings is the lack of epidemiological data on post-abortion and post-partum admissions to psychiatric hospital. While such admissions are not separately tracked in United States health statistics, they are measurable events, reflective of severe psychological stress associated in time with delivery and abortion, and probably less subject to diverse interpretation than are individual consultations with clinical practitioners in their offices. The paper reviews what is known from published international research about post-abortion and post-partum admissions to psychiatric hospitals and discusses comparative findings obtained from computer linkages of Danish national registers. Admissions to psychiatric hospital were tracked for a three-month period after either delivery or abortion for all women under age 50 and then compared with the three-month admission rate to psychiatric hospitals for all Danish women of similar age. The major finding is that for never-married and currently married women, the post-pregnancy-related risk of admission is about the same-around 12 per 10 000 abortions or deliveries. Higher psychiatric admission rates were noted for separated, divorced and widowed women having abortions or carrying to term.

Changes in abortions and births and the Texas parental notification law

BACKGROUND

On January 1, 2000, Texas began enforcement of a law that requires physicians to notify a parent of a minor child seeking an abortion at least 48 hours before the procedure.

METHODS

We assessed changes in the rates in Texas of abortions and births (events per 1000 age-specific population) before enforcement of the parental notification law (1998 to 1999) and after enforcement (2000 to 2002). We did this by comparing the rate changes among minors 15 to 17 years of age at the time of conception (i.e., those who were subject to the law) with those of teens 18 years of age at the time of conception (i.e., those who were not subject to the law).

RESULTS

After enforcement of the law, abortion rates fell by 11 percent among 15-year-olds (rate ratio, 0.89; 95 percent confidence interval, 0.83 to 0.94), 20 percent among 16-year-olds (rate ratio, 0.80; 95 percent confidence interval, 0.76 to 0.85), and 16 percent among 17-year-olds (rate ratio 0.84; 95 percent confidence interval, 0.80 to 0.87), relative to the rates among 18-year-olds. Among the subgroup of minors 17.50 to 17.74 years of age at the time of conception (who would have been subject to the parental notification law in early pregnancy), birth rates rose by 4 percent relative to those of teens 18.00 to 18.24 years of age (rate ratio, 1.04; 95 percent confidence interval, 1.00 to 1.08). The adjusted odds ratio for having an abortion after 12 weeks' gestation among minors 17.50 to 17.74 years of age as compared with 18-year-olds was 1.34 (95 percent confidence interval, 1.10 to 1.62).

CONCLUSIONS

The Texas parental notification law was associated with a decline in abortion rates among minors from 15 to 17 years of age. It was also associated with increased birth rates and rates of abortion during the second trimester among a subgroup of minors who were 17.50 to 17.74 years of age at the time of conception.

[Morbidity of dilatation and evacuation in the second trimester: an analysis]

OBJECTIVE

To compare the rates of complications of dilatation and evacuation (D&E) in the second trimester of pregnancy.

STUDY DESIGN

Retrospective analysis of early complications after D&E in the second trimester (group A: 1988-1994) in comparison with D&E in the first trimester (group B: 1997) and with the induction of abortion by extra-amniotic application of prostaglandins in the second trimester of pregnancy (literature).

RESULTS

The overall complication rate of D&E was statistically significantly higher in the second than in the first trimester (p < 0.0001). The most frequent complication in both groups was a blood loss > 500 ml (p < 0.009). As with blood loss, there was a statistically significant increase in the incidence of postoperative bleeding (p < 0.001) and fever > 38 degrees C (p = 0.042) with rising gestational age, too. We registered similar rates for incomplete abortion, infection, cervical injury, uterine perforation and thrombosis.

CONCLUSION

Second-trimester pregnancy termination with D&E is associated with higher morbidity rates than in the first trimester. Overall, the rates of complications of D&E in our study were acceptable and comparable with the results of previous studies. Compared with the induction of abortion by extra-amniotic prostaglandins, D&E shows lower morbidity rates. In particular, the advantages of D&E are in the early second trimester.

An economic approach to abortion demand

"This paper uses econometric multiple regression techniques in order to analyze the socioeconomic factors affecting the demand for abortion for the year 1985. A cross-section of the 50 [U.S.] states and Washington D.C. is examined and a household choice theoretical framework is utilized. The results suggest that average price of abortion, disposable personal per capita income, percentage of single women, whether abortions are state funded, unemployment rate, divorce rate, and if the state is located in the far West, are statistically significant factors in the determination of the demand for abortion."

Delayed abortion among teenagers: can a population at risk be identified?

Although only a small proportion of abortions performed in the United States are second-trimester abortions, teenagers obtain a large percentage of them. Yet the literature on abortion seekers is remarkably lacking in a discussion of who the pregnant teenagers who seek abortions are, particularly those who seek second-trimester abortions. We report a study of 97 adolescents who turned for help to a public abortion clinic in Missouri during 1989. We examined the impact of demographic variables, social-behavioral variables, and pregnancy-related variables (pregnancy, contraception, and abortion histories and attitudes toward abortion) on the stage of pregnancy at which the teens arrived at the clinic. Only contraceptive use and a positive attitude toward abortion were predictive of late arrival at the abortion clinic.

Dilapan tent-gemeprost regimen vs. combinations of extra-amniotic Rivanol-Laminaria/Lamicel and oxytocin for second trimester abortion

OBJECTIVE

To compare a new regimen for second trimester abortion using Dilapan and vaginal gemeprost suppositories with extra-amniotic Rivanol instillation and oxytocin i.v. immediately or 16 h after instillation.

METHODS

A prospective study was performed in 153 women to analyze the induction-abortion interval, the use of analgesics and the complication rate. Wilcoxon's rank sum test was used for statistical evaluation.

RESULTS

The mean induction-abortion interval was significantly shorter in the Dilapan-gemeprost-treated women than in the immediate or 16-h Rivanol-oxytocin-treated women, 12.5 vs. 23.3 and 26.8 h, respectively. The 24-h cumulative abortion rate was 91% in the former group vs. 49% and 61%, respectively. The use of analgesics was less frequent among the Dilapan-gemeprost-treated women, whereas the complication rate did not differ.

CONCLUSIONS

The Dilapan-gemeprost treatment was advantageous with respect to a shorter induction-abortion interval and ease of handling. However a minority of women do not respond to this treatment and it is therefore necessary to employ alternative methods to complete the abortion in these cases.

Advances in prenatal diagnosis. Social-psychological and policy issues

Chorionic villus sampling (CVS), a new technique for prenatally diagnosing chromosomal and genetic disorders, may soon replace amniocentesis. This procedure, performed by inserting a catheter through the pregnant woman's cervix or through the abdomen and removing cells from the placenta, has the advantages of being available earlier in the pregnancy than amniocentesis (at 9 to 11 weeks gestational age) and of yielding results in a shorter time. Although the medical aspects of the procedure are being investigated, its psychosocial and policy implications have not been studied systematically. These issues include the subjective assessment of risk that prompts women to choose or to reject CVS, the implications of earlier diagnosis for feelings about abortion, the potential of negative findings (i.e., the absence of the designated disorder) for well-being during the remainder of the pregnancy, the ramifications of first trimester identification of fetal sex, equity of access to prenatal diagnosis, and the possible over-utilization of these procedures. Drawing on previous research regarding amniocentesis and more recent research concerning CVS, this article discusses the potential implications of CVS.