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Pregnancy
Options
The November
2002 edition of ReCAPP focuses on options for young women facing unintended
pregnancy. This
edition of Topic in Brief includes the following sections:
Pregnancy
options are the choices that must be considered as soon as a young woman
knows, or even suspects, that she is pregnant. The decision-making process
can be extremely difficult and the sooner she seeks help, the better.
Trusted adults, including educators, can lend their support and help adolescents
make these complex and very personal decisions.
Pregnancy
Options
Refers to the three choices generally available to a young woman experiencing
an unintended pregnancy, including:
- continuing the pregnancy and choosing to parent the child,
- continuing the pregnancy and placing the child for adoption or foster
care, and
- ending the pregnancy by having an abortion.
Adoption
Refers to the legal placement of a baby with new parents. An adoption
can be handled by an agency or in some states, independently, through lawyers,
doctors, counselors, or organizations. There are generally two kinds of
adoptions — open and closed adoption.
- In an open adoption, the birth mother and adoptive parents
know something about each other. They may meet and exchange names and
addresses. The birth father also may be included.
- In a closed adoption, the birth mother and adoptive parents
do not meet or know each others' names. Sometimes in a closed adoption,
the files can be opened later. The laws are different in each state.1
A third
kind of adoption is adoption by relatives, whereby the court grants
legal adoption to relatives of the birth mother.
Foster
Care
Refers to the legal agreement to have another family temporarily care for
the baby until the birth mother can decide between adoption and parenting.
The baby's mother and father must both sign a legal foster care agreement.
This agreement usually addresses frequency of visits by birth parents, length
of time the baby will spend with the foster family, whether or not payment
is made for the baby's care by the birth parents, and the need for birth
parents to consult a social worker.
Laws about
foster care vary from state to state, so it is necessary to contact a
state's department of child welfare to check on current foster care laws.
Abortion
Refers to removing an embryo or fetus from a woman's uterus before it
can live outside the uterus. This is also called an induced abortion,
as opposed to a spontaneous abortion (miscarriage). Abortion
is a legal and safe procedure.
Surgical
abortions can be done with the gentle suction of a handheld syringe, a
process called manual vacuum aspiration (MVA); with suction curettage
(gentle scraping of uterine walls); with dilation and evacuation (where
the cervix is dilated, and the fetus is removed from the uterus with surgical
instruments and suction curettage); or with induction (an injection to
stimulate uterine contractions that expel the fetus). Surgical
abortion is nearly 100 percent effective.2
The procedure
used depends on the length of pregnancy:
- First Trimester Abortion
Almost all abortions (88-90%) are done in the first 12 weeks of
pregnancy. These are called first term abortions or early
abortions, and can be performed surgically or medically.
- Surgical abortion performed early in the pregnancy (up
to about 10 weeks) usually refers to the method called "manual vacuum
aspiration" (MVA). In this procedure, the cervix is numbed, and
the embryo or fetus is removed through a narrow tube with vacuum
suction. This surgery usually takes about ten minutes and can be
done in a clinic or doctor's office. Typically, a woman can return
to normal activities the following day.
- Medical abortion refers to a method by which a woman takes
a medication (mifepristone or methotrexate) up to 49 days after
the first day of her last menstrual period. This is considered "very
early" abortion. The woman takes this medicine on Day One and returns
for another medicine (misoprostol) on Day Three. For most women,
the abortion is complete within four hours of taking the second
medicine. However, depending on the medication used, this process,
which includes bleeding, may last up to four weeks for some women.
A small percentage of medical abortions fail and surgical procedures
are required to end the pregnancy. Medical abortion is not available
from all abortion providers.2
Both early surgical and medical abortion procedures are safe,
and serious complications are rare. Uncomplicated abortion should
not affect future pregnancies. But the risk for complications
increases the longer a pregnancy continues.3
- Second Trimester Abortion
Abortion performed 12 to 14 weeks after a woman's last period can be
performed using a variety of methods. The method used may depend on
the length of the pregnancy and what is best suited to the individual
situation. The procedures include dilation and evacuation (D&E),
during which the cervix is dilated and the fetus is removed from the
uterus with surgical instruments and suction curettage. This procedure
usually takes 10-20 minutes.
Another procedure, though rarely performed, is called induction.
Induction involves a medication or solution injected into the uterus
which stimulates contractions and expels the fetus. Induction is typically
done in a hospital and usually requires an overnight stay.2
Abortion during the second trimester remains a necessary option for
many women. Abortion at this stage of pregnancy is still as safe as,
or safer than, carrying a pregnancy to term. A few of the reasons women
have abortion after the first trimester include financial and geographic
barriers, abortion provider shortage, and legal restrictions (e.g.,
mandatory waiting periods). There are also medical reasons, such as
severe genetic disorders or conditions which threaten the mother's health.4
Parental
Involvement Laws
Most states have parental involvement laws (either parental
consent or notification) for minors seeking abortions. These laws differ
and can change from year to year, so it is important to have up-to-date
references on your state's laws.
- Parental Consent
Refers to a law in many states that requires a minor (18 years or
younger) seeking an abortion to have the consent of a parent or legal
guardian.
- Parental Notification
Refers to a law in many states that requires a minor seeking an
abortion to do so only after notifying a parent or legal guardian. Some
states may require both parents to provide consent.
- Judicial Bypass
Refers to abortion law provisions allowing a young woman to seek
a court order for an abortion without notifying a parent or legal guardian.
Judicial bypass may be awarded if a young woman is deemed "mature enough"
to make the decision without involving her parents or when abortion
is judged to be in her best interests, (e.g., when there are abuse issues).
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| An Overview
of the Issues |
Reasons
for Unintended Pregnancy
Unintentional
pregnancy is a fact of life, despite our advanced knowledge and technology.
Unintended pregnancy is a serious problem which affects all segments of
society, not just young, unmarried, or poor women. Over half of the six
million American women who become pregnant every year do so unintentionally.
What's more, almost 82% of teens age 15-19 unintentionally become pregnant.5
Unintentional pregnancy rates are high for many reasons. These reasons
include:
- a lack of understanding, or misunderstanding, about pregnancy prevention,
- limited access to contraception,
- sexual assault, rape, or incest,
- a partner's unwillingness to use protection,
- a person's cultural or religious beliefs,
- the incorrect use of contraception and
- a contraceptive method failure.
Verification
of Pregnancy
Regardless
of the reason a young woman believes she is pregnant, it is important to
verify as soon as possible. Many teens rely on the over-the-counter pregnancy
testing kits found in drugstores. But results of over-the-counter pregnancy
tests should be confirmed immediately because these tests can be inaccurate
if they are not used correctly. If the results of a drugstore pregnancy
test are positive (indicating pregnancy), the results should be confirmed
at a family planning clinic or doctor's office. A health care provider can
also help determine how far along the pregnancy is, which will give the
young woman more information about her options.
Considerations
of Options
Once
a pregnancy is confirmed with a health care provider, a young woman can
realistically consider pregnancy options. She may decide to have the baby
and raise it. However, she may not feel ready or willing to accept all that
comes with raising a child. In that case, she may decide to have the baby
and place it for adoption, or she may decide to end the pregnancy through
abortion.
In any case,
the decision is best made as soon as possible. If
the young woman chooses to raise the baby herself or to place it for adoption,
she should obtain prenatal care immediately. If she chooses to have an
abortion, it is simpler and safer to have it performed as early in the
pregnancy as possible.
Teens need
to consider many factors as they decide what to do about an unintended
pregnancy. Their health, values, beliefs, and circumstances should all
play a role in their decision-making. Some of the things a pregnant teen
should think about include:
- Any medical problems she may have, especially if there are signs that
something might go wrong with the pregnancy;
- How far along she is in her pregnancy;
- The costs to raise a child, pay for prenatal care and delivery, or
the cost to have an abortion; and
- What her choice will mean for her. Her decision must feel right since
it is ultimately hers to make and live with for a long time.
Obstacles
Around Abortion
If abortion is being considered, it is important to know that most states
have parental involvement laws related to minors seeking abortions. These
laws require either consent by, or notification of, parents before a minor
(18 and under) is granted permission for an abortion. (See a fact sheet
on Laws
Requiring Parental Consent or Notification for Minors' Abortions by
Planned Parenthood Federation of America.)
Unfortunately,
such laws, while intended to protect minors, can actually cause more problems
for pregnant teens. At best, young women find support within their families
to help them deal with crisis pregnancy. However, many young women will
do anything to avoid telling their parents, including illegal or self-induced
abortions. Some justifiably fear physical or emotional abuse by their
parents if forced to disclose their pregnancy. So, in fact, parental consent
or notification laws can potentially put minors at risk.
To address
this potential risk, a legal provision called "judicial bypass" can be
used to override consent or notification laws if the young woman is judged
to be mature or if an abortion is in her best interests. Still, for most
young women, maneuvering through the legal system and having to go to
court are huge barriers in themselves. Many fear that the proceedings
will not be confidential or that they will be recognized by people at
the courthouse. Others cannot arrange transportation or have conflicts
with their school schedules. Additionally, the time required to schedule
a hearing may delay an abortion, which can increase health risks for the
procedure. And there have been numerous reports that young women who finally
manage to arrange a hearing end up facing a judge who is anti-choice or
who routinely denies petitions for judicial bypass.6
Adolescents
face numerous obstacles if they choose to abort a pregnancy. Rather than
deal with these obstacles, some teens will delay seeking an abortion until
after the first trimester. This can occur for many reasons including:
- fear of parents' reactions,
- denial of pregnancy (psychological denial may also occur in cases
of rape or incest), and
- prolonged fantasies that having a baby will result in a stable relationship
with their partner.
In addition,
adolescents may have irregular periods, making it difficult for them to
detect pregnancy. And, as noted above, state laws requiring parental involvement
for minors can cause delays in obtaining an abortion.4
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As teens
wrestle with their feelings about an unintended pregnancy, they are likely
to approach a trusted adult to ask for help. There are many ways that
educators and others can offer support. One important way is to be a good
listener. Effective listening is a skill appreciated by anyone who is
worried or in trouble. (See Listening
Skills in ReCAPP's Skills for Youth section.) It is also helpful if
you have some knowledge about pregnancy options and if you can encourage
a concerned young woman to seek help as soon as possible. Other tips include:
- Be Aware of Pregnancy Counseling Concerns
Counseling teens about pregnancy options is a complex and sensitive
matter. A counselor has the responsibility to provide the young woman
with non-judgmental, non-directive counseling which covers all three
options in a balanced way. Any adult in a position to provide counsel
to a pregnant adolescent should know his/her limits. It is important
to avoid personal bias. If an educator, clinician, or other trusted
adult feels at all judgmental or compelled to direct a young woman in
what to do, s/he should recognize that bias and refer the young woman
elsewhere.
There are organizations — such as family planning clinics, family
services agencies or adoption agencies — with skilled counseling
staff trained to handle this sensitive role. It is best to become familiar
with these local resources before making a referral, and beware of so-called
"crisis pregnancy centers" that are anti-choice. Anti-choice agencies
may appear to be highly professional resources, but in reality, they
do not provide complete or correct information. They may also discourage
use of the most reliable contraceptive methods.
School-based educators should also review their school's education codes
which may restrict teacher involvement under certain sensitive circumstances.
- Use Teachable Moments for Future Pregnancy Prevention
Some educators believe that a crisis pregnancy can be used as a
teachable moment. A teen having experienced an unintended pregnancy
may be more motivated to change risk-taking behavior to prevent recurring
pregnancy scares. Young women (and young men) may be interested in learning
more about how to correctly use contraception if they have a new perspective
on risk-taking consequences. Information can now be personalized, so
it may be worthwhile to discuss prevention strategies that have new
meaning for them.
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| More Information/Resources |
Organizations
and Web Sites with Information on Pregnancy Options
- Planned Parenthood Federation of America
810 Seventh Avenue
New York, NY 10019
(212) 541-7800
To discuss pregnancy options, call toll-free 1-800-230-PLAN.
www.plannedparenthood.org
- The National Abortion and Reproductive Rights Action League (NARAL)
1156 15th Street, N.W., Suite 700
Washington, D.C. 20005
(202) 973-3000
www.naral.org
- Alan Guttmacher Institute (AGI)
1120 Connecticut Avenue, NW, Suite 460
Washington, DC 20036
(202) 296-4012
www.agi-usa.org
- Sex Information and Education Council of the United States (SIECUS)
130 West 42nd Street, Suite 350
New York, NY 10036
(212) 810-9770
www.siecus.org
- Kaiser Family Foundation
2400 Sand Hill Road
Menlo Park, CA 94025
(650) 854-9400
www.kff.org
- The American College of Obstetricians and Gynecologists
409 12th Street, SW
P.O. Box 96920
Washington, DC 20090-6920
(800) 762-2264, ext. 830
www.acog.org
- The Network for Family Life Education
Rutgers, The State University
100 Joyce Kilmer Avenue
Piscataway, NJ 08854-8045
(732) 445-7929
www.sxetc.org
- ETR Associates
4 Carbonero Way
Scotts Valley, CA 95066
(831) 438-4060
www.etr.org
- National Abortion Federation Hotline
This hotline provides referrals to clinics that perform abortions and
answers questions about abortion laws.
(800) 772-9100
- National Council for Adoption
(202) 328-1200
www.ncfa-usa.org/
- Go Ask Alice
Columbia University's Health Education Program
www.goaskalice.columbia.edu/
Suggested
Books and Other References
- The Best Intentions . . Unintended Pregnancy and the Well-Being
of Children and Families
Institute of Medicine, National Academy of Sciences
Edited by Sarah S. Brown and Leon Eisenberg
National Academy Press
Washington, DC, 1995
(888) 624-8373
- Mandatory Parental Consent and Notice Laws and The Freedom to
Choose (report)
NARAL Foundation: Reproductive Freedom & Choice, 2002
1156 15th Street, NW, Suite 700
Washington, DC 20005
(202) 973-3000
www.naral.org/mediaresources/fact/consent.html
- Adolescent Pregnancy Options (article)
Michael D. Resnick
Journal of School Health
September 1992, Vol. 62, No. 7
American School Health Association
www.ashaweb.org/
- The Sexuality Education Challenge . . Promoting Healthy Sexuality
in Young People
Edited by Judy C. Drolet & Kay Clark
ETR Associates
Santa Cruz, CA, 1994
(800) 321-4407
- The Subject is Sex
Pamela Wilson, Marcia Quackenbush, and William H. Kane
ETR Associates
Santa Cruz, CA, 1991
(800) 321-4407
- Guidelines for Comprehensive Sexuality Education . . Kindergarten
- 12th Grade
National Guidelines Task Force
Sex Information and Education Council of the U.S. (SIECUS)
New York, NY, 1992
(212) 819-9770
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