Unexpected Pregnancy Outcomes
Abortion
I. For unplanned pregnancies, the first decision to be made is whether or not to continue
A. Sometimes it is allowed to continue, something goes wrong & fetus stops developing;
such natural cessations of pregnancy are spontaneous abortions (miscarriages)
B. Abortions requiring intervention to end pregnancy are technically called induced abortions
II. Abortion procedures
A. Vacuum aspiration – almost all abortions performed in US are performed during first
trimester using surgical procedure called vacuum aspiration
B. Manual vacuum aspiration (MVA) – variation of vacuum aspiration that can be used from
detection of pregnancy to up to 12 weeks since the last menstrual period (LMP)
C. Medical abortions – relatively new procedures that use drugs to induce abortions,
including mifepristone or methotrexate in combination with misoprostol
1. Mifepristone – discovered by French pharmaceutical company in 1978; was known as
RU486 (RU refers to Roussel Uclaf, the French pharmaceutical company
2. Methotrexate – blocks folic acid & prevents cell division
3. Women who choose a medical abortion should understand that there is a 4 – 8%
chance they will need to return for a surgical abortion
D. Dilation & evacuation – during second trimester of pregnancy, dilation & evacuation
(D&E) is abortion procedure used
1. It involves dilating the cervix, scraping the walls of the uterus & removing the
endometrial lining with suction
Abortion: The Law and the Debate
I. For more than 3 decades, abortion has been vehemently debated in the political sector
A. Neither IVF, contraception nor sterilization generates the political, religious & emotional
heat that abortion does
B. Prolife political groups actively support candidates who are totally opposed to abortion
C. Groups labeled prochoice believe that women should have the right to decide for themselves
what they will do with their bodies
1. Thus, they oppose legislative restrictions on the availability of abortion to women who
choose that option
2. They wish to uphold the Supreme Court decision of 1973, which established the
current status of abortion in the US (Roe v. Wade)
3. The Court ruled that abortion should be available to women during the 1st trimester; the
decision is made by the pregnant woman & her physician
4. In 1983, Supreme Court reaffirmed its 1973 decision
5. 1989 – a more conservative Court due to new appointments decided in Webster v.
Reproductive Health Services that
6. Later, 2 other cases were taken before Court & decided in 1990
a. Hodgson v. MN – Court rejected a law requiring a physician to notify both parents of a
minor before abortion could be performed
b. Ohio v. Akron Ctr for Reproductive Health – Court held that similar law that required
notification of one parent & included judicial bypass was constitutional
7. 1992 – Court reaffirmed constitutionality of states attaching regulations to abortions,
although they also reaffirmed right of woman to have abortion if she chooses
a. Planned Parenthood of SE PA v. Casey – Court ruled PA could require woman seeking
abortion to receive counseling & to wait 24 hrs before getting abortion
b. Court refused to overturn Roe v. Wade as many opponents of abortion had hoped such
a Court would do
8. 2000 – Steinberg v. Carhart – Court ruled bans on intact D&E (partial birth abortions)
unconstitutional since did not take into account pregnant woman's health
9. 1980 – Court decision profoundly affected availability of legal abortions
II. Current Laws on Abortion Services
A. People who oppose legalized abortion have unsuccessfully tried to outlaw abortion services
completely, but they have limited availability under many circumstances
B. October 1998 – Congress passed a $500 billion appropriations bill which contained many
restrictions on abortion; it prohibited:
C. Many states have also passed laws limiting abortion services – limits on public & private
funding for abortion, parental consent laws, waiting periods, bans on some procedures
III. Who has abortions?
A. Alan Guttmacher Institute monitors abortion laws & the characteristics of those having
abortions
B. Centers for Disease Control & Prevention (CDC) also monitors abortion in the US; most
current CDC reported data at time book was written was 2001
1. 51% of abortions were done for women younger than 25 years; 1/3 of abortions were
done for women aged 20 – 24 years; teenagers have 18% of abortions
C. Religion plays a role as well – women who report no religious affiliation are >4 times as
likely to get one as other women (Guttmacher Inst.)
D. Marital status is another variable – 79% of abortions are obtained by women who are not
married
E. 3 primary reasons women give for seeking an abortion – Guttmacher Inst.
1. ¾ say that having a baby would interfere with their work, education or other
responsibilities
2. ~2/3 say they cannot afford a child
3. Half say they do not want to be single parent or are having problems with husband/partner
F. Other reasons
The Safety of Abortions
I. Abortion is an extremely safe procedure
A. <1% of abortion patients experience a major complication; of these the primary risks are:
B. For abortions performed during the 1st 8 weeks of pregnancy, 1 death occurs per million
abortions
C. There is no effect on subsequent pregnancies or births in women who have had the most
common abortion procedure (vacuum aspiration) within the first 12 weeks
II. Some concern has been raised about the psychological health of women as a result of
experiencing an abortion, but there is little evidence that women are negatively affected
A. Study of >5000 American women – those who had had abortion actually had higher selfesteem & greater feelings of self-worth & capability than women who had not had one
Attitudes About Abortion: Changing & Unchanging
I. Since Roe v. Wade, attitudes about abortion have been evolving; many studies have been done to
identify Americans' attitudes
A. Most of the studies asked only a few questions, leaving the interpretation of the results
unclear
II. 2003 – 23% of Americans believed abortion should be legal under any circumstance, 15%
believed it should be legal under most circumstances, 42% in only a few circumstances
III. Percentage saying abortion should be legal in all circumstances rose from 21% in 1975 to 34%
in 1992 & slipped back to 25% in 1996 where it has remained since
IV. Abortion is considered more acceptable during early stages of pregnancy than during later
stages
A. When woman's life is endangered or pregnancy is result of rape or incest, a majority of
Americans believe abortion ought to be an option even during the third trimester
B. When prochoice & prolife supporters are surveyed about their attitudes toward abortion,
not only whether they support abortion or not, they differ significantly
C. Latest data indicate Americans are less supportive of abortion than in the recent past
1. 2005 – when asked if they oppose or favor Supreme Court decision making abortion legal
up to 3 months of pregnancy, 52% favored & 47% opposed Roe v. Wade
Availability of Legal Abortion
I. It is becoming increasingly difficult for a woman to have an abortion in the US
A. Number of abortion providers in US fallen by 37% since 1982 & 11% between 1996 & 2000
1. Proportion of women who live in a county with no abortion provider increased from
28% in 1992 to 34% in 2001
B. Many abortion clinics are picketed on regular basis
C. Violence has also plagued many abortion clinics
1. From 1996 to 1997, number of arsons doubled & bombings tripled against abortion
clinics
2. Abortion providers have been murdered at the clinics where they work in Florida &
Massachusetts
D. 33 states have passed laws requiring that adolescents have parental consent or notification
for abortion
II. Public & private funding for abortion
A. Patchwork of state laws concerning public funding for abortion is complex
B. Each state establishes its own abortion funding policy related to state revenues
Emotions & Abortion
I. Emotional reactions to abortion are varied – some women feel guilty, depressed, angry &
ashamed; others feel none, or just a limited extent, of these feelings
II. Religious & moral beliefs, reactions of medical staff, relatives & friends & strength of
relationship between partners all affect emotional responses
A. The earlier the abortion is performed, the lower the emotional cost
B. Realizing this, a film was developed by abortion opponents & shown widely in US
1. Entitled The Silent Scream, the film is a 28-minute depiction of an abortion using
ultrasound visualization
2. Many physicians & others have taken issue with it
3. Others argue the following points
C. Other extreme emotions associated with the issue of abortion (besides The Silent Scream)
1. Abortion facilities have been bombed, and staff & patients have been targets of harassment
2. Some professionals choose not to subject themselves to this type of treatment & therefore
refuse to work at abortion facilities
Adoption
I. Another response to an unwanted pregnancy is delivery of the baby followed by adoption
placement
A. Women who are unwed & choose not to raise baby or who do not have financial resources
necessary to raise baby often choose adoption
II. Types of adoptions – 2 basic types
A. Closed adoptions – confidential; there is no contact between the birth parents & the
adoptive parents; identities of the birth parents & adoptive parents are kept secret
B. Open adoptions – allow contact between the birth parents & the adoptive parents
III. Adoptions are legally binding & irreversible after a limited period, although there have been
some highly publicized cases of birth parents' seeking to reverse them
A. Birth parents sign relinquishment papers after the baby is born
IV. Adoptions are arranged in 3 ways: agency adoption, independent adoption, & adoption by
relatives
A. Agency adoption – the parents relinquish their baby to an adoption agency
1. These agencies are licensed by the government & may offer a number of services
B. Independent adoptions – birth parents select the adoptive parents & relinquish the baby into
their care
1. Often arranged through a physician or a lawyer &, in some cases, by independent
adoption centers
2. Independent adoptions are usually open adoptions &, although not legal in all states, are
supervised by a lawyer, who usually represents both sides
C. Adoption by relatives – used when the birth parents want the child to stay in the family
Contemplating Adoption
I. Adopting a child is a decision that requires a great deal of consideration; so does the decision of
giving a child up for adoption
II. Planned Parenthood of America suggests that anyone considering giving a child up for adoption
should ask the following questions
III. Someone planning to put their baby up for adoption should discuss the above questions with
her partner, clergy, professional counselor or a trusted relative or friend
Foster Care and Adoption
I. For parents not ready to decide between adoption & parenting, many cities & counties provide
temporary residences for their children; this arrangement is called foster care
A. To arrange for this option, birth parents must sign a legal foster care agreement that allows
another family to care for the child
B. Often foster care agreements specify:
II. Although foster care arrangements & regulations vary from state to state, if the foster care
agreement is violated, the birth parents can lose the child permanently
III. Foster care also provided for children taken from birth parents for abuse, neglect or other behavior
that precludes them from being able to raise their children & places the children at risk
IV. US foster care system includes >500,000 children, of which 131,000 are eligible for adoption;
fortunately, more & more of these children are being adopted
A. 1995 – 20,000 children in the foster care system were adopted; increased to 28,000 in1996 &
to 31,000 in 1997
B. 1997 – Congress passed the Adoption & Safe Families Act, designed to speed up adoption of
children in the foster care system
1. Legislation provided bonuses of $4000 to states for every child in the child protective
system for whom they arranged adoption
C. 2003 – 49,000 children in foster care system were adopted
Finding the Birth Parent
I. Since they seek to determine their complete history or because they are curious or for some other
reason, many adults who were adopted seek to identify their birth parents
A. There is lots of disagreement as to whether & how this process should be facilitated
B. Before WWII, it was common for adoption records to be open
C. Oregon residents decided this issue for themselves in November 1998
1. Approved a ballot initiative requiring the state to unseal confidential birth records
2. On request, adoptees would be given all the information about their past – in spite of the
wishes of their birth parents