Case study of intentional trauma-induced abortion in the late second trimester: Criminal desperation or systems failure?

Background/Significance: In 2004, teens from a Midwestern state responded to an unintended pregnancy by attempting self-induced abortion through abdominal trauma; the young man was subsequently charged with a felony. However, it is not clear that criminalization of his behavior addresses the problems of knowledge and policy that were part of the spectrum of influences on this young couple.

Objective/Purpose: We examine the ways in which the teens' self-induced abortion and the legal fallout illuminate failings in the system of reproductive health knowledge and services as well as gaps in current research.

Methods: We reviewed court documents and media reports regarding the minors' case, state law, legislative transcripts, and informed consent campaign materials. Using a systems framework, we characterized the information and decisions that ultimately created the outcomes of this case.

Results: We identified several points at which a change in the system of knowledge might have averted the need for self-induced abortion or felony prosecution: Sexuality education (none was provided in the teens' school); confidential access to contraceptive information (teens may have had inadequate knowledge of/access to reliable methods); and accurate information regarding abortion access for minors (teens were erroneously told at a "crisis pregnancy center" that the judicial bypass option required parental notification).

Discussion/Conclusions: This case illustrates the unintended consequences of policy and demonstrates clear opportunities where information, intervention, or policy change might have created a different outcome. It also points to the need for expanded research regarding women's knowledge of and responses to local, state, and federal policies.