Abstract
Effects of Receiving vs. Being Denied an Abortion on Quality of Women's Intimate Relationships at 5 years
Ushma Upadhyay, PhD, MPH, M. Antonia Biggs, PhD, Sarah Roberts, DrPH and Diana Foster, PhD
University of California, San Francisco, Oakland, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
When a woman who seeks an abortion cannot obtain one, having a child may affect both her relationship with the man involved in the pregnancy and her prospects for new relationships. We assessed the impact of receiving versus being denied a wanted abortion on women's relationships, both with the man involved in the pregnancy and with new partners, 5 years after seeking an abortion. Using mixed-effects models, we compare relationship outcomes among women who presented for abortion care just under facilities' gestational age limits (“Near-limits,” n=452) with those who presented just over, were denied an abortion and carried to term (“Turnaways,” n=146) at 30 U.S. facilities. At the time of pregnancy 80% of women were in romantic relationships with the man involved in the pregnancy; 61% were at one week and 26% were at 5 years post-abortion seeking. Turnaways were no more likely than Near-Limits to be in an intimate relationship with the man involved in the pregnancy 2 to 5 years after the abortion. At 5 years 53% of women in both groups were in a relationship with a new partner, with no difference by study group. However, Turnaways were significantly less likely to be in a high quality relationship at 5 years with 76% reporting their relationships were “good” or “very good” compared to 83% of Near-Limits (p<0.03). Denial of abortion services may have long term implications for women's relationships.
Public health or related research Social and behavioral sciences
Abstract
Does receiving or being denied a wanted abortion affect the incidence of subsequent unintended and intended pregnancy?
E. Angel Aztlan-James, PhD, MS, CNM, WHNP1, Diana Greene Foster, PhD2 and Ushma Upadhyay, PhD, MPH2
(1)University of Illinois at Chicago, Chicago, IL, (2)University of California, San Francisco, Oakland, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: More than half of all US women will experience an unintended pregnancy in their lifetimes, half of which end in abortion. Little is known about how abortion affects the likelihood of experiencing a subsequent unintended or intended pregnancy.
Methods: Data from the Turnaway Study, a five-year, prospective study of U.S. women who requested abortion between 2008 and 2010 at one of 30 abortion facilities were analyzed for about 800 study participants. Cox proportional hazards modeling was used to examine time to subsequent unintended pregnancy. Logistic regression was used to examine likelihood of subsequent intended pregnancy. Models included other factors that might influence subsequent pregnancy intention.
Results: Neither receiving nor being denied a requested abortion were associated with increased risk of subsequent unintended pregnancy. Older women (aged 35-46) (AHR=0.31, 95% CI=0.16-0.59); those born outside the US (AHR=0.46, 95% CI=0.25-0.82; those with a college degree (AHR=0.53, 95% CI=0.29-0.95) were at decreased risk. Women who had two or more children at baseline (compared to those who had none) (AHR=1.54, 95% CI=1.07-2.22), and those who reported a history of depression (AHR=1.39, 95% CI=1.02-1.91) were at increased risk of subsequent unintended pregnancy.
Receiving a requested abortion was associated with greater odds of reporting a subsequent intended pregnancy, controlling for potential confounders (AOR=3.29, 95% CI=1.08-10.05). No other covariates were associated with subsequent intended pregnancy.
Conclusion: Neither receiving nor being denied abortion affects subsequent unintended pregnancy risk. However, receiving a requested abortion may enable women to have a wanted pregnancy when circumstances are better for them.
Social and behavioral sciences
Abstract
Effect of receiving versus being denied a wanted abortion on women's educational achievement
Lauren Ralph, PhD1, Diana Greene Foster, PhD1 and Jane Mauldon, PhD2
(1)University of California, San Francisco, Oakland, CA, (2)University of California, Berkeley, Berkeley, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction. Despite decades of research, the effect of unintended childbearing on a woman's ability to achieve her educational goals remains unclear. Past research has not been able to disentangle the direct effects of the demands of parenting from common selection factors that predispose women to both unintended childbearing and poor socioeconomic outcomes.
Methods. Data for this analysis are from a longitudinal study of 956 women seeking abortions at 30 U.S. facilities. We examine educational outcomes for 281 women enrolled at school at baseline who received an abortion just under the facility's gestational limit (Near limits) or were over the gestational limit and gave birth (Turnaways). At baseline and 6-month intervals for five years, women reported educational status. We used discrete-time survival analysis to predict the hazard of dropping out or graduating among those enrolled in school at baseline.
Results. At baseline, 29% of women were enrolled in school. Turnaways were equally likely to be in school as Near limits (33 vs. 28%, p=0.19); however, they were more likely to be seeking a high school diploma (40 vs. 24%, p=0.05). Over five years, 88 (31%) graduated, 98 (35%) dropped out, and 95 (34%) experienced no educational event before being censored. In adjusted survival models, there were no differences in the hazard of graduation or drop out by study arm.
Conclusions. Contrary to some previous research, experiencing a birth after an unwanted pregnancy was not related to women's likelihood of dropping out of school or completing a degree over the next five years.
Social and behavioral sciences
Abstract
Effect of being denied a wanted abortion on women's socioeconomic wellbeing
Diana Foster, PhD1, M. Antonia Biggs, PhD1, Caitlin Gerdts, PhD2, Sanders Korenman, PhD3, Lauren Ralph, PhD1 and Sarah Roberts, DrPH1
(1)University of California, San Francisco, Oakland, CA, (2)Ibis Reproductive Health, Oakland, CA, (3)Baruch College, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The most common reason women give for wanting to terminate a pregnancy is that they cannot afford to raise a/another child. Little is known about the immediate or longer term consequences of restricting access to abortion services on women's socioeconomic wellbeing. From 2008 to 2010, we recruited women from 30 abortion facilities across the US. We compare women who received an abortion at a gestation just under the gestational limit (N=413) to women who present just over each of the facilities' limit and were denied the abortion (N=210). Women were interviewed at approximately one week after seeking an abortion, and followed with semi-annual interviews for five years. To examine the effect of denial of abortion on women's wellbeing, we use an intent to treat approach, where being over the facility gestational limit is considered treatment and carrying the pregnancy to term is considered as-treated. We use a two- stage instrumental variable approach to examine the effect of carrying the pregnancy to term and raising the child as a result of abortion denial due to a gestational age limit. Preliminary results indicate that parenting and raising a child as a result of an abortion denial reduces full-time employment, and increases poverty, public assistance receipt and the chance of living alone with children. Restrictions on abortion that prevent women from accessing the service may result in serious socioeconomic consequences for women and their children.
Biostatistics, economics Public health or related laws, regulations, standards, or guidelines Public health or related public policy Public health or related research Social and behavioral sciences
Abstract
Effect of abortion receipt and denial on women's existing and subsequent children
Diana Foster, PhD, Sarah Raifman and M. Antonia Biggs, PhD
University of California, San Francisco, Oakland, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The majority of women having abortions in the U.S. are already mothers; about a third say that their reason for terminating a pregnancy is to care for children they already have. The most common reason for abortion is not having enough money to care for a/another child. Using Turnaway Study data, we first examine the effect on existing children to women seeking abortion, some of whose mothers received an abortion while others' were denied the procedure and carried the pregnancy to term. Second, we examine the effect of unwanted pregnancies carried to term on the child born after such pregnancies compared to the subsequent child born to women who received an abortion. We measure caregiving (residency with the mother, hours with other caregivers and preschool attendance), health (asthma, physical disabilities and injuries) and development (six areas of development using the PEDS: Developmental Milestones scale). For our second set of analyses, we also measure birth outcomes (birth weight, prematurity, health and NICU time) and maternal bonding (Postpartum Bonding Questionnaire). In preliminary results from mixed effects models, we find small negative effects on child development and large negative economic outcomes for children whose mothers were denied abortions compared to children whose mothers received an abortion. As for children born following abortion denial, we find higher odds of poor maternal bonding, lower odds of living with a male adult and higher odds of living below the poverty level compared to subsequent children born to women who received an abortion.
Advocacy for health and health education Biostatistics, economics Conduct evaluation related to programs, research, and other areas of practice Public health or related laws, regulations, standards, or guidelines Public health or related research Social and behavioral sciences