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Topics In Brief

All Topics In Brief

Pregnancy Options

This edition of ReCAPP focuses on options for young women facing unintended pregnancy. This edition of Topic in Brief includes the following sections:

Introduction

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.

Definitions

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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What Educators Can Do

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

1 Pregnancy Choices: Raising the Baby, Adoption, and Abortion (pamphlet). The American College of Obstetricians and Gynecologists (ACOG). December 1999.
2 Fact Sheet: How Abortion is Provided. Planned Parenthood Federation of American (PPFA). 2001. www.plannedparenthood.org/library/ABORTION/howabort_fact.html
3 Fact Sheet: What if I'm Pregnant? Planned Parenthood Federation of America (PPFA). 2001. www.plannedparenthood.org/WOMENSHEALTH/WhatifPregnant.html
4 Fact Sheet: Abortion After the First Trimester. Planned Parenthood Federation of America (PPFA). 2001. www.plannedparenthood.org/library/facts/abotaft1st_010600.html
5 Institute of Medicine, National Academy of Sciences. The Best Intentions . . Unintended Pregnancy and the Well-Being of Children and Families. National Academy Press. 1995.
6 Mandatory Parental Consent and Notice Laws and The Freedom to Choose. Naral Foundation. 2002. www.naral.org/mediaresources/fact/consent.html