Abortion among young women and subsequent life outcomes.In research into why young women seek abortions, some of the more frequently given reasons relate to the educational, economic and partnership consequences of unwanted or mistimed mis·timetr.v. mis·timed, mis·tim·ing, mis·times To time inaccurately or inappropriately; misjudge the timing of: The basketball team mistimed the final play and lost the game. pregnancy. For example, Broen et al. (1) interviewed women at three time points following an abortion, and found that concerns about the effect of having a child on education, career, finances and relationships were rated as important reasons for having an abortion. Similarly, Finer et al. (2) reported that frequently, young women who had abortions stated that they felt unprepared for motherhood, and cited interference with educational opportunities as a primary reason for choosing this option. Seventy-five percent of abortion patients surveyed by Torres and Forrest (3) listed interference with education or being unable to afford a baby as a primary reason for having an abortion, while 50% listed potential relationship problems. Sihvo et al. (4) reported that for women younger than 25, concerns about education and relationship status were the most important determinants of the decision to have an abortion. These findings raise the issue of the extent to which the decision to have an abortion has advantages for the woman. Indirect evidence suggests possible benefits of abortion for subsequent life course outcomes. In particular, a substantial literature has linked teenage parenthood with educational underachievement, (5-7) poverty, (8-10) welfare dependence, (9,11) domestic violence (12) and impaired partnership relationships. (7,12) For example, Hofferth, Reid and Mott (5) found that teenage mothers completed 1.9-2.2 fewer years of schooling than women who first gave birth after age 30. Similarly, Moore Moore, city (1990 pop. 40,761), Cleveland co., central Okla., a suburb of Oklahoma City; inc. 1887. Its manufactures include lightning- and surge-protection equipment, packaging for foods, and auto parts. et al. (8) reported that lower ages at first birth were strongly associated with increasing risks of poverty for women at age 27, and Grindstaff (9) showed that women who gave birth as adolescents were more likely than other mothers to become welfare-dependent. Finally, Harrykissoon, Rickert and Wiemann (12) found that adolescent ad·o·les·cent adj. Of, relating to, or undergoing adolescence. n. A young person who has undergone puberty but who has not reached full maturity; a teenager. mothers were at increased risk for intimate partner violence and relationship problems. One might assume that the adverse outcomes experienced by adolescent mothers are largely or wholly the consequence of mistimed or unwanted pregnancies unwanted pregnancy Obstetrics A pregnancy that is not desired by one or both biologic parents. See Teen pregnancy. , and that the adversities associated with teenage pregnancy teenage pregnancy Adolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is may therefore be mitigated mit·i·gate v. mit·i·gat·ed, mit·i·gat·ing, mit·i·gates v.tr. To moderate (a quality or condition) in force or intensity; alleviate. See Synonyms at relieve. v.intr. To become milder. by abortion. However, only a limited number of studies have directly examined whether young women who have abortions have better life course outcomes than young women who become pregnant but do not seek abortions. Zabin, Hirsch and Emerson (13) found that pregnancy clinic attendees who had abortions were more likely to complete high school and more likely to be employed two years later than were those who carried their pregnancies to term or had negative pregnancy tests pregnancy test Any test used to detect or confirm pregnancy; in early pregnancy, all PTs measure hCG, the developing placenta's principal hormone, which is detectable as early as 6 days after fertilization; in clinical laboratories, serum levels of hCG are . Similarly, Bailey et al. (14) found that Brazilian adolescents who had abortions were more likely than those not having abortions to be attending school one year later. In this article, we examine life course outcomes following abortion before age 21 in a birth cohort cohort /co·hort/ (ko´hort) 1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group. 2. of young women in New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. studied to the age of 25. In New Zealand, the provision of legal abortion is determined by the Contraception contraception: see birth control. contraception Birth control by prevention of conception or impregnation. The most common method is sterilization. The most effective temporary methods are nearly 99% effective if used consistently and correctly. , Sterilisation and Abortion Act of 1977, and is overseen by the Abortion Supervisory Committee. Before a woman may undergo a legal abortion, she must approach her doctor and receive a referral to two specialist consultants. The consultants must agree that one of three conditions is met: The pregnancy would seriously harm the life or the physical or mental health of the woman or baby; the pregnancy is the result of incest incest, sexual relations between persons to whom marriage is prohibited by custom or law because of their close kinship. Ideas of kinship, however, vary widely from group to group, hence the definition of incest also varies. ; or the woman is severely mentally handicapped. An abortion will also be considered on the basis of age or when the pregnancy is the result of rape. (15) The aims of this analysis were to examine the extent to which young women who had an abortion prior to age 21 showed advantaged outcomes when compared with women who became pregnant but did not seek an abortion. We hypothesized that when due allowance was made for prepregnancy factors, women who had an abortion would have relatively advantaged educational, economic and related outcomes. The analysis also compares women having an abortion by age 21 with those not becoming pregnant by 21. We hypothesized that when due allowance was made for prepregnancy factors, these two groups would have similar educational and related outcomes. METHODS Study Design The data used in these analyses came from the Christchurch Health and Development Study, a longitudinal study longitudinal study a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. of a cohort of 1,265 children born in 1977 in the Christchurch, New Zealand, urban region who were studied from birth to age 25. The analyses were based on the 492 female participants for whom full information on pregnancy history and educational, income, welfare dependence, employment and partnership outcomes to age 25 was available. This sample represented 78% of the original cohort of females. All data were collected on the basis of signed parental consent Parental consent laws (also known as parental involvement or parental notification laws) in some countries require that one or more parents consent to or be notified before their minor child can legally engage in certain activities. and, from age 14 onward on·ward adj. Moving or tending forward. adv. also on·wards In a direction or toward a position that is ahead in space or time; forward. , signed consent of the cohort members themselves. All phases of data collection had ethical approval from the Canterbury Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. . Sample members were interviewed at ages 15, 16, 18 and 21 about their pregnancy and abortion experience since the previous assessment. These reports showed that 125 women (25% of the sample) had had at least one pregnancy by age 21. A total of 172 pregnancies were reported, of which 55% had resulted in a live birth, 31% had been terminated by abortion and 14% had ended in miscarriage miscarriage: see abortion. miscarriage or spontaneous abortion Spontaneous expulsion of an embryo or fetus from the uterus before it can live outside the mother. . For our main analysis, we classified participants into three mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" groups: those who had had an abortion before age 21 (48 women); those who had had a pregnancy but not an abortion before age 21 (77); and those who had never become pregnant before age 21 (367). However, this method of classification is not without limitations. In particular, 11 women who had had abortions also had had live births. Furthermore, the classification does not distinguish women who had had a live birth from those who had had a miscarriage. To address these issues, we devised a series of classification schemes to examine the sensitivity of the analysis to alternative representations of an individual's pregnancy and abortion history. In addition, all analyses were conducted including and excluding women whose only pregnancy had ended in miscarriage (11 participants). To cross-validate the self-reported data, we compared our estimates with officially recorded pregnancy and abortion statistics for New Zealand. (16) These comparisons suggested some underreporting of abortion. The observed rate of abortion by age 21 in the cohort (108 per 1,000) was 88% of the rate expected on the basis of population figures (123 per 1,000). However, this difference was not statistically significant. Outcome Measures We examined 10 measures, assessed at age 25, spanning educational, economic and partnership outcomes. * Educational. Cohort members were questioned concerning their history of enrollment in tertiary tertiary (tûr`shēârē), in the Roman Catholic Church, member of a third order. The third orders are chiefly supplements of the friars—Franciscans (the most numerous), Dominicans, and Carmelites. (i.e., any postsecondary) education and training, and concerning any educational or vocational degrees or certification obtained since age 21. This information was used to classify clas·si·fy tr.v. clas·si·fied, clas·si·fy·ing, clas·si·fies 1. To arrange or organize according to class or category. 2. To designate (a document, for example) as confidential, secret, or top secret. participants on four dichotomous di·chot·o·mous adj. 1. Divided or dividing into two parts or classifications. 2. Characterized by dichotomy. di·chot measures of educational achievement between ages 21 and 25: attendance at university; completion of a university degree (bachelor's level or above); enrollment in any form of tertiary education Tertiary education, also referred to as third-stage, third level education, or higher education, is the educational level following the completion of a school providing a secondary education, such as a high school, secondary school, or gymnasium. or training; and attainment of any tertiary educational or vocational qualification. * Economic. Sample members were asked to estimate their personal gross income from all sources over the previous 12 months. For participants living alone or still living with parents or other family members, this estimate was also used as a measure of family income, because it represented the portion of household income over which the participant presumably pre·sum·a·ble adj. That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. had some decision-making decision-making, n the process of coming to a conclusion or making a judgment. decision-making, evidence-based, n a type of informal decision-making that combines clinical expertise, patient concerns, and evidence gathered from power. For participants who were married or living with a romantic partner, who presumably made joint decisions over joint incomes, an estimate of family income was obtained by asking about the partner's gross income during the previous 12 months, and adding this to the personal income estimate. In addition, women were questioned about their receipt of social welfare benefits since age 21. The proportion who reported receiving an unemployment benefit, domestic purposes benefit (for the support of single-parent families single-parent family Social medicine A family unit with a mother or father and unmarried children. See Father 'factor.', Latchkey children, Quality time, Supermom. Cf Extended family, Nuclear family, Two parent advantage. with dependent children), or sickness SICKNESS. By sickness is understood any affection of the body which deprives it temporarily of the power to fulfill its usual functions. 2. Sickness is either such as affects the body generally, or only some parts of it. or invalids benefit at any point in the period served as an outcome measure. Participants were also questioned about their current paid employment. Those who reported working a minimum of 30 hours per week were classified as being in full-time employment. * Partnership. Sample members were questioned about their partner relationships over the past 12 months. Participants who reported having been in an intimate partner relationship for one month or longer in the past year were further questioned about their experience of partner violence and the quality of their relationship. Partner violence was assessed using a 22-item scale that incorporated selected items from the Revised Conflict Tactics Scale The Conflict Tactics Scales (CTS) is a widely used method of identifying intimate partners maltreatment, with a version for the identifying of child maltreatment. It has been used in national surveys on the prevalence of family violence in the USA and other countries. . (17) The selected items spanned the domains of minor psychological aggression aggression, a form of behavior characterized by physical or verbal attack. It may appear either appropriate and self-protective, even constructive, as in healthy self-assertiveness, or inappropriate and destructive. , severe psychological aggression, minor physical assault and severe physical assault. These items were summed to provide a scale measure of the extent of partner violence (alpha=0.85). (18) The measure of relationship quality was derived from the 25-item Intimate Relations Scale. (19) Possible responses to each item ranged from 1 ("doesn't apply") to 3 ("definitely applies"). We used the negative feelings subscale to assess the level of dissatisfaction with the individual's relationship (alpha=0.82). Covariate covariate predictors during the allocation of experimental units in a randomized design. Factors A range of covariate factors were chosen from the study's database on the basis of their association with pregnancy history before age 21 and their associations with educational and achievement outcomes as observed in previous studies of this cohort. * Family background characteristics. Maternal MATERNAL. That which belongs to, or comes from the mother: as, maternal authority, maternal relation, maternal estate, maternal line. Vide Line. and paternal PATERNAL. That which belongs to the father or comes from him: as, paternal power, paternal relation, paternal estate, paternal line. Vide Line. education were assessed at the time of the cohort member's birth and were categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat as "no formal qualifications," "secondary qualifications" or "tertiary qualifications." Family material living standards living standards npl → nivel msg de vida living standards living npl → niveau m de vie living standards living npl were assessed by means of interviewer ratings that were obtained annually from when the survey child was a year old until the child was 10, using a five-point scale that ranged from "very good" to "very poor." These ratings were averaged over the 10-year interval to provide a measure of family living standards during this period. Further, family socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. was assessed at birth using the Elley-Irving revised index of socioeconomic status for New Zealand. (20) This index ranks families into six groups on the basis of paternal occupation (ranging from 1, signifying Signifyin' (slang) is an African-American rhetorical device featuring indirect communication or persuasion and the creating of new meanings for old words and signs. Signifying, in this sense, includes repetition and difference, implication and association, combining words and "professional," to 6, denoting "unskilled"). * Childhood behavior and educational achievement. Childhood conduct problems at ages 7-9, assessed via parent and teacher reports of the extent to which the child exhibited conduct-disordered and oppositional behaviors, were obtained using a scale that combined selected items from the Rutter (21) and Conners (22,23) child behavior rating scales. For these analyses, parent and teacher ratings were summed and then averaged over the three-year interval to provide an overall measure of the extent of conduct problems in middle childhood (alpha=0.97). (24) Child cognitive ability (IQ) was assessed at ages eight and nine using the Revised Wechsler Intelligence Scale for Children Wechsler intelligence scale for children n. A standardized intelligence test that is used for assessing children from 5 to 15 years old. (WISC-R WISC-R Weschler Intelligence Scale for Children - Revised ). (25) Total scores were computed on the basis of results on four verbal and four performance subscales. The split half reliabilities of these scores were 0.93 at age eight and 0.95 at age nine. We combined the observed WISC-R total IQ scores at ages eight and nine by averaging over the two administrations. In addition, at age 13, cohort members were given the Test of Scholastic Abilities (TOSCA TOSCA Toxic Substance Control Act (also abbreviated TSCA) TOSCA Topography Supported Customized Ablation (cornea mapping in eye surgery) TOSCA Topological Oscillation Search with Kinematical Analysis ), (26) which is designed to assess the extent to which the child exhibits the skills and competencies necessary for academic work in high school. TOSCA was scored as recommended in the test manual to give a total scholastic ability score (alpha=0.95). At the assessments at ages 11-13, teacher ratings were obtained of the child's school performance in each of five curriculum areas (reading, handwriting HANDWRITING, evidence. Almost every person's handwriting has something whereby it may be distinguished from the writing of others, and this difference is sometimes intended by the term. 2. , written expression, spelling and mathematics). Ratings were made using a five-point scale ("very good" to "'very poor"), were summed across years and curriculum areas, and then were averaged to provide a teacher rating grade point average for each child (alpha=0.96). Problems with school, including issues with teachers, peers or problem behavior, were assessed at age 15 via parents' ratings of the nature and severity of five kinds of school problems (e.g., not getting along with teachers, being teased tease v. teased, teas·ing, teas·es v.tr. 1. To annoy or pester; vex. 2. To make fun of; mock playfully. 3. or bullied bul·ly 1 n. pl. bul·lies 1. A person who is habitually cruel or overbearing, especially to smaller or weaker people. 2. A hired ruffian; a thug. 3. A pimp. 4. at school, engaging in difficult behavior in class). A total school problems score was obtained by summing the number of problems identified by parents. A measure of secondary school achievement was provided by a count of the number of passing grades (A, B or C) attained at·tain v. at·tained, at·tain·ing, at·tains v.tr. 1. To gain as an objective; achieve: attain a diploma by hard work. 2. in School Certificate examinations, a national series of examinations available to all students that was usually undertaken in the third year of high school (ages 15-16). Additionally, cohort members who reported having attained no secondary school qualifications by age 21 were classified as having left school without qualifications. Statistical Analyses The bivariate bi·var·i·ate adj. Mathematics Having two variables: bivariate binomial distribution. Adj. 1. associations between the three categories of pregnancy and abortion history and the outcomes were modeled by fitting a series of regression regression, in psychology: see defense mechanism. regression In statistics, a process for determining a line or curve that best represents the general trend of a data set. models to the observed data. For continuous outcomes, least squares regression models were fitted. * For dichotomous outcomes, logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. models were fitted. ([dagger]) In each case, the parameters of the fitted model were used to derive tests of significance of the overall association of pregnancy history with each outcome and pairwise comparisons between groups. * A similar procedure was used to examine the associations between covariates and the measure of pregnancy and abortion status. To adjust the observed associations for confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor , the regression models were extended to include the covariate factors. ([dagger]) In fitting these models, both forward and backward methods of covariate selection were used to identify the best fitting and most parsimonious par·si·mo·ni·ous adj. Excessively sparing or frugal. par si·mo model representation for each outcome. From the parameters of the final
fitted model for each outcome, we constructed tests of the adjusted
association with pregnancy and abortion status, as well as tests of
pairwise differences between groups. Estimates of the adjusted means or
percentages for each outcome were obtained using the methods described
by Lee. (27)
Finally, as noted above, the complicated pregnancy history of a number of cohort members led to some classification issues. To examine the sensitivity of the analysis to the way in which the woman's pregnancy and abortion history had been classified, we reanalyzed the data, using two alternative classification approaches. In one, we based the classification on the woman's first pregnancy only; in the other, we used pregnancy without abortion and pregnancy with abortion as correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. dichotomous predictor variables Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression) variable quantity, variable - a quantity that can assume any of a set of values to take into account the possible overlap between abortion and pregnancy without abortion. All analyses were then repeated excluding the 11 women whose only pregnancy had resulted in miscarriage. RESULTS Bivariate Analyses * Outcome measures. For all outcomes, women who had had a pregnancy and had not sought an abortion fared significantly less well than those who had not had a pregnancy (Table 1). Furthermore, in six out of the 10 comparisons, women who had had an abortion had significantly advantaged outcomes when compared with those who had had a pregnancy but not an abortion: They were significantly more likely to have attended university, to have gained a university degree and to have gained a tertiary qualification other than a university degree, and were less likely to have been welfare-dependent. They also had significantly higher mean personal income and experienced a significantly lower mean level of partner violence than those who had become pregnant but not sought an abortion. Finally, the bivariate analyses revealed that in seven out of the 10 comparisons, those who had had an abortion had outcomes that were not significantly different from outcomes among those who had had no pregnancy by age 21. The two groups were similar with respect to all education outcomes, mean family income and both partnership measures. * Covariates. Relative to women who either had had an abortion or had not become pregnant by age 21, those who had been pregnant but not sought an abortion tended to come from educationally and economically disadvantaged This article or section may contain original research or unverified claims. Please help Wikipedia by adding references. See the for details. This article has been tagged since September 2007. backgrounds (Table 2, page 10). They had significantly lower intelligence scores and levels of educational achievement in childhood, and were significantly more likely to leave school without educational qualifications. Adjusted Analyses After adjustment for background factors, women who had had an abortion did not differ from others who had become pregnant in eight of the 10 comparisons (Table 3, page 10). However, the proportion of women with tertiary qualification attainment was 1.7 times as high among those who had had an abortion before age 21 as among those who had been pregnant but had not sought an abortion (95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. , 1.1-2.6), and the proportion who attained a university degree was 2.8 times as high among the former as among the latter (95% confidence interval, 1.2-6.3). In addition, women who had had no pregnancy by age 21 were less likely than women who had had a pregnancy, regardless of its outcome, to have any period of welfare dependency between ages 21 and 25, and were more likely to be employed full-time at age 25. Supplementary Analyses The results of the analyses using the two alternative classifications of women's pregnancy and abortion status prior to age 21 were generally consistent with the findings from the main analyses. First, in all bivariate analyses, associations between the pregnancy and abortion classification and all outcomes were statistically significant (p<.01). Women who had been pregnant and not had an abortion had consistently poorer outcomes (reduced educational achievement, lower income, higher welfare dependence, poorer partner relationships) than those who had had an abortion; women who had not been pregnant had better outcomes than either of the other groups. Second, in all analyses, adjustment for confounding factors showed that most of the differences between women who had had an abortion and others who had become pregnant were explained by the covariates. However, even after adjustment, all analyses produced evidence of significant or marginally significant tendencies for women who had had an abortion to have better educational outcomes than those who had had a pregnancy but not an abortion. Analyses using both alternative classification approaches showed significantly higher levels of degree attainment among those having abortions (p [less than or equal to] .05). In addition, the analysis using the two dichotomous variables showed that compared with women who had had a pregnancy but not an abortion, those who had had an abortion were marginally more likely to have gained any tertiary qualification (p<.10) and had a significantly higher rate of partner violence (p<.05). Third, in all analyses, after covariate adjustment, women who had had an abortion had a significantly higher rate of welfare dependence and a lower rate of full-time employment than those who had never been pregnant (p<.01). Finally, consistent with the findings in Table 3, in all analyses, the adjusted results showed that in comparison with those who had never been pregnant, those who had become pregnant but had not had an abortion had a significantly lower income (p<.001), a higher rate of welfare dependence (p<.01), less involvement in full-time employment (p<.01), a lower level of degree attainment (p<.05) and a lower level of tertiary qualification (p<.05). In addition, the analyses based on the classification using the dichotomous variables suggested a significant tendency for pregnancy without abortion to be associated with a higher rate of exposure to partner violence (p<.01). DISCUSSION Previous research has suggested that the major reasons that young women seek abortion is to reduce the perceived effects of an unwanted or mistimed pregnancy on life course plans. (1-4) In this article, we have used data gathered in a 25-year longitudinal study to explore the extent to which abortion prior to the age of 21 mitigated the educational, economic and social disadvantages that have been associated with early pregnancy early pregnancy Obstetrics First trimester of pregnancy . This analysis showed that compared with women who had become pregnant but had not had an abortion, prior to adjustment for confounding factors, those who had had an abortion had relatively advantaged outcomes on most measures of educational achievement, income, avoidance of welfare dependence and partnership relationships. At first sight, these findings may suggest benefits of abortion. However, subsequent analyses suggested that the differences were largely explained by the fact that those who had sought abortion were a more socially and educationally advantaged group prior to pregnancy. When due allowance was made for prepregnancy factors, only the educational differences between pregnant women seeking and not seeking abortion remained statistically significant. Furthermore, educational outcomes were similar among those who had had an abortion and those who had not become pregnant. These results were confirmed in a series of analyses using different approaches to classifying pregnancy and abortion history. Our results clearly suggest that having an abortion mitigated the educational disadvantage associated with early pregnancy. These results are consistent with previous findings suggesting that abortion among young women may protect their educational opportunities. (13,14) For the women in our sample, perhaps the choice to have an abortion allowed greater freedom to pursue educational goals. At the same time, similar advantages did not extend to the areas of income, welfare dependence and partnership outcomes. These conclusions should be considered in the light of a number of limitations of our research. First and foremost, our study was based on a birth cohort studied in a specific social context, in which particular procedures must be followed before women may obtain a legal abortion. Thus, our findings may be specific to the New Zealand context and the legal requirements that regulate access to abortion in New Zealand Abortion in New Zealand is currently legal in cases where the woman faces a danger to her life, physical health, or mental health, or if there is a risk of the fetus being handicapped, in the event of the continuation of her pregnancy. . Second, the statistical precision of the comparisons between those who had had an abortion before age 21 and those who had had a pregnancy but not an abortion are limited because they were based on relatively small numbers of women. The study of larger groups might reveal further advantages associated with abortion. A third limitation concerns the measures of personal and family income. In this study, family income was calculated for individuals living with a spouse spouse A legal marriage partner as defined by state law or intimate partner by summing the individual's personal income and the spouse's or partner's income. For all other individuals, the measures of personal and family income were equivalent. A number of participants lived with parents or other family members, and may therefore have had greater financial resources than these measures of income might have indicated. Finally, although we have taken into account a range of covariates, the possibility that the results are further confounded by nonobserved factors (including ones related to the process of obtaining an abortion) should not be overlooked. The validity of any causal causal /cau·sal/ (kaw´z'l) pertaining to, involving, or indicating a cause. causal relating to or emanating from cause. conclusions drawn regarding the relationship between abortion and educational outcomes may be affected by the existence of confounding or selection factors that have been omitted from the analyses. Debates about the advantages and liabilities of abortion have been dominated by the rhetoric and political ideologies of those holding prolife and prochoice positions. Those holding prolife positions have tended to depict de·pict tr.v. de·pict·ed, de·pict·ing, de·picts 1. To represent in a picture or sculpture. 2. To represent in words; describe. See Synonyms at represent. abortion as having few advantages and many disadvantages, (28) whereas those holding prochoice positions have promoted the opposite view. (29) Our findings from this study and related work lead to conclusions that fall between these extremes. In a previous article, we showed that exposure to abortion was associated with a moderate increase in risks of subsequent mental health problems even when due allowance was made for confounding factors. (30) The present analysis suggests that abortion may mitigate mit·i·gate v. To moderate in force or intensity. mit i·ga tion n. some of the
educational disadvantages that have been linked to early pregnancy, but
that similar benefits are not evident for economic or partnership
outcomes. The discrepancies between these findings and the rhetoric of
both prolife and prochoice arguments strongly underline underlinean animal's ventral profile; the shape of the belly when viewed from the side, e.g. pendulous, pot-belly, tucked up, gaunt. the need for further research into the risks and benefits associated with abortion as a means of addressing the issues raised by unwanted or mistimed pregnancies. In general, there is a clear need for further study of the social, educational and related outcomes of the decision to terminate a pregnancy so that women may be properly informed of the potential consequences of this decision for their life course. Acknowledgments The research on which this article is based was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation, the Canterbury Medical Research Foundation and the New Zealand Lottery Grants Board The New Zealand Lottery Grants Board is a state sector organisation in New Zealand. The New Zealand Lottery Grants Board is governed by the Gambling Act 2003. Its purpose is to benefit the community by distributing the profits from state lotteries run by the New Zealand . REFERENCES (1.) Broen AN et al., Reasons for induced abortion in·duced abortion n. Abortion caused intentionally by the administration of drugs or by mechanical means. induced abortion and their relation to women's emotional distress emotional distress n. an increasingly popular basis for a claim of damages in lawsuits for injury due to the negligence or intentional acts of another. Originally damages for emotional distress were only awardable in conjunction with damages for actual physical harm. : a prospective, two-year follow-up follow-up, n the process of monitoring the progress of a patient after a period of active treatment. follow-up subsequent. follow-up plan study, General Hospital Psychiatry psychiatry (səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. , 2005, 27(1):36-43. (2.) Finer LB et al., Reasons U.5. women have abortions: quantitative and qualitative perspectives, Perspectives on Sexual and Reproductive Health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene , 2005, 37(3):110-118. (3.) Torres A and Forrest JD, Why do women have abortions? Family Planning family planning Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. Perspectives, 1988, 20(4):169-176. (4.) Sihvo S et al., Women's life cycle and abortion decision in unintended pregnancies, Journal of Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause and Community Health, 2003, 57(8):601-605. (5.) Hofferth SL, Reid L and Mott FL, The effects of early childbearing child·bear·ing n. Pregnancy and parturition. child bear ing adj. on schooling over time, Family Planning Perspectives, 2001,
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(6.) Klepinger DH, Lundberg S and Plotnick RD, Adolescent fertility fertility: see infertility. fertility Ability of an individual or couple to reproduce through normal sexual activity. About 80% of healthy, fertile women are able to conceive within one year if they have intercourse regularly without contraception. and the educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.[1] The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the of young women, Family Planning Perspectives, 1995, 27(1):23-28. (7.) Black C and DeBlassie RR, Adolescent pregnancy adolescent pregnancy See Teenage pregnancy. : contributing factors, consequences, treatment, and plausible solutions, Adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. , 1985, 20(78):281-290. (8.) Moore KA et al., Age at first childbirth childbirth: see birth. Childbirth Childlessness (See BARRENNESS.) Artemis (Rom. Diana) goddess of childbirth. [Gk. Myth. and later poverty, Journal of Research on Adolescence, 1993, 3(4):393-422. (9.) Grindstaff CF, Adolescent marriage and childbearing: the long-term economic outcome, Canada in the 1980s, Adolescence, 1988, 23(89):45-58. (10.) Moffitt TE and Team E-RS, Teen-aged mothers in contemporary Britain, Journal of Child Psychology and Psychiatry, 2002, 43(6): 727-742. (11.) Hobcraft J and Kiernan K, Childhood poverty, early motherhood and adult social exclusion social exclusion Noun Sociol the failure of society to provide certain people with those rights normally available to its members, such as employment, health care, education, etc. , British journal of Sociology, 2001, 52(3):495-517. (12.) Harrykissoon SD, Rickert VI and Wiemann CM, Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period The postpartum period is the period consisting of the months or weeks immediately after childbirth or delivery. Importance to health The postpartum period is when the woman adjusts, both physically and psychologically, to the process of childbearing. , Archives of Pediatrics pediatrics (pēdēă`trĭks), branch of medicine dedicated to the attainment of the best physical, emotional, and social health for infants, children, and young people generally. & Adolescent Medicine adolescent medicine n. The branch of medicine concerned with the treatment of youth between 13 and 21 years of age. Also called ephebiatrics, hebiatrics. , 2002, 156(4):325-330. (13.) Zabin LS, Hirsch MB and Emerson MR, When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy, Family Planning Perspectives, 1989, 21(6):248-255. (14.) Bailey PE et al., Adolescent pregnancy 1 year later: the effects of abortion vs. motherhood in Northeast Brazil, Journal of Adolescent Health, 2001, 29(3):223-232. (15.) Ministry of Health, Considering an Abortion? What Are Your Options? Wellington, New Zealand: Ministry of Health, 1998. (16.) Abortion Supervisory Committee, Report of the Abortion Supervisory Committee for 2002, Wellington, New Zealand: Abortion Supervisory Committee, 2002. (17.) Straus MA et al., The Revised Conflict Tactics Scales (CTS (1) (Clear To Send) The RS-232 signal sent from the receiving station to the transmitting station that indicates it is ready to accept data. Contrast with RTS. (2) (Common Type System) The data typing used in . 2): development and preliminary psychometric psy·cho·met·rics n. (used with a sing. verb) The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and data, Journal of Family Issues, 1996, 17(3):283-316. (18.) Fergusson DM, Horwood LJ and Ridder E, Partner violence and mental health outcomes in a New Zealand birth cohort, Journal of Marriage and Family, 2005, 67(5):1103-1119. (19.) Braiker H and Kelley H, Conflict in the development of close relationships, in: Burgess BURGESS. A magistrate of a borough; generally, the chief officer of the corporation, who performs, within the borough, the same kind of duties which a mayor does in a city. In England, the word is sometimes applied to all the inhabitants of a borough, who are called burgesses sometimes it R and Huston T, eds., Social Exchange and Developing Relationships, New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Academic Press, 1979, pp. 127-154. (20.) Elley WB and Irving JC, Revised socio-economic index for New Zealand, New Zealand Journal of Educational Studies, 1976, 11(1):25-36. (21.) Rutter M, Tizard J and Whitmore K, Education, Health and Behaviour, London: Longmans, 1970. (22.) Conners CK, A teacher rating scale for use in drug studies with children, American Journal of Psychiatry The American Journal of Psychiatry (AJP) is the most widely read psychiatric journal in the world. It covers topics on biological psychiatry, treatment innovations, forensic, ethical, economic, and social issues. , 1969, 126(6):884-888. (23.) Conners CK, Symptom symptom /symp·tom/ (simp´tom) any subjective evidence of disease or of a patient's condition, i.e., such evidence as perceived by the patient; a change in a patient's condition indicative of some bodily or mental state. patterns in hyperkinetic hyperkinetic pertaining to or marked by hyperkinesia. hyperkinetic episodes see Scottie cramp. hyperkinetic circulatory disorders , neurotic neurotic /neu·rot·ic/ (ndbobr-rot´ik) 1. pertaining to or characterized by a neurosis. 2. a person affected with a neurosis. neu·rot·ic adj. and normal children, Child Development, 1970, 41(3):667-682. (24.) Fergusson DM, Horwood LJ and Ridder E, Show me the child at seven: the consequences of conduct problems in childhood for psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects. psy·cho·so·cial adj. Involving aspects of both social and psychological behavior. functioning in adulthood, Journal of Child Psychology & Psychiatry, 2005, 46(8):837-849. (25.) Wechsler D, Manual for the Wechsler Intelligence Scale for Children--Revised, New York: Psychological Corp., 1974. (26.) Reid NA et al., Test of Scholastic Abilities, Wellington, New Zealand: New Zealand Council for Educational Research, 1981. (27.) Lee J, Covariance Covariance A measure of the degree to which returns on two risky assets move in tandem. A positive covariance means that asset returns move together. A negative covariance means returns vary inversely. adjustment of rates based on the multiple logistic regression model, Journal of Chronic Diseases, 1981, 34(8):415-426. (28.) Agee MC, The Health Risks of Abortion, Chicago: Family Research Council, 2003, <http://www.frc.org/get.cfm?i=WA03H45# WA03H45>, accessed Feb. 8, 2006. (29.) Planned Parenthood Planned Parenthood A service mark used for an organization that provides family planning services. Federation of America, Abortion, 2006, <http://www.plannedparenthood.org/pp2/portal/medicalinfo/ abortion>, accessed Feb. 1, 2006. (30.) Fergusson DM, Horwood LJ and Ridder E, Abortion in young women and subsequent mental health, Journal of Child Psychology & Psychiatry, 2006, 47(1):16-24. * These models were of the form [Y.sub.i]=[B.sub.0] + [B.sub.1][X.sub.1i] + [B.sub.2][X.sub.2i] + [U.sub.i], where [Y.sub.i] was the outcome for the ith participant; [X.sub.1] and [X.sub.2] were design variates representing pregnancy with abortion and pregnancy without abortion, respectively, compared with never being pregnant; and [U.sub.i] was a disturbance DISTURBANCE, torts. A wrong done to an incorporeal hereditament, by hindering or disquieting the owner in the enjoyment of it. Finch. L. 187; 3 Bl. Com. 235; 1 Swift's Dig. 522; Com. Dig. Action upon the case for a disturbance, Pleader, 3 I 6; 1 Serg. & Rawle, 298. term. ([dagger]) These models were of the form logit ([Y.sub.i])=[B.sub.0] + [B.sub.1][X.sub.1i] + [B.sub.2][X.sub.2i], where logit ([Y.sub.i]) was the log odds of the outcome Y for the ith participant, and [X.sub.i] and [X.sub.2] were design variates. * Specifically, a Wald test The Wald test is a statistical test, typically used to test whether an effect exists or not. In other words, it tests whether an independent variable has a statistically significant relationship with a dependent variable. of the joint hypothesis that [B.sub.1]=[B.sub.2]=0 led to a chi-square test chi-square test: see statistics. of significance (with 2 degrees of freedom) of the overall association between pregnancy history and the outcome. Similarly, the test of significance on the parameter (1) Any value passed to a program by the user or by another program in order to customize the program for a particular purpose. A parameter may be anything; for example, a file name, a coordinate, a range of values, a money amount or a code of some kind. [B.sub.1] provided a test of the pairwise difference between those who had had an abortion and those who had never been pregnant, the test on the parameter [B.sub.2] provided a test of the pairwise comparison between those who had been pregnant but had not sought an abortion and those who had never been pregnant, and the difference between the parameters [B.sub.1] and [B.sub.2] provided a test of the pairwise comparison between women who had had an abortion and other women who had had a pregnancy. ([dagger]) For continuous outcomes, these models were of the general form [Y.sub.i]=[B.sub.0] + [B.sub.1][X.sub.1i] + [B.sub.2][X.sub.2i] + [summation summation n. the final argument of an attorney at the close of a trial in which he/she attempts to convince the judge and/or jury of the virtues of the client's case. (See: closing argument) ][B.sub.j][Z.sub.ji] + [U.sub.i]; for dichotomous outcomes, logit ([Y.sub.i])=[B.sub.0] + [B.sub.1][X.sub.1i] + [B.sub.2][X.sub.2i] + [summation][B.sub.j][Z.sub.ji], where [Z.sub.j] were the covariate factors. David M. Fergusson is professor and executive director, Joseph M. Boden is a research fellow and L. John Horwood a senior research fellow, all with the Christchurch Health and Development Study, Christchurch, New Zealand. Author contact: david.fergusson@chmeds.ac.nz
TABLE 1. Bivariate associations between women's pregnancy and abortion
history prior to age 21 and social and economic measures at ages 21-25,
Christchurch Health and Development Study, New Zealand
Measure Abortion Pregnancy but
(N=48) no abortion
(N=77)
Education, ages 21-25
% who attended university 29.2 11.7 ([dagger]),
([double dagger])
% who gained university degree 18.8 3.9 ([dagger]),
([double dagger])
% who enrolled in tertiary
study 50.0 39.0 ([dagger])
% who gained tertiary 41.7 22.1 ([dagger]),
qualification ([double dagger])
Economic
Mean personal income, age 25 24.2 ([dagger]) 17.7 ([dagger]),
(000s of NZ$; range, 0-120) (13.7) ([double dagger])
(15.2)
Mean family income, age 25
(000s of NZ$; range, 43.6 (29.3) 35.9 ([dagger])
2.1-150) (24.10)
% ever welfare-dependent, 54.2 ([dagger]) 68.8 ([dagger]),
ages 21-25 ([double dagger])
% employed full-time, age 25 41.71 ([dagger]) 30.0 ([dagger])
Partnership ([section])
Mean exposure to partner 2.0 (2.7) 3.2 ([dagger]),
violence, age 24-25 ([double dagger])
(range, 0-21) (3.6)
Mean dissatisfaction with
partnership, age 25
(range, 10-29) 13.6 14.4 ([dagger])
Measure No pregnancy [chi square]
(N=367)
Education, ages 21-25
% who attended university 39.6 18.61 ***
% who gained university degree 31.3 19.54 ***
% who enrolled in tertiary
study 57.8 21.33 ***
% who gained tertiary
qualification 52.0 9.20 *
Economic
Mean personal income, age 25
(000s of NZ$; range, 0-120) 31.7 (19.2) 20.63 ***
Mean family income, age 25
(000s of NZ$; range,
2.1-150) 53.1 (34.0) 8.31 **
% ever welfare-dependent,
ages 21-25 25.1 55.88 ***
% employed full-time, age 25 73.6 56.95 ***
Partnership ([section])
Mean exposure to partner
violence, age 24-25
(range, 0-21) 1.8 (2.5) 11.38 ***
Mean dissatisfaction with
partnership, age 25
(range, 10-29) 12.5 (3.2) 7.80 **
* p < .05. ** p < .01. *** p < .001. ([dagger]) Significantly
different from the figure for no pregnancy at p < .05.
([double dagger]) Significantly different from the figure for
abortion at p<05. ([section]) Based on participants who reported an
intimate partner relationship at ages 24-25 (42 women who had had an
abortion, 69 who had had a pregnancy but no abortion, and 307 who
had had no pregnancy). Note. Figures in parentheses are standard
deviations.
TABLE 2. Bivariate associations between pregnancy and abortion history
prior to age 21 and measures of family background and childhood
behavior and educational achievement
Measure Abortion Pregnancy
but no
abortion
Family background
% whose mother
lacked formal
educational 74.4 ([dagger]),
qualifications 52.0 ([double dagger])
% whose father
lacked formal
educational
qualifications 54.3 61.6
Mean family living
standard,
ages 1-10 (range, 3.2 ([dagger]),
1-5) ([section]) 2.9 (0.5) ([double dagger]) (0.4)
Mean socioeconomic
status category
at birth (range, 4.3 ([dagger]), ([double
1-6) ([section]) 3.7 (1.6) dagger]) (1.3)
Childhood behavior/educational achievement
Mean conduct
problems score,
ages 7-9 50.1 ([dagger])
(range, 41-83) (7.0) 51.8 ([dagger]) (8.4)
Mean IQ score, 97.7 ([dagger]), ([double
ages 8-9 102.8 (15.2) dagger]) (16.1)
Mean TOSCA ([dagger])
([dagger]) score,
age 13 31.3 ([dagger]), ([double
(range, 0-69) 36.2 (13.9) dagger]) (15.8)
Mean GPA, ages
11-13 (range,
1-5) ([section]) 2.4 (0.8) 2.6 ([dagger]) (0.8)
Mean no. of
school problems
reported, age 0.4 ([dagger])
15 (range, 0-4) (0.8) 0.4 ([dagger]) (0.8)
Mean no. of School
Certificate ([double
dagger])([double
dagger]) passing 2.6 ([dagger]) 1.8 ([dagger]), ([double
grades (range, 0-7) (2.3) dagger]) (2.1)
% who left school
without 44.9 ([dagger]), ([double
qualifications 28.0 ([dagger]) dagger])
Measure No [chi-square]
pregnancy
Family background
% whose mother
lacked formal
educational
qualifications 43.7 22.45 ***
% whose father
lacked formal
educational
qualifications 45.5 6.85 *
Mean family living
standard,
ages 1-10 (range,
1-5) ([section]) 2.8 (0.4) 8.97 **
Mean socioeconomic
status category
at birth (range,
1-6) ([section]) 3.3 (1.4) 7.06 **
Childhood behavior/educational achievement
Mean conduct
problems score,
ages 7-9
(range, 41-83) 47.1 (5.0) 18.92 ***
Mean IQ score, 104.2 (15.6) 4.13 *
ages 8-9
Mean TOSCA ([dagger])
([dagger]) score,
age 13 38.0 (14.2) 4.22 *
(range, 0-69)
Mean GPA, ages
11-13 (range, 2.2 (0.8) 8.02 **
1-5) ([section])
Mean no. of
school problems
reported, age 0.1 (0.5) 8.45 **
15 (range, 0-4)
Mean no. of School
Certificate ([double
dagger])([double
dagger]) passing 4.0 (2.0) 36.07 ***
grades (range, 0-7)
% who left school
without 6.1 67.67 ***
qualifications
* p < .05. ** p < .01. *** p < .001. ([dagger]) Significantly
different from the figure for no pregnancy at p<.05.
([double dagger]) Significantly different from the figure for
abortion at p < 05. ([section]) Lower means correspond to more
positive outcomes. ([dagger])([dagger]) Test of Scholastic Abilities.
([double dagger]) ([double dagger]) School Certificate is a national
series of examinations usually taken in the third year of high
school. Note. Figures in parentheses are standard deviations.
TABLE 3. Adjusted associations between pregnancy and abortion history
prior to age 21 and social and economic measures at ages 21-25
Measure Abortion Pregnancy but
no abortion
Education, ages 21-25
% who attended university 36.2 22.0
% who gained university 9.7 ([dagger]),
degree 26.7 ([double dagger])
% who enrolled in tertiary
study 57.7 64.4
% who gained tertiary 30.4 ([dagger]),
qualification 51.4 ([double dagger])
Economic
Mean personal income, age 25
(000s of NZ$) 25.5 21.9 ([dagger])
Mean family income, age 25
(000s of NZ$) 44.3 38.8 ([dagger])
% ever welfare-dependent,
ages 21-25 52.3 ([dagger]) 57.4 ([dagger])
% employed full-time, age 25 44.2 ([dagger]) 35.9
Partnership ([section])
Mean exposure to partner
violence, age 24-25 1.8 2.6
Mean dissatisfaction with
partnership, age 25 13.3 13.4
Measure No [chi square]
pregnancy
Education, ages 21-25
% who attended university 36.0 4.36
% who gained university
degree 27.3 5.48
% who enrolled in tertiary
study 55.3 2.10
% who gained tertiary
qualification 49.7 7.65 *
Economic
Mean personal income, age 25
(000s of NZ$) 30.8 9.64 **
Mean family income, age 25
(000s of NZ$) 52.8 6.05 *
% ever welfare-dependent,
ages 21-25 28.0 26.97 ***
% employed full-time, age 25 72.9 36.21 ***
Partnership ([section])
Mean exposure to partner
violence, age 24-25 1.9 0.70
Mean dissatisfaction with
partnership, age 25 12.7 1.59
* p < .05. ** p < .01. *** p<.001. ([dagger]) Significantly
different from the figure for no pregnancy at p<.05.
([double dagger]) Significantly different from the figure for
abortion at p < .05. ([section]) Based on participants who reported
an intimate partner relationship at ages 24-25 (42 women who had
had an abortion, 69 who had had a pregnancy but no abortion, and 307
who had had no pregnancy). Note: Analyses are adjusted for all
measures shown in Table 2.
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