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Parental consent: factors influencing adolescent disclosure regarding abortion.

INTRODUCTION

Little information exists about the decision-making processes of pregnant adolescents. In the present legal climate where some states are mandating parental permission prior to teenage abortions, little is known about the nature and effect of parental participation in that process. This study is an attempt to investigate factors related to an adolescent's choice to involve parents in the decision to terminate a pregnancy.

In 1988 the Centers for Disease Control (CDC Surveillance Surveys, 1990) reported that there were 1,371,285 abortions in the United States, 25% of which were obtained by women under the age of 19. Researchers at the National Center for Health Statistics estimated that of the 1.1 million pregnancies among teenagers in 1981, 40% ended in abortion, 13% in miscarriage, and 47% in live births (Senderowitz & Paxmon, 1985).

Since 1977 numerous pieces of legislation have been introduced at the local, state, and national levels to restrict abortion services. Issues such as informed consent, waiting periods, parental notification, and regulations relating to methods of abortion and abortion facilities have been debated (Hatcher et al., 1982). The need for parental consent and/or notification is now being disputed around the world. In the United States, 44% of all abortion facilities require parental consent or notification for patients aged 15 or under, while 30% have such requirements up to age 18 (Smith & Mumford, 1985). Many states are now in the process of looking at this important issue and changing their regulations. The legal debate centers around such issues as a minor's maturity level in making adequate judgments, violation of parental responsibilities, and the preservation of the family as a social unit (Smith & Mumford, 1985).

A review of recent interdisciplinary literature reveals that the majority of health professionals believe that the mandate of parental consent forces teenagers to delay abortion decisions to a point which might increase health risks (Hayes, 1987; Silber, 1987; Thompson, 1989; Torres & Forrest, 1988; Yates, 1988). Medical experts agree that late abortions are more traumatic because the procedures are more complicated and are associated with higher morbidity (Smith & Mumford, 1985).

There is no conclusive body of evidence that suggests that abortion has negative effects on adolescents, whether they tell their parents or not. There is little disagreement among researchers regarding minimal physiological complications following adolescent abortions (Smith & Mumford, 1985; Hatcher et al., 1982). Although there is greater disagreement regarding psychological sequelae, the research which identifies negative reactions such as depression and disorganization does not entail large numbers (Belensky, 1978; Spaulding & Cavenau, 1978). A larger body of objective data reveals a surprisingly low incidence of psychological complications (Osofsky & Osofsky, 1972). Emotional adjustment prior to the abortion has been found to be most relevant (Martin, 1973; Moseley et al., 1981). A recent review of studies by Adler et al. (1990) concluded that women show little evidence of psychopathology after abortion. It was noted, however, that the majority of these studies were short-term, revealing little about the long-term effects of abortion.

Melton (1987) suggests that parental consent laws cause unnecessary embarrassment and anxiety among teenagers and foment family conflict. Battle and Battle (1987), in a study involving black women, note that these laws encourage conflict between adolescents and their mothers, who may view teenage parenthood as a more appropriate option in dealing with pregnancy. Gruber and Anderson (1990) question whether mandatory parental involvement will improve family communication, and Lewis (1979) states that "the data suggest that mandatory parental consultation probably would not promote more harmonious relations." On the other hand, Worthington, Larson, Brubaker, and Colecchi (1989) support the position that parents have a responsibility and right to contribute to decisions regarding abortion; however, they do not mention the potential cost to the adolescent.

Several investigations have examined the choices made by women concerning the resolution of their pregnancy. These studies have significant bearing on the parental consent issue. Lewis (1979, 1980, 1987) compared adults and minors and noted developmental changes in the decision-making process. According to Lewis (1980), younger adolescents may be more caught up in the fantasy aspects of pregnancy and less likely to consider the financial and emotional commitments of motherhood, as well as a host of other related responsibilities. He found that young adolescents appeared to be externally motivated and were more concerned about the effects of their decisions on parents and other family members. Older subjects were more likely to consult an outside professional for advice and to be more concerned about the economics of their pregnancy and its effect on their own lives (Lewis, 1980).

In a phenomenological study, Keairns (1980) interviewed six unmarried women, ages 16-26, finding that they had been very ambivalent about ending their pregnancy. First, they postponed admitting the fact of their pregnancy as long as possible. Second, they attempted to keep the pregnancy and its resolution hidden from significant others who they believed would disapprove. Third, they wanted to forget that they had been pregnant and that they had ended the pregnancy by abortion.

In studies by Olson (1980) and Eisen, Zellman, Teibowitz, Chow, and Evans (1983), the power of modeling was noted. Young women who knew others who had aborted were more likely to choose abortion for themselves, and those who knew others who had carried to term were more likely to follow that course of action.

There has been little research on how abortion decisions are made. In a study by Eisen et al. (1983), discrepancies in behavior and attitudes were found. Adolescents aged 13 to 19 were interviewed in a free clinic in California, and of this group 15% chose to marry and have the child, 23% carried to term but did not marry, 62% aborted, and 1% chose adoption. Among those who reported strongly disagreeing with the practice of abortion prior to decision-making, one third still chose to resolve their pregnancy by having an abortion. In cases where this discrepancy was noted, two significant others, the adolescent's mother and the prospective father, had favored abortion (Eisen et al., 1983).

Eisen et al. (1983) believe that many teenagers may not yet be able to think abstractly in regard to decision making, particularly when the decision concerns their own sexuality. The role of formal operational cognitive skills in making decisions with respect to sexuality and pregnancy is largely unknown.

Parents, of course, are mentioned in most literature on adolescent pregnancy and its resolution. Investigations by Planned Parenthood in Massachusetts and Rhode Island revealed that adolescents involved parents in pregnancy resolution only 33-40% of the time (Donovan, 1983). In another study (Moseley et al., 1981), parents were found to exert considerable influence on the emotional outcome of an abortion; greater opposition from parents correlated with increased postabortion hostility and greater perceived distance from parents.

In a comprehensive examination of the psychological problems of 52 teenagers following abortion, Martin (1973) found no differences in the teenagers' postabortion adjustment regardless of whether parents knew or did not know about their daughter's pregnancy. How the parents responded to the pregnancy did, however, have emotional consequences for the teenager. Of the girls who had difficulty adjusting, none had parents who demonstrated understanding. Sixty-five percent of the girls felt that their relationship with parents prior to the abortion was poor. Those who had a poor relationship with their mothers had a more difficult adjustment.

Several studies (Hibbs, 1983; Rosen, 1980; Sweeney, 1981) relate primarily to parents' involvement in pregnancy decision making. Hibbs (1983) found that the parents of adolescents who chose to carry their pregnancy to term had a different kind of relationship with their daughters than did parents of adolescents who chose to have an abortion. Hibbs reported that parents of the former tended to be more possessive and in control of their daughters, whereas the latter tended to be more accepting of their daughters' individuation and autonomy. Hibbs concluded that parents of adolescents who carried their pregnancy to term were characterized by more extreme fluctuations between intimacy and withdrawal.

In a study by Rosen (1980), questionnaires were administered to pregnant adolescents prior to abortion or delivery, with the findings discussed as they related to four scales: (1) how much conflict the women had in making their decisions, (2) their perceptions of their own competence, (3) attitudes toward traditional female roles, and (4) attitudes toward modern or feminist roles. Rosen found that when respondents first thought they might be pregnant but were not sure, few sought advice from parents. Once they were sure they were pregnant, close to half made decisions without involving parents. Those who did confide in parents reported that mothers most influenced their decision making. Mothers were more influential for white adolescents who planned adoption and for black adolescents who planned to seek an abortion. The only other consistent source of advice reported, especially by white adolescents, was the male partner. Traditionally oriented adolescents were no more or less likely to seek support from mothers than were adolescents who described themselves as feminists.

Despite the current emphasis on parental advice in abortion decisions, few studies relate solely to adolescents who have chosen abortion, or examine family communication patterns during this process. No previous attempt has been made to distinguish adolescents who will or will not confide in parents. Yet these questions are paramount in legal debates facing U.S. courts. Thus, the present study is an attempt to obtain information regarding parental involvement in abortion decisions among adolescents.

METHOD

Clients from five private abortion clinics in the metropolitan Atlanta area, representing women from a wide range of socioeconomic backgrounds, were selected for this study. Two of the clinics served low to middle socioeconomic status (SES) clients, while three were located in areas serving middle to upper SES groups.

For a period of three months, clients aged 21 and under who sought an abortion in these clinics were asked to respond to a questionnaire designed to gather information regarding the support networks they utilized during their pregnancy crisis. A total of 439 clients responded to the survey. There were no refusals.

The survey instrument consisted of 23 questions and was designed to take no more than 10 minutes to complete. The first 8 questions pertained to demographic information and the remaining 15 consisted of substantive questions regarding level of independence, support networks, and quality of communication with significant others. Two examples of questions are: "Do you think communication in your family is open, closed, or open for certain subjects?" "With whom in your family--no one, both parents, mother only, father only, sister, brother, other (aunt, uncle, etc.)--do you feel free to talk about sex and birth control?" Only one of the questions (asking why they did or did not tell their parents about the abortion) was open ended, requiring a written statement. Eighty-four of the 439 respondents did not answer this question.

It was hypothesized that the greater the degree of perceived independence from parental influence, the less likely was the young woman to seek parental advice. Five variables (age, marital status, living arrangements, employment status, and maturity) were used as indicators of perceived independence.

A second hypothesis was that respondents would be more likely to elicit aid from parents when making decisions about abortion if they saw their families as being open to communication and felt free to talk about sex and birth control. Two variables were considered: general family communication and family communication regarding sexuality.

Respondents were divided into two groups based on their response to the question: "Did you tell your parents about your pregnancy?" Those who told their parents (either one or both parents) and those who did not tell either parent were then compared on the seven variables noted above.

RESULTS

Of the 439 clients interviewed, 51% confided in their parents and 49% did not. Eighty percent of the females surveyed (62% white, 38% black) reported this to be their first abortion experience. Participants ranged in age from 12 to 21; the majority were 17 years old. Most came from intact families (46%); 35% were from families of divorce or remarriage and 10% from single-parent households. Sixty-eight percent reported their religion to be Baptist, while 12% reported being Methodist, 6% Catholic, and 12% other religions.

The first question examined was whether the two groups--those who did not tell their parents and those who did tell their parents about the abortion--differed on the five variables believed to be related to independence. A nondirectional t test conducted on the age variable was significant (t = 4.95, df = 441, p |is less than~ .001), suggesting a distinct difference in the ages of the two groups. Those who confided in their parents tended to be younger (mean age of 17) than those who did not (mean age of 18).

The two groups were compared across five categories of job status (no job, part-time, half-time, full-time, and full support of family). The results of the chi-square test were significant (||chi~.sup.2~ = 33.77, df = 4, p |is less than~ .001). Nonconfiders demonstrated more financial independence due to increased hours of work. Confiders demonstrated less financial independence due to no job (62%) or part-time jobs.

Similar results were obtained on the living arrangements variable, which was compared across seven categories (living with both parents, mother only, father only, husband, own apartment, apartment with partner, apartment with others). The results of the chi-square test were again significant (||chi~.sup.2~ = 15.15, df = 6, p |is less than~ .05). Nonconfiders demonstrated more independence by living alone in an apartment or in some other living arrangement outside the family home (excluding partner's apartment). Confiders demonstrated less independence by living with both parents or either mother or father. Those who lived with their partner were as likely to be nonconfiders as confiders.

Marital status did not differentiate between the groups. The data suggest that divorced clients were more likely to tell their parents than were either unmarried or married clients; however, these findings were not statistically significant due to the low number of clients in the divorced category.

On the variable of self-perception of maturity, which was compared across three levels (less than average maturity, average maturity, and better than average maturity), the chi-square test was significant (||chi~.sup.2~ = 9.3, df = 2, p |is less than~ .01). Nonconfiders were more likely to consider themselves more mature than the average adolescent, while confiders were more likely to consider themselves less mature than the average adolescent.

In summary, four out of the five variables (maturity, age, job status, and living arrangements) used to test the hypothesis regarding independence were significant. Those who did not confide in their parents were older, considered themselves more mature, and were more financially and emotionally independent.

The second hypothesis stated that the respondents would be more likely to elicit aid from parents if they saw them as being open to communication. On the variable of general family communication, the two groups were compared across three levels (open, open for certain subjects, and closed) and were found to be significantly different (||chi~.sup.2~ = 36.31, df = 2, p = .001). Nonconfiders were more likely to describe their family communication as closed or open only for certain subjects. Confiders were much more likely to describe family communication as generally open.

On the variable of family communication regarding sex, the two groups were compared across five levels (no communication, communication with both parents, only with mother, only with father, and with others in the family). The chi-square test was again significant (||chi~.sup.2~ = 47.21, df = 4, p |is less than~ .001). Nonconfiders reported never speaking about sex to their parents but confiding in other members of the family or health professionals. Confiders reported feeling comfortable speaking to both parents or father or mother separately about sex.

In conclusion, the degree of financial and emotional independence as well as quality and nature of family communication were found to be closely related to teenagers' decision to confide in parents about terminating a pregnancy.

DISCUSSION

Approximately half of the adolescents in this study chose not to include their parents in their pregnancy resolution. These results confirm the findings of Martin (1973), Rosen (1980), and Donovan (1983). In the present study, when asked why they did not discuss their abortion decision with parents, the clients gave four basic responses: fear of rejection, fear of disappointing parents, wanting to spare parents the problem, and wanting to handle the problem by themselves. When asked why they chose to confide in parents, they most often said: they needed money; they needed emotional support; it was the parents' right to know.

The first major finding of this study was that the adolescents were less likely to involve parents as their degree of financial and emotional independence increased. For example, those who were 18 and older, working full-time, living alone or with persons other than family members, and who considered themselves to be more mature than women their age were less likely to confide in their parents. Studies by Lewis (1979, 1980, 1987) have led to similar conclusions. Lewis explains these results by stating that there are developmental changes which lead to increasing competency among teenagers in dealing with decisions regarding abortion.

The second focus of the present study was one that has rarely been examined in the literature: the nature and quality of family communication and its effect on teenagers' disclosure to parents. In this study, when the teenagers described family communication as poor, they were less likely to confide in their parents. This was also true if they described family communication about sex as closed. In general, researchers believe that communication between adolescents and parents regarding sex is still quite limited (Rosen, 1980; Chilman, 1983; Newcomer & Udry, 1985). Developmentalists Mirkin and Koman (1985) state that when parents ignore, deny, or reject teenagers' growing sexuality, the risks for premature or excessive sexual activity are greater.

Future directions for research should include longitudinal studies of postabortion experiences. The family and its response to adolescent pregnancy and abortion must be investigated. Many clinicians propose a system of classifying healthy and dysfunctional families on dimensions of cohesion, adaptability, and communication (Satir, 1967; Minuchin, 1974; Garbarino, Sebes, & Schellenbach, 1984; Hall, 1987; LeCroy, 1988; Olson, Russell, & Sprenkle, 1979, 1983; Masselam, Marcus, & Stunkard, 1990); instruments such as the Parent-Adolescent Communication Scale (Barnes & Olson, 1985) and the Family Adaptability and Cohesion Evaluation Scale (Olson et al., 1985) might be used to examine families of abortion patients.

Follow-up studies as to whether teenagers were content with their decision to involve parents would be most informative. Interviews with more open-ended discussions might be used to supplement the objective data. A discriminant or regression analysis might be used to suggest predictors of those young women who would be most likely to consult their parents in the abortion decision. Such studies could provide valuable data related to the provision of counseling for those adolescents who cannot rely on family members for support during a pregnancy crisis.

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Author:Griffin-Carlson, Mary S.; Mackin, Kathleen J.
Publication:Adolescence
Date:Mar 22, 1993
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