dr.

Kirana Anggraini, MKM

UNINTENDED PREGNANCY
Adolescent Childbearing:
Socioeconomic Issues
 Adolescents who have children are substantially
less likely to complete high school than those
who delay childbearing.
 Teenage mothers are more likely to be single
parents or, if they are married, to experience
marital dissolution
 Although family sizes among younger as well as
older mothers have declined over time, younger
mothers continue to have more children than
delayed childbearers (Moore, 1992).
 Because of their fewer years of schooling,
larger families, and lower likelihood of
being married, teenage mothers acquire
less work experience, have lower wages
and earnings, and are substantially more
likely to live in poverty.
Adolescent Childbearing:
Medical Issues
 Young adolescents (particularly those under age
153) experience a maternal death rate 2.5 times
greater than that of mothers aged 20–24 (Morris
et al., 1993).
 Infants born to mothers less than 15 years of age
are more than twice as likely to weigh less than
2,500 grams (about 5.5 pounds) at birth and
three times more likely to die in the first 28
days of life than infants born to older mothers
(McAnarney and Hendee, 1989).
 The incidence of sudden infant death
syndrome is higher among infants of
adolescents, and these infants also
experience higher rates of illness and
injuries (Morris et al., 1993).
 Several studies have indicated that very
young adolescent mothers are underweight
and give birth to smaller babies because of
poor diets and inadequate or no prenatal
care (Stevens-Simon and White, 1991).
 Common medical problems among
adolescent mothers include poor weight
gain, pregnancy-induced hypertension,
anemia, sexually transmitted diseases
(STDs), and cephalopelvic disproportion
(Stevens-Simon and White, 1991).
 Similarly, the greater incidence of illness and
injury in infants of adolescent mothers is
more likely due to environmental factors
such as poverty, poor health habits, and
insufficient supervision than to the age of
the mother per se (Stevens-Simon and
White, 1991).
Childbearing by Single Women

 More than 40 percent of infants born after

unintended conception begin life with
unmarried parents.
 Moreover, couples who marry after
conception—usually unintended—are more
likely to divorce than couples who marry
before conception (Bumpass and Sweet,
1989).
 Unintended pregnancies within marriage are
associated with a greater risk of divorce after
the child's birth.
 For all these reasons, children born after
unintended conceptions are very likely to
live apart from one or both of their parents,
usually their father, sometime during
childhood.
 A large body of research suggests that the
absence of a father—either because of
divorce or an out-of-wedlock birth—is
associated with negative outcomes in
children when they grow up.
 Children raised by only one parent, usually
the mother, are more likely to drop out of
high school, less likely to attend college,
and less likely to graduate from college if
they ever attend
 Before leaving high school, children in one-
parent households score lower on standardized
achievement tests, have lower grade point
averages, have more erratic attendance
records, and have lower college expectations
(Astone and McLanahan, 1991).
 These children also show more behavioral and
emotional problems while growing up, as
reported by parents and teachers (Thomson et
al., 1994; Zill et al., 1993; Furstenberg et al.,
1987).
 Children raised by single mothers exhibit different
patterns of home leaving and family formation.
 They leave home earlier than children in two-
parent families (Kiernan, 1992; Thornton, 1991);
they are more likely to become teenage parents
and unmarried parents (Haveman and Wolfe, 1994;
Wu and Martinson, 1993; McLanahan, 1988;
McLanahan and Bumpass, 1988); and, if they are
married, are more likely to divorce (McLanahan
and Bumpass, 1988).
 Estimates from the NLSY show that the risk of
becoming a teenage mother is 11 percent for
children raised by both parents and 27 percent for
children raised by single mothers (McLanahan and
Sandefur, 1994).
 Finally, children who live with only one parent
have more problems finding and keeping a
steady job after leaving school and are
more likely to have encounters with the
criminal justice system than children who
live with both parents (Haveman and Wolfe,
1994; McLanahan and Sandefur, 1994;
Powers, 1994).
Prenatal Care

 Unintended pregnancy might receive

insufficient prenatal care.
 Ambivalence toward maintaining the
pregnancy may lead to a delay in seeking
prenatal care;
 Time may be lost when women who are not
intending to be pregnant do not recognize
the symptoms of pregnancy.
 Regardless of the reasons for delaying care,
the woman and her developing fetus may be
less vigilance in detecting problems such as
pregnancy-induced hypertension, less
support for practicing healthy behaviors such
as smoking cessation, and less preparation
for parenthood (Kogan et al., 1994).
 Women who have mistimed or unwanted
conceptions tend to initiate prenatal care later
in pregnancy and to receive less adequate care
(Figure 3-3) than women who have intended the
pregnancy.
 When compared with women who planned to
conceive, women with an unwanted pregnancy
are 1.8 to 2.9 times more likely to begin care
after the first trimester (DePersio et al., 1994;
Kost et al., 1994; Pamuk and Mosher, 1988;
Watkins, 1968).
Behavioral Risks in Pregnancy

 They are more likely to smoke and to drink

during pregnancy.
Low Birthweight

 A number of researchers have examined the

risk of delivering a low birthweight (<2,500
grams) infant following an unintended
conception.
Infant Mortality

 Data from the NSFG and other surveys, it was

estimated that if all sexually active couples
had routinely used effective contraception in
1980, there would have been almost 1 million
fewer abortions (533,000 rather than 1.5
million), 340,000 fewer live births that were
unintended at conception, 5,000 fewer
infant deaths, and a reduction in the infant
mortality rate of 10 percent (World Health
Organization, 1987).
Poor Child Health and
Development
 Before 2 years of age, children whose
conceptions had been mistimed or unwanted
exhibited higher levels of fearfulness and lower
levels of positive affect. When they were of
preschool age, they had lower scores on verbal
development tests, even though they had no
deficit of verbal memory. The authors
hypothesize that this critical developmental skill
is lagging because ''significant adults,
particularly the mother may be less available"
to the children (Baydar and Grady, 1993:14).
Consequences for the Parents

 Worldwide, childbearing at very young or

very old age, the bearing of many children,
and the bearing of children who are closely
spaced (less than two years apart) contribute
to the high level of maternal deaths (about
500,000 per year) and to the reproductive
complications that women suffer (National
Research Council, 1989a,b; Zimicki, 1989).
 Unintended pregnancy can increase the
likelihood of depression during pregnancy
(Orr and Miller, 1995), and, regardless of
marital status at birth, women who give birth
following an unintended conception are more
likely to suffer from postpartum depression
as well (Salmon and Drew, 1992; Najman et
al., 1991; Condon and Watson, 1987).
 They may also be at greater risk of
experiencing domestic violence. For
example, in a study done in New Zealand,
13.4 percent of women who experienced an
unintended pregnancy also experienced
physical violence from their partners over a 6-
year period after conception; for those
women who experienced intended
pregnancies, the rate was 5.4 percent
(Fergusson et al., 1986).
Preconception Care

 Most women enter prenatal care several weeks into

the pregnancy, even with the most earnest attempts
to initiate care after missing one, and sometimes
two, menstrual periods.
 Meanwhile, the conceptus has completed a critical
interval that includes uterine implantation,
organogenesis, and early system development.
 For the health care provider, this means that the
length of care for such patients is 7 or 8 months at
best, with no opportunity to have influenced fetal
development during the first 1 or 2 months.
 The risk of neural tube defects (NTDs), such
as spina bifida, may be decreased when
folic acid is consumed before conception
and through the early months of
pregnancy.