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The unwanted child
Child Abuse & Neglect, Vol. 22, No. 2, pp. 155-157, 1998 Copyright © 1998 Elsevier Science Ltd Printed in the USA, All rights reserved 0145-2134/98 $19.0(I + .00
Pergamon
PII S0145-2134(97)00126-9
BRIEF
COMMUNICATION
THE U N W A N T E D CHILD TAMARA SAFONOVA AND E. A.
LEPARSKY
Pediatrics Research Institute of the USSR, Academy of Medical Sciences, Moscow, Russia (Adapted for English publication by Jane Gray, M.D., Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA)
TO A LARGE extent, the physical and mental health of a child is determined by the social, emotional, and moral milieu surrounding him prior to his birth. Leparski and colleagues (1989) found that 82.3% of women who had a child die during the first year of life had experienced a combination of unfavorable psychosocial factors prenatally. One factor in particular was that of an unwanted pregnancy. A child who causes unpleasant feelings in the mother even before birth finds himself in an entirely different situation than a child who brings a woman satisfaction and an increased sense of social importance. When a child is unwanted, there is a danger that the child may be rejected and deprived of sensory and emotional stimuli. The purposes of this research were to determine factors contributing to a woman's negative attitude toward pregnancy and to identify outcomes of unwanted pregnancies. The study was done between April 1984 and April 1985 in one of Moscow's delivery houses where women from different districts of the city give birth. Information was collected on 1,454 women (corresponding to 30% of all deliveries within that time period). Four hundred and ninety children of these women were followed until the age of 3. Documents studied included: • Birth registration card, containing information on the prenatal health status of the mother and the child's neonatal health. • Child health card, containing information on the physical health, development, and morbidity of children during the first 3 years of life. • Questionnaires for mothers, containing information completed during the post-partum hospital stay and again 3 years later. One of these questions addressed the woman's attitude toward her pregnancy, whether it was wanted or unwanted; and if the pregnancy was unwanted, whether her attitude had changed during the pregnancy. To determine factors which influence a woman's attitude toward pregnancy and to identify the most important ones, comparisons were made between women with wanted and unwanted preg-
Received for publication May 9, 1990; final revision received June 6, 1991; accepted for publication July 1, 1997. This paper was written in 1990, with the last revision in 1991. Money conversion rates and other statements relating to USSR are relevant for that time period. 155
156
T. Safonovaand E. A. Leparski
nancies and outcomes for their children. Relative risk was calculated to express the ratio between the incidence of bad outcomes in the population with a risk factor(s) and the incidence in a population without the risk factor. Relative risk measures the strength of the association between risk factors and outcome (WHO, 1984). Women included in this study were representative of all Moscow women when compared for age, marital/socioeconomic status, educational level, and rates of perinatal mortality. Of the 1,454 study cases, 131 (9%) women had a negative attitude toward their pregnancy, 72 (5%) changed their mind (from negative to positive) during pregnancy, and 86% (the control group) had a positive attitude. The principal factor contributing to an unwanted pregnancy was the unmarried status of the mother. Of the 1,454 mothers studied, 135 (9.3%) were unmarried (corresponding to the average in the Russian Federation). Unmarried women had a significantly higher percentage of unplanned pregnancies (20.5%) than did married women (9.0%). The percentage of unwanted pregnancies was 2.9 times greater in the unmarried group (14.9% vs. 5.1%). More than 9% of the unmarried women had both unplanned and unwanted pregnancies. This was eight times higher than married women (1.2%). The combination of these two factors, unplanned and unwanted pregnancy, greatly increased the risk of unfavorable pregnancy outcomes, such as prematurity (relative risk = 3.7) when compared to women with planned and wanted pregnancies. In the unwanted pregnancy group, 20% of the women abused alcohol, while in the control group only 2.2% of women used alcohol frequently. Husbands of women with unwanted pregnancies abused alcohol twice as often as husbands in the control group. Just over 4% of women in the study group smoked 10-20 cigarettes per day during pregnancy. This was twice as high as in the control group. Almost 4% of women in the study group used both alcohol and tobacco during pregnancy as compared to .8% in the comparison group. Thirty-two percent of women with unwanted pregnancies had inadequate living conditions; this was 2.9% times higher than in the control group. In 64% of the women with unwanted pregnancies, the preceding pregnancy had terminated in an abortion. A low annual per capita income, less than 70 rubles, or $40.69 U.S. dollars by commercial conversion rates (Izvestiya, 1991) was also more common in the unwanted pregnancy group (28.3% vs. 11.8% in the control group). Factors such as pelvic or systemic pathology did not significantly affect a woman's attitude toward pregnancy. The relative risk factors associated with unwanted pregnancy were (in diminishing order): unmarried women with unplanned pregnancies, poor marital relationships, unfavorable psychologic climate in the family, combination of tobacco/alcohol abuse in the women, low per capita income, and an inadequate family situation (mother a student, unmarried, or under age 19). Children from unwanted pregnancies were more likely than those in the control group to have unfavorable pregnancy outcomes. The percentage of premature infants in the unwanted pregnancy group was almost three times as great as in the controls (28.3% vs. 9.5%). Over twice as many low birth weight infants (less than 2500 gms) came from the unwanted pregnancy group. In general, there was no significant difference in the incidence of neonatal complications between the children from wanted (32.3%) and unwanted (36.9%) pregnancies, except for the percentage of small for gestational age infants (intrauterine developmental delay) which was 1.6% times greater among children from unwanted pregnancies. The number of mothers with inadequate prenatal care was substantially higher in the unwanted pregnancy group. Almost 7% of women with unwanted pregnancies (as compared to 2.7% of women with wanted pregnancies) consulted a physician late in pregnancy and had infrequent prenatal visits. Routine visits to the pediatrician were twice as frequent for wanted children. A father's negative attitude toward the child and psychological stress in the home were also more common among the unwanted children. At the same time, there was no difference in the number of children who were bottle fed: 47.8% of unwanted pregnancies and 46% of wanted pregnancies. This study demonstrates that several unfavorable prenatal psychosocial circumstances can negatively affect the child. Even though the legal status of unmarried mothers has improved in
The unwanted child
157
Moscow and the public attitude towards them has undergone changes, psychological problems of unwed mothers in Moscow have largely remained the same. However, unlike the Prague study (Matejcek, Dytrych, & Schuller, 1988), which revealed a two fold increase in unwanted pregnancies among women with a large number of children, this study found no relationship between the number of children in the family and the attitude of a woman toward her present pregnancy. Prospective observations of the health of unwanted children outside the USSR (this paper was written prior to the dissolution of the USSR) did not provide a definite answer as to what degree prenatal deprivation affects the physical condition of children. Thus, in the children reported on in the Prague study, no significant differences in health during the perinatal period were found between the wanted and unwanted children (Matejcek et al., 1988). However, our data regarding a higher incidence of prematurity and low birth weight among children from unwanted pregnancies supports the data of Finnish researchers, who found that women with unwanted pregnancies have a higher incidence of low birth weight and premature babies (Myhrman, 1988). Even if the unwanted pregnancy inflicts no specific physical damage to the child, the psychosocial atmosphere (i.e., the family's life style, the psychologic climate in the family, and the mother's attitude toward the child) has an important influence on the child's health. An unwanted pregnancy (in combination with a number of psychosocial factors, i.e., single parenting, frequent family conflicts, negative attitude of the father, low utilization of medical services, and tobacco and alcohol abuse) should be considered a risk factor which may affect the emotional development of a child. A comprehensive approach by physicians, social workers, psychologists, and possibly lawyers is needed to reduce the unfavorable impact of an unwanted pregnancy on the physical and emotional health of the child.
REFERENCES Leparski, E. A., Safonova,T. Ya., & Temicheva, L. S. (1989). Medicosocial patronagee as a new form of medical care of mothers and child. Zdravoochranenie RSFSR, 7, 32-36. Myhrman, A. (1988). The Northern Finland cohort, 1966-82. A follow-up study of children unwanted at birth (pp. 103-110). In H. P. David, Z. Dytrick, Z. Matejcek, & V. Schuller (Eds.), Born unwanted. New York: SpringerPublishing Co.; Prague: Avicenum SzechoslovakMedical Press. Matejcek, A., Dytrych, Z., & Schuller, V. (1988). The Prague cohort through age nine (pp. 53-86). In H. P. David, Z. Dytrick, Z. Matejcek, & V. Schuller (Eds.), Born unwanted. New York: Springer Publishing Co.; Prague: Avicenum Szechoslovak Medical Press. Division of Family Health, WHO (1984). A workbook on how to plan and carry, out research on the risk approach in maternal and child health, including family planning. Geneva: WHO. Izvestiya, December 3, 1991.
Pergamon
PII S0145-2134(97)00126-9
BRIEF
COMMUNICATION
THE U N W A N T E D CHILD TAMARA SAFONOVA AND E. A.
LEPARSKY
Pediatrics Research Institute of the USSR, Academy of Medical Sciences, Moscow, Russia (Adapted for English publication by Jane Gray, M.D., Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA)
TO A LARGE extent, the physical and mental health of a child is determined by the social, emotional, and moral milieu surrounding him prior to his birth. Leparski and colleagues (1989) found that 82.3% of women who had a child die during the first year of life had experienced a combination of unfavorable psychosocial factors prenatally. One factor in particular was that of an unwanted pregnancy. A child who causes unpleasant feelings in the mother even before birth finds himself in an entirely different situation than a child who brings a woman satisfaction and an increased sense of social importance. When a child is unwanted, there is a danger that the child may be rejected and deprived of sensory and emotional stimuli. The purposes of this research were to determine factors contributing to a woman's negative attitude toward pregnancy and to identify outcomes of unwanted pregnancies. The study was done between April 1984 and April 1985 in one of Moscow's delivery houses where women from different districts of the city give birth. Information was collected on 1,454 women (corresponding to 30% of all deliveries within that time period). Four hundred and ninety children of these women were followed until the age of 3. Documents studied included: • Birth registration card, containing information on the prenatal health status of the mother and the child's neonatal health. • Child health card, containing information on the physical health, development, and morbidity of children during the first 3 years of life. • Questionnaires for mothers, containing information completed during the post-partum hospital stay and again 3 years later. One of these questions addressed the woman's attitude toward her pregnancy, whether it was wanted or unwanted; and if the pregnancy was unwanted, whether her attitude had changed during the pregnancy. To determine factors which influence a woman's attitude toward pregnancy and to identify the most important ones, comparisons were made between women with wanted and unwanted preg-
Received for publication May 9, 1990; final revision received June 6, 1991; accepted for publication July 1, 1997. This paper was written in 1990, with the last revision in 1991. Money conversion rates and other statements relating to USSR are relevant for that time period. 155
156
T. Safonovaand E. A. Leparski
nancies and outcomes for their children. Relative risk was calculated to express the ratio between the incidence of bad outcomes in the population with a risk factor(s) and the incidence in a population without the risk factor. Relative risk measures the strength of the association between risk factors and outcome (WHO, 1984). Women included in this study were representative of all Moscow women when compared for age, marital/socioeconomic status, educational level, and rates of perinatal mortality. Of the 1,454 study cases, 131 (9%) women had a negative attitude toward their pregnancy, 72 (5%) changed their mind (from negative to positive) during pregnancy, and 86% (the control group) had a positive attitude. The principal factor contributing to an unwanted pregnancy was the unmarried status of the mother. Of the 1,454 mothers studied, 135 (9.3%) were unmarried (corresponding to the average in the Russian Federation). Unmarried women had a significantly higher percentage of unplanned pregnancies (20.5%) than did married women (9.0%). The percentage of unwanted pregnancies was 2.9 times greater in the unmarried group (14.9% vs. 5.1%). More than 9% of the unmarried women had both unplanned and unwanted pregnancies. This was eight times higher than married women (1.2%). The combination of these two factors, unplanned and unwanted pregnancy, greatly increased the risk of unfavorable pregnancy outcomes, such as prematurity (relative risk = 3.7) when compared to women with planned and wanted pregnancies. In the unwanted pregnancy group, 20% of the women abused alcohol, while in the control group only 2.2% of women used alcohol frequently. Husbands of women with unwanted pregnancies abused alcohol twice as often as husbands in the control group. Just over 4% of women in the study group smoked 10-20 cigarettes per day during pregnancy. This was twice as high as in the control group. Almost 4% of women in the study group used both alcohol and tobacco during pregnancy as compared to .8% in the comparison group. Thirty-two percent of women with unwanted pregnancies had inadequate living conditions; this was 2.9% times higher than in the control group. In 64% of the women with unwanted pregnancies, the preceding pregnancy had terminated in an abortion. A low annual per capita income, less than 70 rubles, or $40.69 U.S. dollars by commercial conversion rates (Izvestiya, 1991) was also more common in the unwanted pregnancy group (28.3% vs. 11.8% in the control group). Factors such as pelvic or systemic pathology did not significantly affect a woman's attitude toward pregnancy. The relative risk factors associated with unwanted pregnancy were (in diminishing order): unmarried women with unplanned pregnancies, poor marital relationships, unfavorable psychologic climate in the family, combination of tobacco/alcohol abuse in the women, low per capita income, and an inadequate family situation (mother a student, unmarried, or under age 19). Children from unwanted pregnancies were more likely than those in the control group to have unfavorable pregnancy outcomes. The percentage of premature infants in the unwanted pregnancy group was almost three times as great as in the controls (28.3% vs. 9.5%). Over twice as many low birth weight infants (less than 2500 gms) came from the unwanted pregnancy group. In general, there was no significant difference in the incidence of neonatal complications between the children from wanted (32.3%) and unwanted (36.9%) pregnancies, except for the percentage of small for gestational age infants (intrauterine developmental delay) which was 1.6% times greater among children from unwanted pregnancies. The number of mothers with inadequate prenatal care was substantially higher in the unwanted pregnancy group. Almost 7% of women with unwanted pregnancies (as compared to 2.7% of women with wanted pregnancies) consulted a physician late in pregnancy and had infrequent prenatal visits. Routine visits to the pediatrician were twice as frequent for wanted children. A father's negative attitude toward the child and psychological stress in the home were also more common among the unwanted children. At the same time, there was no difference in the number of children who were bottle fed: 47.8% of unwanted pregnancies and 46% of wanted pregnancies. This study demonstrates that several unfavorable prenatal psychosocial circumstances can negatively affect the child. Even though the legal status of unmarried mothers has improved in
The unwanted child
157
Moscow and the public attitude towards them has undergone changes, psychological problems of unwed mothers in Moscow have largely remained the same. However, unlike the Prague study (Matejcek, Dytrych, & Schuller, 1988), which revealed a two fold increase in unwanted pregnancies among women with a large number of children, this study found no relationship between the number of children in the family and the attitude of a woman toward her present pregnancy. Prospective observations of the health of unwanted children outside the USSR (this paper was written prior to the dissolution of the USSR) did not provide a definite answer as to what degree prenatal deprivation affects the physical condition of children. Thus, in the children reported on in the Prague study, no significant differences in health during the perinatal period were found between the wanted and unwanted children (Matejcek et al., 1988). However, our data regarding a higher incidence of prematurity and low birth weight among children from unwanted pregnancies supports the data of Finnish researchers, who found that women with unwanted pregnancies have a higher incidence of low birth weight and premature babies (Myhrman, 1988). Even if the unwanted pregnancy inflicts no specific physical damage to the child, the psychosocial atmosphere (i.e., the family's life style, the psychologic climate in the family, and the mother's attitude toward the child) has an important influence on the child's health. An unwanted pregnancy (in combination with a number of psychosocial factors, i.e., single parenting, frequent family conflicts, negative attitude of the father, low utilization of medical services, and tobacco and alcohol abuse) should be considered a risk factor which may affect the emotional development of a child. A comprehensive approach by physicians, social workers, psychologists, and possibly lawyers is needed to reduce the unfavorable impact of an unwanted pregnancy on the physical and emotional health of the child.
REFERENCES Leparski, E. A., Safonova,T. Ya., & Temicheva, L. S. (1989). Medicosocial patronagee as a new form of medical care of mothers and child. Zdravoochranenie RSFSR, 7, 32-36. Myhrman, A. (1988). The Northern Finland cohort, 1966-82. A follow-up study of children unwanted at birth (pp. 103-110). In H. P. David, Z. Dytrick, Z. Matejcek, & V. Schuller (Eds.), Born unwanted. New York: SpringerPublishing Co.; Prague: Avicenum SzechoslovakMedical Press. Matejcek, A., Dytrych, Z., & Schuller, V. (1988). The Prague cohort through age nine (pp. 53-86). In H. P. David, Z. Dytrick, Z. Matejcek, & V. Schuller (Eds.), Born unwanted. New York: Springer Publishing Co.; Prague: Avicenum Szechoslovak Medical Press. Division of Family Health, WHO (1984). A workbook on how to plan and carry, out research on the risk approach in maternal and child health, including family planning. Geneva: WHO. Izvestiya, December 3, 1991.