Baby talk
Understanding the Decline in Adolescent Fertility in the United States, 2007–2012
Laura Lindberg, John Santelli & Sheila Desai
Journal of Adolescent Health, forthcoming
Methods: We used data on sexual activity and contraceptive use from National Surveys of Family Growth for young women 15–19 years of age, and contraceptive failure rates, to estimate a Pregnancy Risk Index (PRI) for the periods 2007, 2009, and 2012. Logistic regression was used to test for change over time in sexual activity, contraceptive use, and PRI. Statistical decomposition was used to calculate attribution of change in the PRI to changes in sexual activity or contraceptive method use.
Results: Sexual activity in the last 3 months did not change significantly from 2007 to 2012. Pregnancy risk declined among sexually active adolescent women (p = .046), with significant increases in the use of any method (78%–86%, p = .046) and multiple methods (26%–37%, p = .046). Use of highly effective methods increased significantly from 2007 to 2009 (38%–51%, p = .010). Overall, the PRI declined at an annual rate of 5.6% (p = .071) from 2007 to 2012 and correlated with birth and pregnancy rate declines. Decomposition estimated that this decline was entirely attributable to improvements in contraceptive use.
Conclusions: Improvements in contraceptive use appear to be the primary proximal determinants of declines in adolescent pregnancy and birth rates in the United States from 2007 to 2012. Efforts to further improve access to and use of contraception among adolescents are necessary to ensure they have the means to prevent pregnancy.
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Sally Brinkman et al.
Lancet, forthcoming
Background: Infant simulator-based programmes, which aim to prevent teenage pregnancy, are used in high-income as well as low-income and middle-income countries but, despite growing popularity, no published evidence exists of their long-term effect. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) programme, on pregnancy outcomes of birth and induced abortion in Australia.
Methods: In this school-based pragmatic cluster randomised controlled trial, eligible schools in Perth, Western Australia, were enrolled and randomised 1:1 to the intervention and control groups. Randomisation using a table of random numbers without blocking, stratification, or matching was done by a researcher who was masked to the identity of the schools. Between 2003 and 2006, the VIP programme was administered to girls aged 13–15 years in the intervention schools, while girls of the same age in the control schools received the standard health education curriculum. Participants were followed until they reached 20 years of age via data linkage to hospital medical and abortion clinic records. The primary endpoint was the occurrence of pregnancy during the teenage years. Binomial and Cox proportional hazards regression was used to test for differences in pregnancy rates between study groups. This study is registered as an international randomised controlled trial, number ISRCTN24952438.
Findings: 57 (86%) of 66 eligible schools were enrolled into the trial and randomly assigned 1:1 to the intervention (28 schools) or the control group (29 schools). Then, between Feb 1, 2003, and May 31, 2006, 1267 girls in the intervention schools received the VIP programme while 1567 girls in the control schools received the standard health education curriculum. Compared with girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth (97 [8%] of 1267 in the intervention group vs 67 [4%] of 1567 in the control group) or at least one abortion as the first pregnancy event (113 [9%] vs 101 [6%]). After adjustment for potential confounders, the intervention group had a higher overall pregnancy risk than the control group (relative risk 1•36 [95% CI 1•10–1•67], p=0•003). Similar results were obtained with the use of proportional hazard models (hazard ratio 1•35 [95% CI 1•10–1•67], p=0•016).
Interpretation: The infant simulator-based VIP programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.
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Paul Sullins
Sage Open Medicine, July 2016
Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for U. S. women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion.
Method: Panel data on pregnancy history and mental health history for a nationally-representative cohort of 8,005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, involuntary pregnancy loss). Risk ratios (RR) were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and poisson regression models.
Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (RR 1.45, 95% CI 1.30-1.62, p. < .0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (RR 1.24, 95% CI 1.13-1.37, p. < .0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%, 95% CI 6.0-11.3) of the prevalence of mental disorders examined over the period were attributable to abortion.
Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.
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Suvi Leppälahti et al.
Human Reproduction, September 2016, Pages 2142-2149
Study design, size, duration: This nationwide, retrospective cohort study from Finland, included all women born in 1987 (n = 29 041) and followed until 2012.
Participants/materials, setting, methods: We analysed socioeconomic, psychiatric and risk-taking-related health outcomes up to 25 years of age after underage (<18 years) abortion (n = 1041, 3.6%) and after childbirth (n = 394, 1.4%). Before and after conception analyses within the study groups were performed to further examine the association between abortion and adverse health outcomes. A group with no pregnancies up to 20 years of age (n = 25 312, 88.0%) served as an external reference group.
Main results and the role of chance: We found no significant differences between the underage abortion and the childbirth group regarding risks of psychiatric disorders (adjusted odds ratio 0.96 [0.67–1.40]) or suffering from intentional or unintentional poisoning by medications or drugs (1.06 [0.57–1.98]). Compared with those who gave birth, girls who underwent abortion were less likely to achieve only a low educational level (0.41 [95% confidence interval 0.31–0.54]) or to be welfare-dependent (0.31 [0.22–0.45]), but more likely to suffer from injuries (1.51 [1.09–2.10]). Compared with the external control group, both pregnancy groups were disadvantaged already prior to the pregnancy. Psychiatric disorders and risk-taking-related health outcomes, including injury, were increased in the abortion group and in the childbirth group similarly on both sides of the pregnancy.
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Can left-right differences in abortion support be explained by sexism?
Gordon Hodson & Cara MacInnis
Personality and Individual Differences, January 2017, Pages 118–121
Abstract:
Individuals on the right (vs. left) generally oppose abortion, but why? Past research (C.C. MacInnis, M.H. MacLean, & G. Hodson, 2014) tested whether differences in perceived preborn-humanness explain this difference, finding little evidence. Here we re-analyze two large datasets from New Zealand and the U.S., testing whether sexism can mediate the relation between conservatism and abortion opposition. This pattern would be consistent with feminist critiques, and with Social Dominance Theory (J. Sidanius & F. Pratto, 1999), whereby individual differences in ideology (e.g., conservatism) predict policy positions (e.g., abortion) through legitimizing myths (e.g., sexism) that justify/facilitate the ideology-policy relation. After controlling for potential confounds (e.g., participant sex; religiosity; abortion experience), 30% (Study 1) or 75% (Study 2) of the left-right difference in abortion stance was explained by sexism. Despite political rhetoric on the right emphasizing concerns for the pre-born, individual differences in abortion positions may instead concern the maintenance of group-based inequalities that disadvantage women. Implications are discussed.
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The Timing of Teenage Births and the Signaling Value of a High School Degree
Danielle Sandler & Lisa Schulkind
U.S. Census Bureau Working Paper, September 2016
Abstract:
This paper estimates the effect of high school graduation on later life outcomes for young women who have a child as a teenager. Teenage mothers tend to have poor economic outcomes later in life. However, the girls who become teenage mothers come from less advantaged backgrounds than those who delay childbearing, making causality difficult to establish. This paper examines the effect of having a child around the time of high school graduation, comparing young mothers who had their child before their expected graduation date to those who had their child after. Examining this question builds our understanding both of the long run consequences of teenage fertility and the signaling value of a high school diploma. We find that girls who give birth during the school year are 7 percent less likely to graduate from high school; however, this has little effect on their eventual labor market outcomes. Despite being much more likely to obtain a high school degree, the control group does not enjoy higher labor earnings later in life, suggesting that the signaling value of a high school degree is zero for this population.
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Fertility Choice in a Life Cycle Model with Idiosyncratic Uninsurable Earnings Risk
Kamila Sommer
Journal of Monetary Economics, forthcoming
Abstract:
Motivated by large shifts in uninsurable earnings risk over time, this paper studies the link between delaying and reducing fertility on the one hand, and earnings and fertility risks on the other. When children are modeled as consumption commitments, increases in earnings risk are associated with a reduction in family sizes and patterns of delayed childbearing. Since household ability to bear children declines with age, the postponement of birth associated with the increased earnings risk drives down the number of birth per family further. An access to in-vitro fertilization (IVF) is shown to have only a limited offsetting effect.
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Inna Cintina
Health Economics, forthcoming
Abstract:
Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. Using county-level vital statistics data in conjunction with the pharmacy specific location data from the Not-2-Late Hotline database, I study whether the increased access to EC affects fertility rates within the state and beyond the borders of the state that allows it. Unlike other studies that rely on geographic variations in access, I show that increased availability of EC in Washington, measured by the distance to the closest ‘no-prescription EC pharmacy’, is associated with a statistically significant albeit economically moderate decrease in abortion rates in Washington counties where women had access to ‘no-prescription EC’. These effects are localized (i.e., decrease with travel distance) and robust in a number of specifications. Finally, I find some evidence in support of geographical spillover effects in Idaho, but not in Oregon. However, after accounting for the availability of abortion services, the decrease in ‘treated’ Idaho counties is rather small.
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The impact of periconceptional maternal stress on fecundability
Shekufe Akhter et al.
Annals of Epidemiology, forthcoming
Methods: Daily stress was reported on a scale from 1 to 4 (lowest to highest) among 400 women who completed daily diaries including data on lifestyle and behavioral factors, menstrual characteristics, contraceptive use, and intercourse for up to 20 cycles or until pregnancy. Discrete survival analysis was used to estimate the associations between self-reported stress during specific windows of the menstrual cycle and fecundability (cycles at risk until pregnancy), adjusting for potential confounders.
Results: One hundred thirty-nine women became pregnant. During the follicular phase, there was a 46% reduction in fecundability for a 1-unit increase in self-reported stress during the estimated ovulatory window (fecundability odds ratio [FOR] = 0.54; 95% confidence interval [CI] 0.35–0.84) and an attenuated trend for the preovulatory window (FOR = 0.73; 95% CI 0.48–1.10). During the luteal phase, higher stress was associated with increased probability of conception (FOR = 1.63, 95% CI 1.07–2.50), possibly due to reverse causality.
Conclusions: Higher stress during the ovulatory window may reduce probability of conception; however, once conception occurs, changes in the hormonal milieu and/or knowledge of the pregnancy may result in increased stress. These findings reinforce the need for encouraging stress management techniques in the aspiring and expecting mother.