What are the factors most strongly associated with teenage pregnancy?

The Centre for Analysis of Youth Transitions released a report this week which links teenage conception data to the education records of all girls attending state schools in England. It looks at associations between pregnancy and individual and social factors such as absenteeism and deprivation. As it’s a 53 page document we’ve put together a brief summary of the findings here.

This Department for Education funded report compares information on teenage pregnancy (number of conceptions, conceptions leading to maternity or abortion) to data from English schools (pupils who are eligible for free school meals, who are frequently absent, who have special educational needs etc). For those of us working in this area, the key findings are not all that surprising:

“Teenage conception and maternity rates are higher in deprived areas”

“Girls who attend higher performing schools are less likely to conceive, and more likely to have an abortion if they do conceive”

We know already that teenage pregnancy relates to particular social factors, and that young women in deprived areas are more likely to get pregnant, and when pregnant more likely to continue the pregnancy and become young parents. A 2004 study looking at national variation in teenage abortion and motherhood found that “abortion proportions and social deprivation are strongly correlated”, and that young women’s socio-economic backgrounds are a strong influence on their decision to continue or end a pregnancy. The researchers interviewed young people who had had abortions/given birth and their responses give a fascinating insight into the inevitability of particular pregnancy choices for young women:

“There was no question of me keeping it because I knew I was going to go to university...I didn’t want a baby...I’d had a good education and I had a career path to go down, it was all laid out for me.”

This latest piece of research found that eligibility for free school meals and being persistently absent from school were the factors most strongly associated with teenage pregnancy and the decision to continue with a pregnancy. Those who are eligible for free school meals are more than twice as likely to conceive as those who are not. This is important information for anyone working in sexual and reproductive health and education services, and clearly there is a need to think about making these services truly accessible to young people outside of school, through outreach and non-educational settings.

Although we know there are important individual and social factors to consider when planning work which aims to prevent unwanted pregnancies, one finding from the study bears highlighting:

“Teenage conceptions occur in all social groups, areas and types of school. Similarly, teenage conceptions occur in rich and poor areas and in schools with high and low levels of attainment: no characteristic provides complete “protection” from teenage conception”

In other words, there are no young people who don’t need (and deserve) evidence-based and accessible information and support with pregnancy and pregnancy decision-making. In an ideal world, this information would be available to young people in and out of school, regardless of their ethnic and social background.

Bipolar and pregnant

Thank you to guest blogger Zoe for allowing us to share her thoughts on the recently reported case of a woman who was granted legal access to abortion following a challenge to her ability to consent. This is cross-posted on Zoe's own blog 'The Fementalists'.

Today a woman, identified only as “SB”, won her High Court battle to be allowed to have an abortion. This fact may seem strange to many readers as since the Abortion Act was passed in 1967 legal abortion has been mostly accessible to women in England, Scotland, and Wales . However, the woman at the centre of this case has bipolar disorder and it was argued by doctors and her family that she lacked mental capacity to consent to the procedure. Lawyers representing the health authority told the judge “she is believed to lack the capacity to make a decision regarding the termination of her pregnancy due to her mental disorder.'' Fortunately, the judge disagreed with this assessment, stating that it would be "a total affront" to her autonomy to decide that she was unable to have an abortion.

I have been following this case closely as I also have bipolar disorder and as a young woman with a male partner I worry a lot about the possibility of an unplanned pregnancy, to say nothing of worrying about what my future holds in terms of planned pregnancy. It was stated in the Court that the woman in this case had stopped taking her medication and thus relapsed, culminating with her being detained under the Mental Health Act. However, many medications for bipolar are not suitable to take when pregnant as they can cause birth defects such as neural tube defects, heart defects, and developmental delay or neurobehavioural problems. Thus many people have to stop taking their medication if they wish to continue with their pregnancies. This is believed to be what happened in the “SB” case. While this may seem like a relatively minor thing, the consequences of this can be devastating. Rates of relapse into bipolar mania and psychosis are estimated at 50% to 75% respectively and WebMD states that “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions than pregnant women who do not have bipolar disorder.” So clearly the risk of being detained under the Mental Health Act also greatly increases during pregnancy because of the additional problems caused by stopping medication.

For me, this represents the nightmare scenario. Finding myself pregnant with a wanted foetus only to stop my medication, relapse and be detained under the Mental Health Act, and to then decide that for my own health I would like a termination and be denied it because it is argued that I lacked capacity. It is truly a terrifying prospect to find yourself unable to control your own body because you have a mental illness. Much more needs to be done to provide perinatal care for women with severe and enduring mental illness to ensure that a situation like this never arises again. Fortunately in this case the judge has made the right decision and SB is expected to have an abortion in the following days. Arguably, this situation should never have arisen in the first place.

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The effect of homophobia and transphobia on universal access to reproductive health

Today is IDAHO, otherwise known as ‘The International Day Against Homophobia and Transphobia’. We decided to blog about the relevance of reproductive rights to people of all (or no) genders and sexualities, and some of the problems those who identify as LGBT* can face in accessing sexual and reproductive health services and relevant information.

Why are reproductive rights important for people of all genders and sexualities?

When I tell people I work on a project which educates young people on pregnancy options they’ve asked if we only visit girls’ schools, and have expressed skepticism at the usefulness of covering this topic at a workshop for LGBT* youth. At EFC we believe everyone has a stake in understanding how reproduction works, and how people can be supported to make decisions about sex, contraception and pregnancy that are right for them. Here are some thoughts on why this is a subject which breaks though cisgendered/heterosexual ‘norms’:

-    Most people with a womb have at least the capability to get pregnant at some point in their lives. Even those who don’t choose to have vaginal intercourse can become pregnant, for example through sperm accidentally coming into contact with the vagina through non-penetrative intercourse, or as a result of rape.
-    Research has shown that young people who identify as gay, lesbian and bisexual may in fact be at a higher risk of unplanned pregnancy than their heterosexual peers. Stigma surrounding sexuality can lead some young people to ‘prove’ heterosexuality through sexual contact with a partner of the ‘opposite’ sex.
-    As Thomas Beatie has shown with his high-profile pregnancies, trans men and transmasculine people can and do become pregnant and may require specific information on this process.
-    Those who are unable to conceive in what is often seen as the ‘natural’ or ‘traditional’ way, may decide to access services which allow them to become pregnant (e.g. IVF) or to become parents through other means (adoption, fostering and surrogacy).
-    People who cannot themselves become pregnant may have close contact with those who do, whether it be a partner, family member or friend.
-    Many of the individuals and groups which seek to restrict abortion access also argue against LGBT* rights – for example, anti-choice group SPUC is currently running a campaign against equal marriage and has claimed that ‘making homosexual couples the legal parents of children is not in the best interests of children’.

What are some of the barriers for people who are LGBT* in accessing reproductive health services?

Outright stigma, and homo/trans/biphobia is a clear barrier for equal access to services. The stories gathered by #transdocfail showed systematically poor treatment of trans* people in health services, likely to be reflected in consultations relating to sexual and reproductive health. Media outrage and sensationalised headlines relating to LGBT* parenting are unlikely to make those who identify as such eager to access support and services. And as well as stigma, there may be legal restrictions to reproductive rights – the Swedish government has only just vowed to remove a statute which requires all transgender people to be sterilised in order to have their gender recognised legally.

Beyond direct objection to equal reproductive rights, there is also often a lack of tailored resources and information for those who are lesbian, gay, bisexual and/or transgender. In our own work we are trying to address this by using language that is inclusive, and thinking of ways to address gaps in resource provision, making links between the reproductive rights and LGBT* rights movements where possible. Thankfully, some progress is being made – we’ve listed some useful resources below but please do add your own comments and suggestions.

Useful resources

• A brilliant book for talking to children about ‘where babies come from’ which doesn’t make assumptions about gender and sexuality
• The Terrence Higgins Trust has produced sexual health resources for trans men and trans women 
• Stonewall’s ‘A Pregnant Pause’ provides advice ‘for lesbians on how to get pregnant’ 
• 9 Facts about Trans Sexual and Reproductive Health (U.S resource) 
• The Transcending Anatomy blog has specific information on pregnancy
• Blog from Abortion Gang entitled ‘Why queer justice and reproductive justice movements should work together’

What might the ‘Protection of Life During Pregnancy Bill’ mean for Irish women seeking abortion?

The Irish government has produced a bill which if passed, will, according to Prime Minister Enda Kenny, ‘clarify the circumstances’ in which medical practitioners can intervene to save a woman’s life by providing abortion. Kenny has stated that the new bill “would continue within the law to assert the restrictions on abortion that have applied in Ireland and which will apply in future”. In other words, it does not seek to change Irish law on abortion, which states that abortion is restricted only to cases where the pregnant woman’s life is in danger. Following the recent death of Savita Halappanavar in Galway there has been a demand for clarification on the circumstances in which doctors can legally provide life-saving treatment. Kenny claims that if the bill goes through it will “at last bring certainty to pregnant women and legal clarity to medical personnel who work within the system”.

So what does the bill actually say?

The bill is carefully worded so as not to present decision making around abortion as privileging the rights of the woman over the rights of the developing pregnancy. Suggested provisions are purely about saving a woman’s life in emergency situations and all efforts must be made to protect the ‘unborn child’ (as the pregnancy is referred to) wherever possible:

“Essentially the decision to be reached is not so much a balancing of the competing rights rather, it is a clinical assessment as to whether the mother's life, as opposed to her health, is threatened by a real and substantial risk that can only be averted by a termination of pregnancy.”

Some provision is made for those women who claim to be suicidal in the face of having to continue an unwanted pregnancy. It is proposed that in such cases, three doctors are to examine the woman and must reach a unanimous decision on the threat to her life. If the three doctors do not agree, the woman may appeal to another three consultants, meaning that her case could potentially be reviewed by six separate medical professionals.

What are people saying about the bill?

Members of the government claim that the bill would provide much needed clarity to enable doctors to work within the very restrictive Irish abortion law. However, there have been criticisms from both pro-choice and anti-abortion campaigners.

Some anti-abortion campaigners have evidenced concerns about the law being ‘relaxed’ with access to abortion expanded. Former Irish Prime Minister John Bruton said the idea that “a simple threat of suicide would make right something that would otherwise be wrong is a really dangerous principle”. And in a recent televised debate, a Fine Gael politician was asked if potentially fatal health risks are an 'acceptable risk' in pregnancy, or whether they are grounds for abortion in some cases. He responded: "But sure we’re all going to end up dead anyway." This begs the question of why he’s against abortion, and indeed whether he thinks medical care is redundant for all people whose lives may be in danger or just pregnant women.

Many pro-choice campaigners have taken issue with the ‘suicide clause’ in the bill. A spokesperson from the Centre for Reproductive Rights calls it ‘outrageous and paternalistic’ and goes on to criticise Irish abortion law more generally as being an “absolute violation of international human rights norms on women's right to health and dignity. It's totally off track with the rest of Europe."

In summation, the bill is not yet passed, and if it does go through both houses of Irish parliament, it will not make any changes to the law itself. Even with these amendments the thousands of Irish women who travel to the UK (and elsewhere) to access abortion would still need to do so. Arguably it might make provision for rare cases in which the woman's life is threatened but this will still sit within a legal framework which threatens to prosecute doctors whose actions are seen as being outside of these restrictions.

To follow the debate we suggest checking out the Irish ‘Doctors For Choice’ campaign which will provide regular updates.

The Protection of Life During Pregnancy Bill can be viewed in full here.

Masturbation is ‘self-abuse’ and ‘unnatural’, according to SPUC

SPUC (Society for the Protection of Unborn Children) is an anti-abortion organisation which speaks to young people in schools across the country on topics like abortion and euthanasia.

We’ve written before about our concerns with the misinformation that SPUC provides on contraception and abortion, and about the stigmatisation of abortion, as well as non-heterosexual lifestyles. However, a recent blog quoting SPUC’s communications manager Anthony Ozimic exposes another aspect of SPUC’s policies which may not be fitting for schools wishing to deliver relevant and accessible sex education to their pupils.

In addressing the Telegraph’s recent obituary of ‘IVF pioneer’ Robert Edwards, SPUC outlines its problem with masturbation (as well as other aspects of IVF technology). Ozimic states:

“The sperm used to fertilise the eggs in IVF is almost always obtained by masturbation, assisted by the provision of pornography. Masturbation instrumentalises and thus debases the sexual faculty, which is proper to marital union, not laboratory experiments. The sexual organs are structured for depositing sperm into the vagina, not into a jar. A masturbator - even one motivated by a desire to fertilise eggs, even his wife's - is 'making love' to his hand, which is unnatural and a form of self-abuse. Masturbation for any purpose - including providing sperm samples for medical purposes - is intrinsically unethical.”

Remember that SPUC claims to be a secular organisation. When SPUC speakers talk about sex and relationships in schools, they do not do so from an officially Catholic position. Ozimic notes that “Catholics in particular should note that it is forbidden” but implies that masturbation is debasing and unnatural for all.

We know that in fact, a majority of people have engaged in some kind of masturbation. It is safe and can be a good way for people to get to know their bodies without risk of sexually transmitted infections or unwanted pregnancy. It’s sad to think that a new generation of young people is being fed these same stigmatising messages about masturbation which can create guilt and shame around what is a natural and common act.

40 Days for Life and so called ‘turnarounds’

This article published in The Guardian yesterday highlights the actions of members of US based anti-abortion campaign 40 Days for Life in the UK. Laura from EFC takes a deeper look at what’s behind the ‘peaceful’ prayer vigils they carry out.

As we approach the end of 40 Days for Life’s most recent spate of prayer vigils it was good to see an article highlighting the negative impact of the misinformation they give out to pregnant women about abortion. 40DfL are often able to hide behind their claim that they are merely praying peacefully outside clinics which provide abortion, but unfortunately they are also providing dangerous medical information to those entering or passing by the clinics. The Guardian article notes:

Flicking through a 40 Days leaflet...saturated in emotive language about "your tiny baby", its pseudo-medical statements imply that abortions often cause "serious physical complications" – a tactic that has earned them the moniker 40 Days for Lies among counter-protesters.

We have written before about 40DfL’s links with crisis pregnancy centres which give misinformation to pregnant women. But there was one part of this particular article which stayed with me. A man named Joseph who represents 40DfL claims to have persuaded a girl of 12 not to have an abortion after confronting her outside a BPAS clinic in London:

"She was 12 years old," he says excitedly, "and she didn't even know who the father was. Dead set on abortion. Now she's gone inside for an ultrasound, but she's agreed to come along with me afterwards. We have a clinic where she can get the loving help she needs to carry her baby full-term."

There are serious issues with this. First of all, at 12, this girl is legally unable to consent to sex and this case becomes a matter of child protection. Beyond that, we know that those young women who have been given the space and support to make their own pregnancy decision (free from pressure and coercion) are more likely to have positive outcomes whether they choose to continue or end the pregnancy. We might also question if it is appropriate to enforce one’s own moral views on a young woman who may have little to no support to raise a child, or a desire to do so. The 40DfL doorsteppers aren’t trained counsellors, they have no knowledge of this young woman’s life experiences, desires and needs, only an ideological desire to ‘save her baby’. As the author of the Guardian article points out, the effects on these so called ‘turnarounds’, AKA real women with real lives ‘will be lifelong’.

Except, you see, this 12 year old didn’t actually exist. Following the publication of the article BPAS confirmed that they hadn’t actually seen anyone of that age in the clinic.

This means that 40DfL thought that the fabrication of a 12 year old girl ‘dead set on abortion’ would be a compelling story to further their cause. That the public would understand and warm to a campaign which attempts to convince women to forgo professional medical advice for biased and misleading information based purely on the desire to prevent abortion. This imaginary figure may not exist, but unfortunately the tactics used to coerce and stigmatise other vulnerable women do. And I for one am shocked that 40DfL would gloat about them.

Irish Hospital Prepared to Forcibly Perform a C-Section on Non-Consenting Woman

EFC volunteer Sarah writes about a recent court case in Ireland which could have required a pregnant woman to undergo a caesarean section against her will.

How would you feel if I told you that a hospital in Ireland went to court last week, because they felt it necessary to tie down a woman, forcibly give her an anaesthetic, and slice open her abdomen, then her uterus? Horrified; disgusted; transported back to a time of symphysiotomies and the Magdalene Laundries? Well, they did.

Last Saturday morning, Waterford Regional Hospital made an emergency application to the High Court in an attempt to compel a pregnant woman to undergo a caesarean section. Lawyers for the hospital said that the woman was refusing to give consent for the procedure, but that a “natural” birth would pose a risk to her unborn child. The woman had a scar on her uterus from a previous caesarean and there was a risk that it would rupture during a vaginal delivery. If this were to happen the baby could have died or have had severe brain damage and the woman herself would have been at risk of a haemorrhage.

The medical staff said that the latest scans were “non-reassuring” and the consultant obstetrician said that he had “advised her strongly” to have a caesarean. The Senior Counsel for the hospital stated that the Judge needed to balance the right of the woman to refuse medical treatment versus the right to life of the unborn child. The right to life of the unborn is guaranteed in the Irish Constitution under Article 40.3.3 °. Just before the Judge was about to rule on the case, the court heard that the woman had “consented” to a C-section and an emergency order was no longer necessary.

In the six news articles I’ve read on this story, there isn’t any mention of why the woman wanted to opt for a vaginal birth; the only reference is that she would have “liked” to. She may have had a perfectly valid, well thought-out reason, but the mainstream press don’t seem too concerned about the actual wishes of this person. It does say that over the weekend she began to waver between consenting to the procedure on the Sunday or Monday as she wanted her husband to be present if possible; the medical staff did not consider this a reasonable request.

The risks associated with a caesarean include increased risk of bleeding, infection of the incision, the urinary tract, or the tissue lining the uterus, injury to surrounding organs such as the bladder and the bowel, and in rare cases blood clots, wound hematoma, and pulmonary embolus. Now, I understand that this case had its own particular risks associated with undergoing a vaginal birth. However it’s not as if the doctors were asking this woman to undergo an easy, risk-free option. A C-section comes with its own dangers and as this woman is a consenting adult who had undergone the procedure before, we have to assume that she was well aware of this. The right to refuse medical treatment exists because we trust people to make their own decisions about their bodies.

This case is reminiscent of the attitude taken when symphysiotomies were performed on women against or without their consent. This procedure involved sawing open a woman’s pelvic bone during childbirth. The subsequent childbirth was excruciating, the recovery time was lengthy, and many were left incontinent and/or incapable of enjoying sexual activity. The practice was used so as to avoid performing a C-section, which limited the amount of children a woman could have. It was used by doctors who objected to family planning and was performed on women in Ireland up until 1984.

Under Irish law, women are treated as incubators. The right to bodily autonomy is just one of the many rights which we no longer have while pregnant. Our right to health is automatically diminished, as we have no option to take the less-risky route of terminating the pregnancy. Rape victims have no right to choose not to go through the added trauma of invasive exams, ante- and post-natal care, and the birth process. Women with non-viable foetuses have no right not to extend this heartbreak for further months and go through the trauma of birth. We are bearers of children and little else. If we are not willing to give ourselves over to this task we can be restrained, refused measures to preserve our health, and in some cases, forced to sacrifice our lives.

This case made clear the lack of respect given for women’s decisions about their own bodies. If this woman had continued to withhold her consent and the court order granted, hospital staff were prepared to physically restrain her and cut her open against her will. This is yet another example of the disempowering and dangerous effects the 8th Amendment has on women. If Irish people want to achieve any semblance of equality between the genders, we have to fight for its repeal.