Despite concerns that alcohol-abstinence recommendations lead women to terminate otherwise wanted pregnancies, only anecdotal evidence has been published Koren and Pastuszak, ; Koren, Legal scholars argue that policies punishing pregnant women for drug use punish women for carrying pregnancies to term, i. Anti-abortion rights activists opposed punitive policies for this reason Gomez, These activists feared that the policies would lead women to have abortions.
However, while punitive policies are in place Gomez, ; Roberts, ; Guttmacher Institute, , there is no evidence from published research that punitive policies have had this effect. One way to examine whether abstinence recommendations and punitive policies lead women to terminate otherwise wanted pregnancies is to examine women's reasons for obtaining abortions.
Of studies finding ATOD as a reason for abortion, none have examined ways in which women talk about why the use is a concern, the level of use about which women worried, or whether pregnancies were otherwise wanted. Further, although few women report ATOD as a reason for abortion, alcohol and drug use is common among women receiving abortions Costa et al. Thus, other factors may explain which women report ATOD as a reason. For example, Hancock et al. Specifically, we:. This mixed methods study analyzes data from baseline interviews conducted as part of the Turnaway Study. The Turnaway Study was designed to assess the effect of receiving versus being denied an abortion on women's physical and mental health and socioeconomic well-being.
Women seeking an abortion at 1 of 30 clinics throughout the USA between January and December were recruited for participation in the study. Abortion facilities' gestational age limits vary widely across the USA due to either facility restrictions e. Turnaway Study sites were selected based on the criterion that no other facility within miles had a later gestational limit for providing abortion. Facilities were identified using the National Abortion Federation directory and contacts within the abortion research community.
All but two sites agreed to participate, one of which was replaced with a facility with an identical catchment area and similar patient volume. Recruitment sites were located throughout the USA, reported a median of abortions in range: — , and had gestational limits from 10 weeks through the end of the second trimester. More details about recruitment sites have been published previously Gould et al.
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Participant recruitment began at one abortion facility in January and gradually expanded over the next 3 years. Eligible participants were pregnant English- or Spanish- speaking women, aged 15 years or older, with no known fetal anomalies or demise, presenting for abortion care within the gestational age range of one of three study groups. Of eligible participants approached, The baseline interview took place by telephone a week after women sought the abortion.
The current paper combines the three groups for analysis. A variable for seeking a first trimester abortion is included in analyses. We combined the reasons and main reasons for analysis purposes because women often did not report a main reason, reported more than one main reason and reported new reasons as main reasons. Differences were resolved through consensus. Non-binge alcohol use was alcohol use over the past month without binge drinking or either alcohol-related problem.
All alcohol use variables correspond to the month prior to pregnancy recognition. Any drug use is any illicit drug or prescription drug misuse during the month prior to pregnancy recognition. Type of drug was dichotomized as marijuana only versus other drugs i.
Marijuana was examined separately because there is less evidence of harms due to use during pregnancy than with other drugs English et al. All drug use was assessed for the month before discovering pregnancy. Tobacco is a dichotomous variable of any versus no tobacco in the month before the baseline interview. Other pregnancy-related characteristics were: difficulty deciding which was a dichotomous measure defined as making the decision to have an abortion was very difficult versus somewhat difficult, neither easy nor difficult, somewhat easy and very easy.
Pregnancy intentions were measured with the London Measure of Unplanned Pregnancy.
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The London Measure is a validated measure of pregnancy intentions that assesses contraceptive use, intentions to become pregnant, extent to which women wanted to become pregnant and partner interest in becoming pregnant in the month before becoming pregnant as well as changes women may have made in preparation for pregnancy and women's perceptions of the timing of the pregnancy Barrett et al.
Self-rated health is a dichotomous variable of rating health prior to pregnancy as good or very good versus fair, poor or very poor. Qualitative data were analyzed through thematic coding Miles and Huberman, ; Maxwell, to address objective 1.
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Our quantitative analysis approach accounted for clustering by recruitment site and was conducted in STATA Forty-six participants 4. Twenty-five 2.
No woman reported tobacco without also mentioning alcohol or drugs. Some who mentioned ATOD as a reason mentioned concerns that their use had or would affect their baby's health if they were to continue the pregnancy. Sought abortion at 22 weeks. Smoked cigarettes. Sought abortion at 24 weeks. This was primarily a concern in relation to drugs.
Only one woman mentioned alcohol in relation to parenting. Sought abortion at 8 weeks. Discovered pregnancy at 14 weeks, sought abortion at 26 weeks. I'm trying to get off of it and worked very hard to get off of it. The other aspect was lack of ability or readiness to parent due to where they were in recovery from drug use disorders.
Sought abortion at 14 weeks. Other women mentioned ATOD without further explanation. Sought abortion at 23 weeks. Sought abortion at 11 weeks. Fifty percent had used drugs before discovering pregnancy, with marijuana being the most common drug. No statistical tests done. Denominator is those reporting binging. Seven had blacked out, with a median of two blackouts range: 1— Most women reporting drug use used it more than four times a week. Of the 11 women reporting drugs as a reason who did not report drug use in response to drug survey questions, three described a partner's use as the reason, six mentioned treatment or recovery as the reason, one mentioned both partner's use and recovery and one misusing prescription painkillers had not used them in the month before discovering pregnancy.
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There were similar differences for drugs. Women reporting ATOD as a reason also discovered pregnancies later There were no differences in pregnancy intentions. Only one woman reporting ATOD as a reason had an intended pregnancy.
Qualitative data indicate that her partner's resumption of drug use was the reason for abortion. In the multivariable model, women who had difficultly deciding whether to have an abortion had about three and a half times the odds of reporting ATOD as a reason for seeking an abortion [odds ratio OR : 3. About 1 in 20 women surveyed cited ATOD as a reason for having an abortion. Eighty-four percent of those citing alcohol as a reason had binged or had an alcohol-related problem-symptom and about half binged more than once a week before discovering their pregnancy.
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Alcohol overdose: The dangers of drinking too much. A word about alcohol poisoning. Alcohol poisoning deaths. Centers for Disease Control and Prevention. Drinking too much too fast can kill you. National Council on Alcoholism and Drug Dependence. American Diabetes Association. Cowan E, et al. Ethanol intoxication in adults.
Baum CR. Ethanol intoxication in children: Epidemiology, estimation of toxicity, and toxic effects. Alcohol toxicity and withdrawal. Merck Manual Professional Version. Sivilotti MLA. Isopropyl alcohol poisoning.
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