Comparison of Health, Development, Maternal Bonding, and Poverty Among Children Born After Denial of Abortion vs After Pregnancies Subsequent to an Abortion

Abstract

Importance: Evidence indicates that there are potential health, development, and maternal bonding consequences for children born from unwanted pregnancies.

Objective: To examine the association of women receiving or being denied a wanted abortion with their children's health and well-being.

Design, setting, and participants: A 5-year longitudinal observational study with a quasi-experimental design conducted between January 18, 2008, and January 25, 2016, examined women who received abortions just under the gestational age limit of 30 abortion facilities across the United States and women who were denied abortion just beyond the gestational age limit in these facilities. Analyses compared the children of 146 women who were denied an abortion (index children) with children born to 182 women who received an abortion and had a subsequent child within 5 years (subsequent children). Interview-to-interview retention averaged 94.5% (6895 of 7293) across the 11 semi-annual interviews.

Exposures: Being born after denial of abortion vs after a new pregnancy subsequent to an abortion.

Main outcomes and measures: Perinatal outcomes and child health, child development, maternal bonding, socioeconomics, and household structure.

Results: This study included 328 women who had children during the study period (mean [SD] age at study recruitment, 23.7 [4.9] years). There were no differences by study group in consent to participate in the study, completion of first interview, or continuation in the study. Among the 328 children in the study (146 index children and 182 subsequent children), there were 163 girls and 165 boys. Perinatal and child health outcomes were not different between subsequent and index children, and there was no clear pattern of delayed child development. However, mixed-effects models adjusting for clustered recruitment and multiple observations per child revealed that poor maternal bonding was more common for index children compared with subsequent children (9% vs 3%; adjusted odds ratio, 5.14; 95% CI, 1.48-17.85). Index children lived in households with lower incomes relative to the federal poverty level than did subsequent children (101% vs 132% of federal poverty level; adjusted regression coefficient, -0.31; 95% CI, -0.52 to -0.10), and were more likely to live in households without enough money to pay for basic living expenses (72% vs 55%; adjusted odds ratio, 5.16; 95% CI, 2.34-11.40).

Conclusions and relevance: These findings suggest that access to abortion enables women to choose to have children at a time when they have more financial and emotional resources to devote to their children.

Figure.. Comparison of Children Born After Denial of Pregnancy With Children Born Subsequently to Women Who Received an Abortion

All outcomes are reported as odds ratios (squares) with 95% CIs (whiskers) from a mixed-effects multivariate model adjusting for covariates (maternal race/ethnicity, maternal age at time of recruitment, birth order [first vs second or greater], sex of child, and except for perinatal outcomes, child’s age at interview) and for clustering by child and site. Perinatal birth outcomes are based on 1 observation per child and include children placed for adoption. All other analyses, with the exception of child lives with mother, are based on multiple observations per child but exclude 15 index children placed for adoption; breastfeeding outcomes were limited to infants younger than 6 months (317 observations), and maternal bonding was limited to children younger than 1.5 years (836 observations). Poor Maternal Bonding determined by a Postpartum Bonding Questionnaire score of 12 or above. Index children were defined as children born after denial of abortion, and subsequent children were defined as children born from the next birth after an abortion. Dashed vertical lines indicate no difference between the index children and subsequent children. NICU indicates neonatal intensive care unit; SNAP, Supplemental Nutritional Assistance Program; TANF, Temporary Assistance for Needy Families; and WIC, Women, Infants, and Children program.