PERINATAL AND WOMENS HEALTH Abhilash Chandra

PPD THEME ASSIGNMENT USydMP III

TEENAGE PREGNANCIES AND ABORTION

Case: Ms A, a 16-year-old school girl, presented to Nepean Hospital at 9 weeks gestation requesting a termination of pregnancy. She had multiple partners and was not sure about the identity of the father. This was her first pregnancy. Discussion: Unsafe sexual practices and unwanted pregnancies are significant health issues for Australian teenagers. About one in four Year 10 students and half of all Year 12 students have had vaginal intercourse1. 61% of females had at least one sexual partner in the last year. The most recent sexual encounter for about two thirds of young people was with their regular girlfriend or boyfriend, whereas the most recent sexual encounter for 10.8% of teenagers was with someone they had met for the first time. Factors identified in teenagers engaging in such risk-taking behaviour include loneliness, boredom, substance abuse, and peer pressure. Unplanned pregnancies are seen quite commonly in these population groups. This essay outlines some of the issues underlying unplanned pregnancies in teenagers, the options available to these women, the ethics of termination of pregnancy, and potential complications of abortion. Each year, almost one million teenagers in Australia become pregnant of which 85% are unintended2. The highest at-risk groups in Australia are young women in lower socioeconomic groups such as in Western Sydney, teenagers in regional areas, and indigenous Australians. In 2001, the fertility rate for Queensland indigenous mothers aged 15-19 was 74.2 births per 1,000 compared to 22.5 per 1,000 in the general Queensland population3. The most common reasons for unplanned pregnancy were attributed to a lack of sex education at schools4 and lack of youth health centres in regional areas where the highest rates of teenage pregnancy occur. In the first 12 months of sexual activity, young women are still deciding on what contraception to use. About 50% of teenagers are sexually active for 12 months before they visit their doctor for prescription contraception5. 86% of young people in relationships of one year's duration or less do not use condoms every time they have sex. Over half of those who use the contraceptive pill do not use condoms to protect themselves from sexually transmissible diseases. Approximately half of all teenage pregnancies occur within the first six months of becoming sexually active and young women are the most common users of the morning-after pill at Australian family planning clinics6. The options for women with unplanned pregnancies are: parenting, foster care, adoption, and abortion. As many as one in six women aged 20 to 29 who are asked about pregnancy will have experienced a pregnancy as a teenager. About half of these unwanted pregnancies were terminated. Statistics from 1998 show that medical abortion is the second most common hospital procedure for Australian women aged between 12 and 24 years 7. According to Medicare records from 1997 to 1999, there were 22 abortions per 1,000 teenagers, which is one of the highest teenage abortion rates in the West, following USA, Hungary, New Zealand, United Kingdom and Canada8. Between 2002-2003, 73,267 termination procedures were performed, with women aged 0-19 representing 10,478 1

PERINATAL AND WOMENS HEALTH Abhilash Chandra

PPD THEME ASSIGNMENT USydMP III

(14.3%) of this total number8. This was more than one for every three livebirths. Less than 2% of abortions are for foetal abnormalities, the others are for social and economic reasons4. Abortion has been a very controversial subject for many years. Before the views about abortion is discussed, an appropriate definition needs to be given. The medical definition of abortion is termination of pregnancy by any means before the foetus is sufficiently developed to survive9. There are two sides to the abortion debate: 1) the PRO-LIFE group are against abortion all together; and 2) the PRO-CHOICE group believe that it is the individual womans right to choose if she wants to bear the child or have an abortion. The argument given by the pro-life group is that it is always wrong to cause the death of a person or potential person, and hence abortion is always wrong and immoral. The counter arguments by the pro-choice group are that the woman is an incubator of a foetus the woman is a person whereas the foetus is not. Their argument is that the time and criteria for when a foetus is deemed to be alive is unclear. The early foetus has neither central nervous system nor brain, and therefore no mental activity. Hence, the early embryo is a potential but not yet a human being. In addition, the concept of autonomy requires that a competent individual be entitled to make a decision that can lead to the death of her foetus. Another argument for the pro-choice group is that it is the parents moral responsibility to make sure that the environment that a child is brought into will be heathy and supportive it is a far greater crime to treat a child poorly for eighteen years then it is to terminate a foetus who cannot think, feel, or be aware of its existence. Many Australian laws relating to abortion are unclear10. Australian legislation concerning abortion is based on English Common Law which has generally been interpreted that abortion is illegal. However, the law has also been interpreted by some judges such that abortions can be carried out delibrately and legally in certain circumstances. To be lawful, an abortion is an option where the birth of a child would jeopardise the physical and mental health and wellbeing of the woman and her family. This means that a woman is not entitled to terminate a pregnancy unless she can establish that her health or that of her children would be injured. As such, the concept of beneficience (maintaining the mothers health for as long as possible) and non-maleficience (minimising harm to the mother) are able to be met. Australian societys views support a womans access to abortion. Opinion polls have consistently shown that majority of Australians support womens right to choose and believe that forcing a woman to have an unwanted child is worse than allowing abortion. Pregnancy counselling is an essential component in the management of all, and especially teenage, unplanned pregnancies. Ideally, counselling should support the young woman in making a free and fully informed decision about her options, and give information on abortion, adoption and parenting. Many teenagers feel uncomfortable or unable to talk with family so professional counselling offers a valuable resource. Marie Stopes International is the only national provider of abortions in Australia with clinics in Western Australia, Queensland, New South Wales and Victoria, but there are private clinics in every state and territory that provide the service, and pregnancy terminations are also performed in public hospitals. Numerous complications can result from termination of pregnancy. Post Abortion Syndrome is a type of post-traumatic stress disorder listed in the Diagnostic and Statistic Manual of Mental Disorder. Many women suffering abortion trauma are not consciously

PERINATAL AND WOMENS HEALTH Abhilash Chandra

PPD THEME ASSIGNMENT USydMP III

aware that the abortion is the main cause of their problems. Post-abortion syndrome can manifest in 1) Self-destructive behavior such as suicidal tendencies, drug and alcohol abuse, eating disorders, or domestic violence; 2) Chronic problems with relationships including marriage and family breakdown. These young women are also susceptible to mental health disorders including postnatal depression, anxiety attacks, compulsive disorders and other mental health problems. Health professionals are not being trained to identify, treat or prevent Post Abortion Syndrome. Very few counselors or health professionals are prepared to deal with abortion trauma, and even fewer are skilled to do so. Most women seriously damaged by abortion have no access to the professional help they need. Some pregnant teenagers are so shocked and frightened that they try to cope by ignoring or denying the pregnancy. This means they don't receive proper antenatal care, or miss the safest window of opportunity for abortion. Research indicates that sex education and access to effective contraception are essential in preventing unplanned pregnancy in the teenage population. There are additional physical risks if the woman is not able to get a confidential legal abortion11. Illegal abortions are unsafe, and often associated with high rates of illness and death. Unsafe abortion can result in haemorrhage, infection, cuts or chemical burns. Treatment can require hospitalization, blood transfusions, antibiotics and other drugs. Sometimes, abortion results in death of both the mother and the fetus. As an unplanned pregnancy may result in expulsion from school, dishonor, isolation from family and friends, disease, and in severe cases, death, many teenage girls turn to illegal abortion. Illegal abortion is often from an untrained person under unsafe conditions. In summary, underage sex and teenage pregnancies remain a major health issue in certain at-risk Australian communities. These women may be unaware about the options available to them mainly due to a lack of knowledge and education. Almost all will consider abortion, and a significant proportion will go on to terminate the pregnancy. It is essential that these populations get appropriate counseling, advice and support as repercussions may be devastating for the woman physically and psychologically. References: 1 Lindsay J, Smith A, Rosenthal D. Secondary students, HIV/AIDS and sexual health 1997. Melbourne: La Trobe University, Centre for the Study of Sexually Transmissible Diseases, 1997. Monograph Series. Report No. 3. 2 www.sydneysabortion.8m.com. 3 Australian Bureau of Statistics. Births Australia, 2001 Canbera: Australian Bureau of Statistics 2002. 4 UNICEF. A league table of teenage births in rich nations. Innocenti Report Card No. 3, July 2001. Florence, Italy: UNICEF Innocenti Research Centre, 2001. 5 Alan Guttmacher Institute. Sex and Americas teenagers. New York: AGI, 1994. 6 Mirza T, Kovacs GT, McDonald P. The use of reproductive health services by young women in Australia. Aust N Z J Obstet Gynaecol 1998; 38: 336-338. 7 Moon L, Meyer P, Grau J. Australias young people: their health and wellbeing 1999. Canberra: Australian Institute of Health and Welfare, 1999. (AIHW Catalogue No. PHE 19).

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PPD THEME ASSIGNMENT USydMP III

van der Klis KAM, Westenberg L, Chan A, et al. Teenage pregnancy: trends, characteristics and outcomes in South Australia and Australia. 1999. Aust N Z J Public Health; 24: 316-319. 9 Scarpelli EM. Personhood: a biological phenomenon. 2001. J Perinat Med. 29(5): 417-26. 10 De Crespigny LJ, Savulescu J. Abortion: time to clarify Australia's confusing laws. 2004. MJA;181(4):201-3. 11 Sparrow MJ. A woman's choice. 2004. Aust N Z J Obstet Gynaecol. 44(2):88-92.