Keep or adopt: a study of factors influencing pregnant adolescents' plans for their babies

Resolving unintended pregnancy crisis: Is adoption a viable option? A cross-sectional study in Kumasi, Ghana

Objectives

Unintended pregnancy presents a crisis situation with limited options for resolution. Abortion appears to be a commonly chosen option but is stigmatized in many societies including Ghana. Keeping a child from an unintended pregnancy is also unsuitable for many people. Carrying through with the pregnancy and placing the child up for adoption is a potential management option but there is scanty literature on how viable this option is to women globally including Ghana. The study sought to assess acceptability of this option and its barriers and facilitators in Ghana.

Methods

This study was a part of a bigger analytical cross-sectional study on unintended pregnancy in Kumasi conducted in three centres from January to April 2014. Exit interviews were conducted for 461 consenting women to capture data on demography, reproductive profile and acceptability of giving up a child from an unintended pregnancy for adoption. Frequencies, proportions and means were computed and presented in tables.

Results

Over 85% of respondents would not give up their children for adoption as a way to manage their unintended pregnancy, whereas about 6% were undecided. A need for the child to grow up in a two-parent home was considered more important than the financial security of the adoptive parents while disappointment from family and friends came up as marked barrier to adoption.

Conclusions

Keeping a pregnancy and placing the child up for adoption is presently not ideal for managing an unintended pregnancy crisis. More education is needed to increase awareness of adoption as an option in resolving this crisis while continued efforts are made at primary prevention through using contraceptives. The complex adoption process must be made friendly for women with unintended pregnancies who neither desire parenting nor abortion.

Pregnant and Parenting Adolescents

This study comlpared pregnant adolescents intending to relinquish their infants, pregnant adolescents intending to parent, and parenting adolescents on measures of coping and psychosocial adjustment. Comparisons were also made either to a group ofnonpregnant adolescents or to norms. Pregnant adolescents intending to relinquish their infants showed better overall levels of self-image than pregnant adolescents intending to parent, and parenting adolescents. Parenting adolescents showed significantly more disruption in specific areas of psychosocial adjustment than pregnant adolescents intending to parent. These differences were discussed as target areas for intervention. The parenting experience also affected the types of coping strategies used by adolescents. Both groups, pregnant adolescents and nonpregnant adolescents, were more likely to use less active coping strategies than parenting adolescents. A negative relationship found between these less active forms of coping and psychosocial adjustment underscored the importance of targeting individual differences in adolescents' responses to the stressors of pregnancy and parenthood.

Adolescent perceptions of adoption. Implications for resolving an unplanned pregnancy

This research examines the attitudes and perceptions that adolescents have of adoption. Of particular interest is how these attitudes might help to explain the decline in the choice of the adoption alternative as a way of resolving an unplanned pregnancy. Although participants appear to have generally favorable attitudes toward adoption, there were high levels of uncertainty about how parents and friends would feel about adoption. In relation to other pregnancy resolution alternatives, adoption is the least discussed option. Finally, many were uncertain about how to go about adoption and there were perceptions that making an adoption plan was complicated and of questionable legality.

Parenting or placing: decision making by pregnant teens

This research studies decision making for resolution of an unplanned pregnancy as a dynamic process and examines predictors of both the initial plan and the consistency of the adoption plan. Among 162 pregnant adolescents in a maternity residence, 57% entered the program planning adoption for their baby. Nearly half of them changed that plan by discharge and decided to parent. Social influence variables were predictive for both the original plan and consistency. Mother's preference was the strongest predictor of initial plan, and birthfather's preference was the strongest for consistency. Sociodemographic and social psychology variables were not predictive.

Pregnancy testing and counseling

Pregnancy testing and counseling are increasingly accepted as necessary services for adolescents within the primary care setting. For teenagers in need of a pregnancy test, the easy-to-perform, highly sensitive and specific enzyme immunoassay analysis for measuring beta-human chorionic gonadotropin (beta-HCG) is ideal. However, no single beta-HCG analysis should be taken as absolute evidence for the presence or absence of pregnancy. Instead, an integrated approach using all of the health care professional's skills in adolescent health care should be taken. In some cases a careful history and physical examination will confirm the pregnancy. At other times serial quantitative serum HCG titers, pelvic ultrasonography, and culdocentesis may be necessary to rule out the possibility of ectopic pregnancy or threatened abortion. For more than three quarters of pregnant adolescents the pregnancy is unplanned and may represent a major conflict for themselves, their partner, and their families. When such an event occurs the health care professional will frequently be sought as a resource. Successful pregnancy counseling has many components. The adolescent will need to visualize the counselor as an available, sensitive, nonjudgmental individual who believes in the right of the pregnant teenager ultimately to progress to her own decision. The counseling process should be firmly based on an understanding of adolescent psychosocial and biologic development, crises intervention techniques, and family dynamics. The counselor needs to be a reliable information source. If the adolescent decides to go to term, programs offering comprehensive prenatal services to teenagers should be identified. Information concerning high-quality, low-cost abortion services also will need to be available for those who wish to terminate. It is important to monitor the quality of care given in prenatal and abortion service referrals. Few adolescents currently choose to place their babies for adoption. Counseling in this area is especially needed. Several types of adoption procedures are available and at appropriate times during a teenager's neonatal care adoption should be presented as a reasonable alternative to parenthood. Throughout this process, the health care professional will have opportunities to discuss a wide variety of health related topics with the adolescent and often her partner and their respective families. Ideally, whatever her final decision, it is the goal of the counselor to make the experience a positive and maturing influence on her life and the lives of other persons involved.