Saving unwanted children: a proposal for a National Rearing Institute

Unwanted children are carried, born, and reluctantly raised each year; they are prone to abortion, abandonment, neglect, and abuse. Meanwhile, many developed societies are suffering from depopulation. To address these two issues concurrently, I propose that governments should grant pregnant women and mothers an irreversible and unconditional one-time chance to relinquish all their legal rights and obligations associated with each of their children under a specific age to a National Rearing Institute that adopts the children and rears them to the age when they can fully exercise their rights as adult citizens. I call this set of policy arrangements "Project New Republicans." This project aims to (1) protect and support the best interests of unwanted children, (2) maximize the health outcomes of the mothers who gave birth to these children and help the mothers to achieve self-realization, and (3) preserve an influx to the population from procreation against depopulation. The project is primarily grounded on both the utilitarian and intra- / inter-generational accounts of justice. It also ameliorates the oppression and domination of women by unjust social structures in alignment with the human rights-based approach.

Role of community-level emergency contraceptive pills awareness and possibilities of long-acting reversible or permanent methods in reducing unwanted births in Bangladesh: evidence from a nationwide cross-sectional survey

OBJECTIVE

This study aims to investigate the role of community-level emergency contraceptive pill (ECP) awareness in reducing unwanted births (UWBs) in Bangladesh and explore the regional variation in women's appropriateness to adopt long-acting reversible contraceptives or permanent methods (LARCPMs) based on their child desire.

DESIGN, SETTINGS AND PARTICIPANTS

We used data from the cross-sectional Bangladesh Demographic and Health Survey 2017-2018. We analysed the planning status of the last live birth 3 years preceding the survey of 20,127 ever-married women of reproductive age.

METHODS

Considering women were nested within clusters, a mixed-effect multiple logistic regression was implemented to investigate the association between community-level ECP awareness and UWB by controlling for the effects of contextual, individual, and household characteristics.

RESULTS

Only 3.7% of women belonged to communities with high ECP awareness. At the national level, 2% of women had UWB. About 2.1% of women who resided in communities of low ECP awareness had UWB, while UWB was only 0.5% among women residing in high ECP awareness communities. The odds of UWB was 71% lower among women who resided in high ECP awareness communities than among those who resided in communities with low ECP awareness. However, community-level ECP awareness could not avert mistimed birth. Dhaka, Chattogram and Rangpur held the highest share of UWB. Fertility persisted for 89% of the women who wanted no more children. Among women who wanted no more children, 15% were not using any method, 13% used traditional family planning methods and only 13% adopted LARCPM. These women mostly resided in Dhaka, followed by Chattogram and Rajshahi.

CONCLUSION

This study highlights the significant positive role of ECP awareness in reducing UWB in Bangladesh. Findings may inform policies aimed at increasing LARCPM adoption, particularly among women residing in Dhaka and Chattogram who want no more children.

Exploration of adverse patterns of placement of young people in secure care: The unwanted child?

BACKGROUND

Emerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes.

AIMS

This study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics.

METHODS

Data were derived from the (2016) cross-sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI).

RESULTS

Overall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long-distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long-distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements.

CONCLUSIONS

Distant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi-agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.

Unintended Birth and Children's Long-term Mental Health

Research has examined the proximate effects of unintended birth on infants and young children, but we know relatively little about the longer-term effects. Given that unintended birth is associated with several childhood risk factors, it might set the stage for poor mental health in adulthood. Drawing on rich intergenerational survey data from the National Longitudinal Survey of Youth, 1979 ( N = 3,742), this study used a variety of statistical techniques to examine whether maternal pregnancy intentions are associated with children's depressive symptoms during early adulthood. Results from ordinary least squares regression suggest that children resulting from unintended pregnancies experienced more depressive symptoms in their 20s than children resulting from intended pregnancies, controlling for a host of characteristics. Results from propensity-weighted and sibling fixed-effects models suggest that there is little to no causal relationship, however. Much of the initial association between maternal fertility intentions and children's depressive symptoms is attributed to the mother's sociodemographic characteristics.

Artificial gametes and the ethics of unwitting parenthood

In this paper, we explore the ethical and legal implications of a hypothetical use of artificial gametes (AGs): that of taking a person's cells, converting them to AGs and using them in reproduction-without that person's knowledge or consent. We note the common reliance on genetic understandings of parenthood in the law and suggest that injustices may arise if unwitting genetic parents are sued for child support. We draw parallels between the hypothetical use of AGs to facilitate unwitting parenthood and real examples of unwitting parenthood following cases of sperm theft. We also look at the harm that might be caused by becoming a genetic parent, independently of financial obligations, and ask whether such harm should be understood in terms of theft of property. These examples help to highlight some of the current and prospective difficulties for the regulation of genetic and legal parenthood, and show how existing regulatory assumptions are likely to be further challenged by the development of AGs. We conclude by suggesting that the reliance on genetic connections to generate parental responsibility (financial or otherwise) for offspring is flawed and that alternative ways of establishing parental responsibility should be considered.

Benefits of meeting the contraceptive needs of Cameroonian women

(1) In 2013, an estimated 40% of pregnancies in Cameroon were unintended. (2) More than six in 10 women who want to avoid pregnancy either do not practice contraception or use a relatively ineffective traditional method. These women can be said to have an unmet need for modern contraception. (3) Meeting just half of this unmet need would prevent 187,000 unplanned pregnancies each year, resulting in 65,000 fewer unsafe abortions and 600 fewer maternal deaths annually. (4) If all unmet need for modern methods were satisfied, maternal mortality would drop by more than one-fifth, and unintended births and unsafe abortions would decline by 75%. (5) Investing in contraceptive commodities and services to fulfill all unmet need among women who want to avoid pregnancy would result in a net annual savings of US$5.4 million (2.7 billion CFA francs) over what would otherwise be spent on medical costs associated with unintended pregnancies and their consequences. (6) Expanding contraceptive services confers substantial benefits to women, their families and society. All stakeholders, including the Cameroon government and the private sector, should increase their investment in modern contraceptive services.

Why do families relinquish care? An investigation of the factors that lead to relinquishment into out-of-home respite care

BACKGROUND

Families/carers relinquishing the care of family members with a disability into the care of out-of-home respite facilities is an under-researched area in the disability field. With this in mind, the aim of this study was to explore the factors that lead to families relinquishing care, the potential early indicators that families are considering relinquishment; the factors that may prevent relinquishment and the outcomes for families/carers after relinquishment occurs.

METHOD

Thirty-two client files (of individuals for whom families have relinquished their care in a defined 12-month period) were reviewed for information around their relinquishment into out-of-home respite care facilities for an extended stay. Staff members involved with these families (a total of 17) were also interviewed to provide more information.

RESULTS

A thematic analysis of the results found that the factors that led to relinquishment could be categorised into: (1) characteristics inherent to the individual with intellectual disability; (2) characteristics inherent to the family/carer; and (3) characteristics associated with the support context that the carer/family is currently experiencing. It was also found that families'/carers' experienced positive outcomes after relinquishment had occurred; however, feelings of guilt and mourning were initially felt.

CONCLUSIONS

Extra supports (e.g. increased respite care, planning for movement of the family member into out-of-home permanent accommodation and case management) and positive interventions such as parent training were highlighted as potential strategies to achieve more lasting benefits from short-stay out-of-home respite care.

[Analysis on basic vaccination situation of left-behind children in rural areas in Anhui and Sichuan Provinces]

OBJECTIVES

To understand the vaccination situation of left-behind children in rural areas, provide the evidence for developing vaccination strategies for left-behind children.

METHODS

The counties with population over 1,000,000 were selected from Anhui and Sichuan provinces respectively to conduct survery to the children who were born between the year 2003 and 2006, and had registration on vaccination book(card).

RESULTS

The proportion of left-behind and outflow children are 17.94% and 6.05% respectively. The information about the children's parents going out most came from village doctors. The proportion of the parents going out after children born was 51.60%, staying outside for more than 10 months was 78.50%. 67.97% parents came back home during the spring festival, 35.43% left-behind children went out with their parents.

CONCLUSION

Although the number of outflow children was smaller than the left-behind children, it was easy to develop immunization gap. It is the difficult part of management on EPI to migrant children. The information aboat the children's parents going out mostly came from village doctors. It is important to mobilize the enthusiasm of doctors. It is especially essential that we should propagandize to the people with vaccination knowledge to the parents came back home during spring festival.

Pregnancy wantedness and child attachment security: is there a relationship?

OBJECTIVES

Few studies examine the consequences of unwanted pregnancy on child development, and most of those that do, use measures of pregnancy intention. Here we use measures of pregnancy wantedness, together with measures of maternal motivation, to examine the potential effect of wantedness on the child's attachment relationship with its mother.

METHODS

Using data collected from 78 primiparous Black women who had applied for an Early Head Start program in a Midwestern city and who had completed a pregnancy acceptance questionnaire, we created four measures: Pregnancy Wantedness, Positive Maternal Motivation, Negative Maternal Motivation, and Social Reinforcement for the pregnancy. Each child had been assessed at about 11 months of age for Difficult Temperament and at about 14 months of age for Attachment Security. We then tested both regression and linear structural equation models in order to predict the child's attachment security with the remaining variables.

RESULTS

Pregnancy Wantedness is predicted with an R (2) of .198 by Negative Maternal Motivation and Social Reinforcement but does not predict Attachment Security, which is predicted with an R (2) of .375 by Positive Maternal Motivation, Negative Maternal Motivation, and Difficult Temperament.

CONCLUSIONS

Our analyses indicate that in a multivariate context there is no relationship between the wantedness of a pregnancy and the subsequent attachment security of the child for this sample of low-income Black primiparous mothers. This finding is related to some conceptual and measurement issues of pregnancy wantedness, the irrelevance of some aspects of wantedness to parent-child interaction, and the powerful effect of maternal motivations on child attachment security.

Crimes and misdemeanours: the case of child abandonment

In 2002, a child was abandoned in a Burger King restaurant in Amsterdam by a Chinese woman, who hoped that the baby would be picked up by someone able to give the child a better life. She was convicted for child abandonment and imprisoned. Whereas some forms of child abandonment are criminalised, others are socially accepted and not even on the ethics agenda. This paper is an invitation to reflect on the inconsistency in the ways in which we prosecute, punish or try to correct some forms of child abandonment and yet make allowances for others.

Genetic ties: are they morally binding?

Does genetic relatedness define who is a mother or father and who incurs obligations towards or entitlements over children? While once the answer to this question may have been obvious, advances in reproductive technologies have complicated our understanding of what makes a parent. In a recent publication Bayne and Kolers argue for a pluralistic account of parenthood on the basis that genetic derivation, gestation, extended custody and sometimes intention to parent are sufficient (but not necessary) grounds for parenthood. Bayne and Kolers further suggest that definitions of parenthood are underpinned by the assumption that 'being causally implicated in the creation of a child is the key basis for being its parent'. This paper examines the claim that genetic relatedness is sufficient grounds for parenthood based on a causal connection between genetic parents and their offspring. I argue that parental obligations are about moral responsibility and not causal responsibility because we are not morally accountable for every consequence to which we causally contribute. My account includes the conditions generally held to apply to moral responsibility, i.e. freedom and foreseeability. I argue that parental responsibilities are generated whenever the birth of a child is a reasonably foreseeable consequence of voluntary actions. I consider the implications of this account for third parties involved in reproductive technologies. I argue that under some conditions the obligations generated by freely and foreseeably causing a child to exist can be justifiably transferred to others.

Perspectives on newborn abandonment

OBJECTIVES

The goals of this study were to identify the socioeconomic influences that may lead to newborn abandonment and the attributes common to individuals who abandon their infants, to develop an understanding of the legislative issues affecting the abandonment of newborns by state, and to describe an emergency care program designed to preserve newborn life.

METHODS

A retrospective review of case files, publications, and headline news was undertaken to identify commonalties among individuals who abandon their infants. Accurate statistical data about this issue are nonexistent; however, extrapolations can be made from documented cases. Predictors of abandonment assist healthcare workers in identifying and preventing the needless deaths of newborn infants through early education and prevention programs. If these children survive, they often become the challenges of emergency care staff.

RESULTS

There are now at least 46 states that have proposed or enacted legislation related to infant abandonment. The laws are designed to promote the safe surrender of newborns to designated child protective agencies, including emergency departments. These legislative controls now regulate safe havens to accept newborns that would otherwise be abandoned.

CONCLUSIONS

There is still much to learn about infant abandonment. A national database to compile statistics about the incidence of abandonment is currently not available. Research is necessary to validate the findings collected in retrospective reviews. The choices parents make between the options of abandoning versus surrendering the infant to a safe haven require further study. Preventative programs and education of the public and particularly of the high-risk groups require a greater emphasis on improving child protection procedures. Programs in emergency departments must be developed to expedite care and to support and protect life.

Social situation of expectant mothers and alexithymia 31 years later in their offspring: a prospective study

OBJECTIVE

We studied the association between alexithymia in adulthood and social situation of the child's family at the time of the child's birth.

METHODS

The study forms part of the prospective Northern Finland 1966 Birth Cohort Project. The original material consisted of all 12,058 live-born children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The material represents 96% of all births in the region. In 1997 a 31-year follow-up study was made on part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5983 participants of the field study. Of them, 85% returned the questionnaire properly completed. Factors indicative of the social situation of the child's family were already gathered during pregnancy and the time of birth from the mothers, thus eliminating recall bias.

RESULTS

Alexithymia was more common in subjects from rural than urban dwelling areas. Unwanted children or subjects born into families with many children also exhibited an association with alexithymia in adulthood.

CONCLUSIONS

Maternal social situation and environment predict alexithymia in the offspring.

[How consistent are personal data? Analysis of statements on the planning status of pregnancies]

The consistency of responses on the planning status of births is analyzed using data from a longitudinal fertility survey being carried out by the Demographic Institute of the Austrian Academy of Sciences. Interviews were conducted in 1978 and 1981 with a sample of two marriage cohorts; in both sets of interviews a question was asked concerning the reaction to a pregnancy at the time the woman heard about it. "After linking the data for the pregnancies leading to first or second births, a consistency index suggested by Ryder and Westoff...was applied which distinguishes between random and nonrandom consistency. For the first births a proportion of 54.4% identical answers yields a consistency index of 38.0...; for second births a proportion of 53.7% identical answers results in [a] consistency index of 30.1...." Differential consistency is also analyzed according to selected socioeconomic and demographic variables as well as a variable measuring the correspondence of husband's and wife's desired family sizes in the opinion of the husband. (summary in ENG)

Who should pay for bad genes?

Parents have long been able to influence the genetic composition of their children through their choice of a reproductive partner, if only very approximately. They are, however, increasingly able to determine the genetic make-up of their children in other, more precise ways, such as by selecting a particular gamete or embryo or by genetically modifying an embryo prior to artificial implantation. This Article discusses parents' obligations to their children and other members of the community stemming from their children's genes. In a just state, it argues, parents would be responsible for redressing any genetic disadvantage their children suffer as a result of parents' voluntary actions. Within the context of a liberal egalitarian account of distributive justice, this responsibility might most fairly be discharged through a compulsory insurance plan that provides compensation to genetically disadvantaged children when they might have had non-disadvantaged children instead would in some circumstances incur greater liability, because they could not fairly push the cost of their choices off on other members of the insurance pool. The Article also asks whether parents wrong a child by allowing it to be born with a genetic impairment when, had they taken steps to remove the impairment, the unimpaired child they had would have been a different person from the genetically disadvantaged child because the better-off child's capacities and experiences differed considerably from those that the disadvantaged child would have had. Contrary to many people's moral intuitions, the Article argues that parents do not wrong such a child. Nevertheless, parents remain morally obligated to bear any added costs occasioned by the child's impairment. Any other approach would allow them unjustly to shift the burden of their choices to other parents. Finally, the Article takes up the much debated question of whether parents harm a child by allowing it to be born with a life not worth living when they could have prevented its birth. It suggests that the answer to this question should be irrelevant to parents' legal liability. Acting on behalf of the parental insurance pool, the state may nonetheless adopt a variety of measures to help potential parents avoid giving birth to such children, which one can assume virtually all would prefer.