reproduction

New York recently changed their abortion laws to allow late-term abortions when the circumstances put the mother or the fetus at risk. The law has since spurred controversy, causing a backlash in many states to limit abortion access and curb women’s reproductive rights. The law and its political backlash highlight how we often think about pregnancy as a yes-or-no answer, an all-or-nothing commitment. But a recent article in The Upshot emphasizes how this binary view of pregnancies as either “planned” or “unplanned” is inaccurate. Recent research shows that in 9 to 19% of pregnancies the mother was not sure what she wanted at the time. However, most service providers do not account for this kind of ambivalence.

Sociologist Heather Rackin argues that the distinction between  “unintended” vs. “unwanted” pregnancies is important:

“It might not be that unintended pregnancy has all these negative consequences that we think about…for some people, it might have positive consequences.”

However, when pregnancies are unwanted, mothers tend to lack resources needed to raise a child. Family planning services can address this distinction by providing continual care depending on the needs and desires of their patients. To reduce the number of unwanted pregnancies, doctors have been encouraged to ask patients about their desires to become pregnant. For those that may not want to be pregnant, contraceptive methods with more efficiency than birth control may be ideal. On the other hand, doctors can provide prenatal guidance and a contraceptive method that is reversible for patients who are uncertain.

In short, pregnancy and parenthood are complex — decisions to raise a child cannot be reduced to whether a pregnancy is planned or unplanned.

Pregnancy can be risky and expensive at any age.  But for those who can afford the costs, holding off until an older age can be advantageous. A recent article in The Atlantic describes how first-time moms over 40 tend to have greater education and financial stability. Drawing from a national fertility study, sociologist Karina Shreffler finds that half of women over 40 had to pursue expensive treatments like in vitro fertilization (IVF) in order to get pregnant. Older women are also at higher risk for various medical conditions. However, more affluent women have the financial ability to bear these expenses. Shreffler discusses numerous advantages that accompany this choice:

“People who are pursuing college are more likely to create this broader life plan: when to time their education, when to form their families, when to go for the promotion…We just don’t see that to that extent with women who don’t have college degrees.”

Waiting to have children can lead to more financial success and additional career opportunities, benefiting the children of older moms. Sociologist Karen Guzzo explains,

“These women are aware that, the longer they work before having kids, the more established they’ll be when they need to take time off — and the more valuable they’ll be to their companies.”

But again, these benefits are contingent upon the economic ability to bear the added costs that come with waiting to have children. As long as affluent, educated women are better equipped to benefit from late motherhood than women without college degrees, these benefits will perpetuate inequality.

It is old news that many women are postponing childbearing until after they have established their careers. Those of us who have rounded to the other side of thirty have been warned repeatedly, by doctors, mothers, and the general public alike, about the impending, relentless ticking of our biological clocks and our diminished chances of pregnancy. With this demographic trend has come the tired yet all-too-relevant trope of the childless urban professional suddenly obsessed with pregnancy. (See, for reference, half of the characters in Sex and the City and all three female leads on Friends.)

However, men are actually just as baby-crazed, if not moreso, than their female counterparts, according to an article by Katie McDonough at Salon.com. Sociologist Robin Hadley from Keele University surveyed 81 women and 27 men on their feelings about not having children. While men and women both expressed a desire for children at about the same rate, men were more likely to feel depressed, angry, isolated, and jealous about not having children. In fact, 69% of childless men surveyed “had experienced yearning for a child, in comparison to just 11% of women.”

According to Hadley,

This challenges the common idea that women are much more likely to want to have children than men, and that they consistently experience a range of negative emotions more deeply than men if they don’t have children.

The so-called “mommy wars” have apparently made it all the way to the delivery room, according to Jennifer Block, writing for Slate:

For a long time home birth was too fringe to get caught in this parenting no-fly zone, but lately it’s been fitting quite nicely into the mommy war media narrative: There are the stories about women giving birth at home because it’s fashionable, the idea that women are happy sacrificing their newborns for some “hedonistic” spa-like experience, or that moms-to-be (and their partners) are just dumb and gullible when it comes to risk management…

For many parents, home birth is a transcendent experience. …Yet as the number of such births grows, so does the number of tragedies—and those stories tend to be left out of soft-focus lifestyle features.

Debates about home birth have erupted in the media and the blogosphere in recent months, largely focused on the relative risks of home birth versus hospital birth. But at the heart of the issue is who, and what evidence, to trust.

I could list several recent large prospective studies… all comparing where and with whom healthy women gave birth, which found similar rates of baby loss—around 2 per 1,000—no matter the place or attendant. We could pick through those studies’ respective strengths and weaknesses, talk about why we’ll never have a “gold-standard” randomized controlled trial (because women will never participate in a study that makes birth choices for them), and I could quote a real epidemiologist on why determining the precise risk of home birth in the United States is nearly impossible. Actually, I will: “It’s all but impossible, certainly in the United States,” says Eugene Declercq, an epidemiologist and professor of public health at Boston University, and coauthor of the CDC study that found the number of U.S. home births has risen slightly, to still less than 1 percent of all births. One of the challenges is that “the outcomes tend to be pretty good,” Declercq says…But to really nail it down here in the U.S., he says, we’d need to study tens of thousands of home births, “to be able to find a difference in those rare outcomes.” With a mere 30,000 planned home births happening each year nationwide, “We don’t have enough cases.”

And, as sociologist Barbara Katz-Rothman notes, decisions about where to give birth are likely made more on the basis of perceived, rather than real, risk.

“What we’re talking about is felt risk rather than actual risk,” explains Barbara Katz-Rothman, professor of sociology at the City University of New York and author of much scholarship on birth, motherhood, and risk. Take our fear of flying. “Most people understand intellectually that on your standard vacation trip or business trip, the ride to and from the airport is more likely to result in your injury or death than the plane ride itself, but you never see anybody applaud when they reach the airport safely in the car.” The flight feels more risky. Similarly, we can look at data showing our risk of infection skyrockets the second we step in a hospital, “but there’s something about the sight of all those gloves and masks that makes you feel safe.”