Tag Archives: abortion/reproduction

Poverty Poses a Bigger Risk to Pregnancy Than Age

Cross-posted at Family Inequality and The Atlantic.

The problem of income inequality often gets forgotten in conversations about biological clocks.

The dilemma that couples face as they consider having children at older ages is worth dwelling on, and I wouldn’t take that away from Judith Shulevitz’s essay in the New Republic, “How Older Parenthood Will Upend American Society,” which has sparked commentary from Katie RoipheHanna RosinRoss Douthat, and Parade, among many others.

The story is an old one — about the health risks of older parenting and the implications of falling fertility rates for an aging population — even though some of the facts are new. But two points need more attention. First, the overall consequences of the trend toward older parenting are on balance positive, both for women’s equality and for children’s health. And second, social-class inequality is a pressing — and growing — problem in children’s health, and one that is too easily lost in the biological-clock debate.

Older mothers

First, we need to distinguish between the average age of birth parents on the one hand versus the number born at advanced parental ages on the other. As Shulevitz notes, the average age of a first-time mother in the U.S. is now 25. Health-wise, assuming she births the rest of her (small) brood before about age 35, that’s perfect.

Consider two measures of child well-being according to their mothers’ age at birth. First, infant mortality:

(Source: Centers for Disease Control)

Health prospects for children improve as women (and their partners) increase their education and incomes, and improve their health behaviors, into their 30s. Beyond that, the health risks start accumulating, weighing against the socioeconomic factors, and the danger increases.

Second, here is the rate of cognitive disability among children according to the age of their mothers at birth, showing a very similar pattern:

(Source: Calculations made for my working paper)

Again, the lowest risks are to those born when their parents are in their early 30s, a pattern that holds when I control for education, income, race/ethnicity, gender, and child’s age.

When mothers older than age 40 give birth, which accounted for 3 percent of births in 2011, the risks clearly are increased, and Shulevitz’s story is highly relevant. But, at least in terms of mortality and cognitive disability, an average parental age in the late 20s and early 30s is not only not a problem, it’s ideal.

Unequal health

But the second figure above hints at another problem — inequality in the health of parents and children. On that purple chart, a college graduate in her early 40s has the same risk as a non-graduate in her late 20s. And the social-class gap increases with age. Why is the rate of cognitive disabilities so much higher for the children of older mothers who did not finish college? It’s not because of their biological clocks or genetic mutations, but because of the health of the women giving birth.

For healthy, wealthy older women, the issue of aging eggs and genetic mutations from fathers’ run-down sperm factories are more pressing than it is for the majority of parents, who have not graduated college.

If you look at the distribution of women having babies by age and education, it’s clear that the older-parent phenomenon is disproportionately about more-educated women. (I calculated these from the American Community Survey, because age-by-education is not available in the CDC numbers, so they are a little different.)

Most of the less-educated mothers are giving birth in their 20s, and a bigger share of the high-age births are to women who’ve graduated college — most of them married and financially better off. But women without college degrees still make up more than half of those having babies after age 35, and the risks their children face have more to do with high blood pressure, obesity, diabetes, and other health conditions than with genetic or epigenetic mutations. Preterm births, low birth-weight, and birth complications are major causes of developmental disabilities, and they occur most often among mothers with their own health problems.

Most distressing, the effects of educational (and income) inequality on children’s health have been increasing. Here are the relative odds of infant mortality by maternal education, from 1986 to 2001, from a study in Pediatrics. (This compares the odds to college graduates within each year, so anything over 1.0 means the group has a higher risk than college graduates.)

This inequality is absent from Shulevitz’s essay and most of the commentary about it. She writes, of the social pressure mothers like her feel as they age, “Once again, technology has given us the chance to lead our lives in the proper sequence: education, then work, then financial stability, then children” — with no consideration of the 66 percent of people who have reached their early 30s with less than a four-year college degree. For the vast majority of that group, the sequence Shulevitz describes is not relevant.

In fact, if Shulevitz had considered economic inequality, she might not have been quite as worried about advancing parental age. When she worries that a 35-year-old mother has a life expectancy of just 46 more years — years to be a mother to her child — the table she consulted applies to the whole population. She should breathe a little bit easier: Among 40-year-old white college graduates women are expected to live an average extra five years compared with those who have a high school education only.

When it comes to parents’ age versus social class, the challenges are not either/or. We should be concerned about both. But addressing the health problems of parents — especially mothers — with less than a college degree and below-average incomes is the more pressing issue — both for potential lives saved or improved and for social equality.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

Women, Sexuality, and the HPV Vaccine

Cross-posted at Sociology Lens.

A number of researchers suggest that the marketing and advertising of Gardasil has been aimed at girls and women instead of boys and men. In this post I discuss two contradictory messages aimed at women through these advertisements.

The first type of ad focused around the protection of young girls. The makers of Gardasil imply that being a good parent means vaccinating your daughter and therefore protecting her from cervical cancer (an observation also made here at Sociological Images). For example, one advertisement read, “How do you help your daughter become one less life affected by cervical cancer?” Another advertisement had a similar sentiment, stating “Your daughter can’t possibly know the importance of the cervical cancer vaccine, but thankfully, she has her mother” (source).

This narrative of protectionism is not surprising. In other contexts, like sex education debates, the discourse about adolescent sexuality, and in particular, girls’ sexuality, reveals a desire to protect their “innocence.”

The other type of ad moves away from the narrative of protectionism and focuses on empowerment and choice. One ad stated, “I chose to get vaccinated after my doctor to me the facts” (source). Another ad read, “I chose to get vaccinated because my dreams don’t include cervical cancer” (source).

Instead of focusing on the ways in which girls and women can be protected, the ads suggest that girls and women need to protect themselves. It seems like the advertising department at Merck (the makers of Gardasil) recognize that they needed another strategy if they wanted to appeal to young women who feel empowered about their sex lives.

These two strategies are opposed to one another. One strategy suggests that girls and women need to be protected, while the other strategy relies on the ability of girls and women to be active and educated decision makers. Merck is tapping into two gendered narratives in order to sell to as many people as possible. This is, of course, the way that advertising works. But it does reveal the different, and sometimes contradictory, cultural ideas about women’s sexuality, ideas that advertisers will draw on in order to make a profit.

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Cheryl Llewellyn is a Ph.D. candidate in sociology at Stony Brook University.  She writes for Sociology Lens, where you can read her post about the feminization of the Gardasil.

Framing Breastfeeding: Grumet Graces Another Cover

Along with “work/life balance” and other tired topics, an evergreen issue in the media remains the controversies surrounding breastfeeding.  Less than six months ago, Jamie Lynne Grumet lit up the blogosphere by posing for the cover of TIME Magazine while breastfeeding her standing toddler.  Outcry included pronouncements that the image was almost pornographic, psychologically damaging to her child, and exploitative of her white, twenty-something good looks.  The drama of the image worked as the magazine flew off shelves and was named one of the top ten most controversial covers by the New York Daily News.

Within the “lactivist” community there seemed to be double-edged concern — on one hand, glee that an image of a breastfeeding woman was so publicly displayed — on the other, anger that the image so clearly did not depict the intimacy and bonding between mother and child that they insist breastfeeding promotes.

Sensing an opportunity to “set the record straight” as well as launch their own uptick in cover attention, the nonprofit quarterly magazine Pathways to Family Wellness persuaded Grumet to pose for them, this time surrounded by her husband, adopted son, and cradling her nursing naked now 4-year-old child in her lap.  The inclusion of other family members changes the image from one of solo defiance to a message about her family system.  On the cover, Grumet still looks directly at the camera, not at her feeding child, but her glance is far from defiant.

Grumet agreed to pose again in order to send a different message about breastfeeding, one she preferred.  Grumet has said that this image portrays toddler breastfeeding more realistically, “incorporating the husband and siblings.” Yet, the multicultural family portrait has its own sense of staging.   The idyllic family pile-on seems hardly part of everyday life, much less every feeding.  Both images – part of the wider debate over breastfeeding — are carefully crafted to tell a particular story.

Some critics have mentioned that while Grumet’s intention may have been to reframe the image of breastfeeding, perhaps unwittingly again, she has contributed to the fanning of the flames around this issue. Others have accused her of “milking the moment.”   The breastfeeding support website KellyMom tracked down the three other mothers who were all photographed for the TIME cover. KellyMom interviewed them about their experiences during the shoot, then reaction to, and fallout from the cover.  Unfortunately, given the nature of the debate, individual women can often seem like pawns in these ever-intermittent media storms.

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Elline Lipkin, PhD, is a Research Scholar with UCLA’s Center for the Study of Women.  She is the author of Girls’ Studies and The Errant Thread, recipient of the Kore Press First Book Award for Poetry. She tweets at @girlsstudies.

How Are Women Voting? And Why?

Nate Silver, the statistics guru behind FiveThirtyEight, is predicting that the gender gap in tomorrow’s election will be “near historic highs.”   According to Silver’s averaging of recent poll data, Obama has a 9-point lead among women, Romney has the same size lead among men.

Women haven’t always leaned Democratic.  The trend started in the 1990s, as data at Mother Jones reveals:

Single women are especially likely to vote Democratic.  Seventy percent voted for Obama in 2008:

A concern for reproductive rights, especially in light of recent Republican comments, are likely a big driver of women’s retreat from the political right.  Their concerns very well may swing the election.  In a poll of swing states, Gallup found that abortion topped the list of concerns for women; it didn’t make men’s top five:

It will be interesting to see how long the Republicans will hold onto positions unfriendly to women’s reproductive options.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

Rape and Other “Gifts from God”

Cross-posted at Caroline Heldman’s Blog.

During a debate this past Tuesday, Indiana Republican senate nominee, Richard Mourdock, made the case against the rape exception for abortions: “I’ve struggled with it myself for a long time, but I came to realize that life is that gift from God, and even when life begins in that horrible situation of rape, that it is something that God intended to happen.”

So according to Mourdock, God intends for rape to happen, and the outcome of rape is a gift from God.

What puzzles me is how Mourdock’s rape enthusiast comments fit with Missouri Republican senate candidate Todd Akin’s recent comments that “legitimate rape” (read“forcible rape”) rarely leads to pregnancy because, ”If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Mourdock and Akin’s beliefs, when considered together, produce a bizarre philosophy. I would like to know: Why would God create female bodies that reject God’s “gifts”? And if women don’t get pregnant from “forcible rape,” does that mean that God doesn’t intend ”forcible rapes”? Put another way, does God only intend certain types of rape, you know, the ones that come with “the gift”?

One-in-five Americans agree with Mourdock and Akin’s abortion stance. Razib Khan’sanalysis of the General Social Survey shows that 20% of Americans think abortion should be illegal in cases of rape. Republicans with lower levels of education who identify as extremely conservative and believe the Bible is the word of God are more likely than other Americans to hold this belief.

For Mourdock, Akin, and more than 50 million other Americans, God truly does work in mysterious ways.

Caroline Heldman is a professor of politics at Occidental College. You can follow her at her blog and on Twitter and Facebook.

The Science of Lady Parts and the GOP

Cross-posted at Caroline Heldman’s Blog.

Last Thursday, Republican Representative and Tea Party favorite, Joe Walsh (R-Ill), told reporters that when it comes to abortion, “there’s no such exception as life of the mother” because of ”advances in science and technology.” This astounding claim was news to the medical community.

Walsh joins the ranks of some other prominent Republican men who don’t understand basic lady parts science: Representative Todd Akin (R-MO), who claimed that pregnancy from “legitimate rape” is “really rare” because “the female body has ways to shut the whole thing down,” and conservative comedian Rush Limbaugh, who doesn’t understand the basics of birth control pills. (He thinks you take a pill every time you have sex!)

These remarks would be humorous if it weren’t for the fact that these men are part of a broader effort by the extreme wing of the Republican Party to take aim at women’s reproductive health.

At the state level, Republican lawmakers enacted a record number of anti-abortion measures in 2011, four times as many as the previous year. A study from the Guttmacher Institute shows that legislators in 45 state capitals introduced 944 provisions to limit women’s reproductive health and rights in the first three months of 2012. These states are proposing/passing abortion ultrasound requirements, gestational limits, health insurance exemptions for contraception coverage, and stringent limitations on medical abortions.

In the past two years, 19 states have introduced bills modeled on a Nebraska law that bans abortion 20 weeks after fertilization. The Oklahoma State Senate redefined “person” as starting at conception, while the Mississippi House approved a bill requiring women who want an abortion to undergo an examination to determine if there is a fetal heartbeat. Texas and Virginia require women to undergo an ultrasound prior to receiving an abortion, and many other states have similar proposals underway. Texas recently cut reproductive services for 130,000 poor women.  As this chart from NARAL indicates, twice as many states passed anti-choice laws in 2011 than in 2010.

 

At the federal level, in 2010, the newly elected House Republican majority was quick to propose major cuts to reproductive health services. They made several attempts to eliminate funding for Planned Parenthood, the largest family planning provider in the U.S. that has been around for a century. They also tried to gut Title X, a program that funds family planning and preventive breast and cervical cancer screenings. Both proposals were stopped by Senate Democrats. Ironically, on the same day that House Republicans tried to eliminate Title X funding, Representative Dan Burton (R-IN) proposed contraceptive funding for wild horses (something that we desperately need, actually).

Congressional Republicans also proposed an amendment to the health care bill that allows federally funded hospitals to turn away women in need of an abortion to save their lives. This is by far the most brazen attack on the “mother’s health” exception to restrictions on abortions. In May of 2012, Republicans proposed a veto on sex-selective abortions that failed to pass the House, despite broad Republican support for the bill. And in early 2012, Republicans in Congress held hearings on whether the new health care law should include contraception coverage. These hearings included virtually no female experts, so House Democrats held more inclusive hearings that (gasp) included women. Limbaugh assailed one hearing participant, Georgetown student Sandra Fluke, calling her a “slut” and a “prostitute.”

Prominent conservatives, including Republican Party leadership, have roundly dismissed the assertion that the party is engaged in a War on Women, but the recent flurry of legislation curbing reproductive freedoms tells a different story. Given baffling comments from the likes of Walsh, Akin, and Limbaugh, the generals in this War on Women obviously need to include lady parts science as part of basic training.

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Caroline Heldman is a professor of sociology at Occidental College.  You can follow her at her blog and on Twitter and Facebook.

Intra-State Variation in Vulnerability to Climate Change

Scholars are busy attempting to predict the effects of climate change, including how it might harm people in some parts of the globe more than others.  A recent report by The Pacific Institute, sent in by Aneesa D., does a more fine-grained analysis, showing which Californians will be the most harmed by climate change.

They use a variety of measures for each Census tract to make a Vulnerability Index, including natural factors (like tree cover), demographic factors (like age), and economic factors (like income).  At the interactive map, you can see the details for each Census tract.  Their compiled index looks like this:

You can also see the Vulnerability Index for each measure individually.  Here is the data for the percent of people over age 65 who live alone, a variable we know increases the risk of death from heat wave.

And here’s the data for the percent of workers who labor outside:

There’s lots more data at the site, but what’s interesting here is that, even in incredibly wealthy parts of the world, climate change is going to have uneven effects.  When it does, the most vulnerable people in the more vulnerable parts of the state are going to migrate to the other parts.  Most Californians don’t imagine that their cities will be home to refugees, but this is exactly what will happen as parts of California become increasingly difficult to live in.

Lisa Wade is a professor of sociology at Occidental College and the author of Gender: Ideas, Interactions, Institutions, with Myra Marx Ferree. You can follow her on Twitter and Facebook.

Targeting the “Supply Side” of Abortion

Opponents of abortion have long targeted the “demand side” of abortion by passing legislation aimed at dissuading patients from going through with an abortion. Examples of this type of restriction include parental consent/notification laws, waiting periods, and mandatory counseling. Research shows that targeting patients has had little impact on national abortion rates; they’ve been declining, but several factors are likely contributing to the decrease, including increased accessibility to contraceptives.

New approaches to restricting abortion have focused on the “supply side” of the abortion equation — that is, targeting the doctors and clinics that provide abortions. These regulations often require certain staffing and equipment requirements, resulting in clinics being shut down (often due to the expense of implementing the regulations). Reduced access to clinics often means that women have to travel further for an abortion — increasing costs (the procedure itself, travel, and accommodations), especially when a patient has to navigate waiting periods and counseling requirements.

Mississippi’s sole abortion clinic, for example, the focus of abortion opponents for many years, faced closure recently because of a law that changed licensing procedures. The law now requires all doctors performing abortions to have admitting privileges at local hospitals (difficult for the out-of-state doctors to acquire). The clinic was granted an extension to meet the requirements, though the law was allowed to stand.

So, does targeting the supply side of abortion work to reduce the procedure?

A recent article in the New England Journal of Medicine did a natural experiment to answer this question.  In 2004, Texas passed two new restrictions on abortion, one on each side. The “demand side” legislation required that women receive information about risks at least 24 hours before an abortion can be performed. The “supply side” legislation required that abortions after 16 weeks of gestation be performed in a hospital or an ambulatory surgical center instead of a clinic. At the time the law was passed, none of Texas’ non-hospital based clinics met the legal requirements, and very few abortions were performed in hospitals.

If the “demand side” legislation had an effect, the number of abortions would decrease at all levels of gestation. As Chart A illustrates, there was no change whatsoever in the number of abortions performed before 16 weeks — indicating that the demand side legislation had almost no impact.

If the supply-side legislation had an effect, the number of abortions provided after 16 weeks should have dropped.  In fact, Chart B shows that the number of later abortions performed dropped 88% after the legislation was implemented.

So, targeting the supply side reduced the number of abortions performed in Texas, but did the  women carry their baby to term?

No. Some of these women left the state to receive an abortion; in fact, the number of who received an out-of-state abortion more than quadrupled from 2003 to 2004. Accordingly, the average distance women had to travel to receive an abortion after 16 weeks increased from 33 miles in 2003 to 252 miles in 2004.

As has been noted on this site before, nations that have highly restrictive abortion laws do not have lower abortion rates; in fact, in those countries where abortion is illegal, many of those abortions are unsafe, resulting in high numbers of maternal deaths. Although targeting the supply-side of abortion might be appealing, it will probably not reduce the abortion rate nationwide. Instead, it likely places onerous restrictions on women with fewer resources, since they will be less able to meet the increased costs that result from having to travel for abortions.

Thanks to ­­­Jenna for the submission!

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Amanda M. Jungels is a PhD Candidate in the Department of Sociology at Georgia State University, focusing on sexuality, gender, and cognitive sociology. Her dissertation focuses on disclosures of private information at in-home sex toy parties. She is the current recipient of the Jacqueline Boles Teaching Fellowship, given to outstanding graduate student instructors.