Teen Pregnancy & Abortion Access in Massachusetts

Citrus High School honor student Judy Fay works at a blackboard as her teacher looks on proudly during an English class. Her attendance is possible because of the creation of a program for pregnant girls in 1967. Instead of expulsion or punishment, we must invent radical and compassionate methods for these girls to continue their education without fear of stigmatization.

Teen pregnancy is a phenomenon that comes at both individual and societal costs. In 2013, Massachusetts had the lowest teen pregnancy rate of any state or United States territory; however, this number varied based on the race of the individual. In some cases, teenagers of color had two times more births per 1000 women than non-Hispanic white teenagers.1 Such inequality exists as a function of lacking resources allocated to these populations, and socioeconomic status was not even explored as a covariate in this report from the Center for Disease Control. This lack of exploration into the concrete variables that contribute to teen pregnancy underlines the disconnect between resource allocation and human health impact.

Moreover, at many stages  of coping with a pregnancy, teenagers face inequity based purely on their intersectional identities. Here we explore three of these stages: risk factors for teen pregnancy, inequality in abortion access, and parenting outcomes. Combatting discrimination in this area necessitates reform on the levels of media discourse, medical access, and policy decisions. Becoming pregnant as a teenager has lifelong impacts, whether or not the teenager wants and is able to abort the fetus or carry it to term. Drastic health outcomes also may affect the development of the child, should the woman carry it to term. Therefore, reform is vital to promoting a healthier Massachusetts, so that women at risk of teen pregnancy, especially those from disadvantaged backgrounds, have equal opportunities for autonomy over their bodies and over the course of their lives.


Destigmatizing Teen Pregnancy

While researching for this project, we saw how easy it can be to reduce teenage pregnancy down to statistics, to view it as a sad and preventable situation rather than a positive occurrence in a young woman’s life. Studies discuss the “risk” of teenage pregnancy, and the unfavorable situations that can raise this risk, such as childhood exposure to abuse, violence, and family strife, lack of academic success, or alcohol and drug use.2

However, many women who are pregnant as teenagers are happy to become mothers, and almost all of them want to be the best mother that they can for their unborn son or daughter.

We spoke with Eileen Amy, a registered nurse and International Board Certified Lactation Consultant (IBCLC) who works as a childbirth educator and prenatal educator at Brigham and Women’s Hospital in Boston. Amy works closely with pregnant teen mothers in the teen childbirth class offered by the hospital, and said that she sees women of all ages, both married and unmarried, in her classes.

“There are young couples who are married, or who are very committed to each other…Some people come to these classes with their own mothers, who provide great support,” Amy, who has been working at the hospital for 20 years, said.3

Amy also said that many teenagers are nervous about how to bring up their own pregnancy with their parents.

“A lot of them will talk about unease, or finding it was a hard thing to tell their own mother or father. But their parents end up coming to some sort of acceptance,” she said.

According to Amy, the youngest mothers whom she has seen in her classes are 14, but this is becoming more rare as access to birth control improves. The oldest women in her classes are in their early 20s.

These women are, however, extremely excited to become mothers, Amy said.

There are a lot of complaints about physical discomfort, but they’re all completely infatuated with seeing the baby and seeing the ultrasound, figuring out the position of the baby… somebody’s planning a baby shower, and they’re super thrilled and excited about that… [They] revel in the excitement, and maybe in the attention, which anybody would.

Teen pregnancy is often viewed as an accident, or something unintended. However, Amy said that many of the pregnant teens she works with will say that their pregnancies were intended.

“A lot of people will tell you, ‘Oh, I was using birth control, but it didn’t work.’ They will tell you it’s an intended pregnancy and it’s possible that early on, it wasn’t expected, therefore it wasn’t really a planned, sought after [pregnancy],” Amy said.

“But, who am I to judge?” she added.

Amy also said that many of the teens that she works with are the daughters of women who were teen mothers themselves.

“I remember being in a group for prenatal mothers and a lot of them were really thrilled that they became pregnant at 19, and not at 16…like their mother,” Amy said. “They felt like that was a real advance.”

One of the most unfortunate truths about teen pregnancy is that, despite the preparedness of the mother, it often leads to women having to drop out of school to raise their child.3 Amy said that women she works with are often very dedicated to continuing their education, although this can be difficult to achieve. When I asked her if the women she works with choose to drop out of high school or college, she told me that was an unlikely choice.

“They are eligible for tutoring so they can be home and do the classes that way. Some are very motivated to get through that semester or that term. That’s what I’ve seen,” Amy said.

College, too, remarkably, people will… take an incomplete and then they’ll go back — they say they’ll go back to it, it’s always possible that doesn’t happen — but it seems that people… cut corners to get through what they need to before the birth, and their plan is to go back to it after.

Supportive parents or partners are also able to fill in for teen mothers so they can continue their education.3

Family strife, such as abuse, violence, or divorce, also has ties to teenage pregnancy. I asked Amy about the family lives of the women she works with, and she said that many women view their pregnancy as a way to improve the life of their child, even if their own life has been less than perfect.

“It seems so stereotypical, but pregnancy brings [attention] with it…and it’s a positive step in your life for so many people,” she said. “I think people see it as a new chapter, as adolescents and as everybody else.”3

Amy emphasized that all parents want to do the best for their children:

“[Young parents] really want to do the best they possibly can. They’re just at a different point in their own development. They really want the same as everybody wants for their child, which is to have a good life. Some of them are grappling with complicated relationships with their own parents, so it’s certainly going to mean they’re going to have to work harder without the mentoring [of their own parents]. And they’re just younger, so they’ve had less life experiences. Some can be motivated to work above and beyond all of that.”

sexeducation_cited-page-001


Inequality in abortion access as a form of state-sanctioned violence

With the recent shooting and protests against Planned Parenthood, administered by the state and by individual terrorists and pro-life organizations, it is evident that there are many structures actively seeking to dismantle the liberation of women across the nation.12 While the rules regarding abortion access in Massachusetts are less strict than those in neighboring states Rhode Island and New Hampshire, there still exist a series of physical and emotional obstacles that a woman must overcome in order to obtain a safe medical operation.13

Abortion access and demand is not equal for all women in Massachusetts. There are a variety of factors that influence the kind of care a woman receives.

Class During the first trimester, an abortion can cost anywhere between $350-500. After 20 weeks, the cost rises to least $1000. In Massachusetts, Medicaid does provide free abortion care for poor women, but there can be problems with enrolling women in a timely manner necessary for the operation. Women who are not eligible for Medicaid include the working poor who cannot afford health insurance and the homeless. Women in Massachusetts with federal insurance – soldiers and their families, Native Americans using the Indian Health Services, women in federal prisons, and federal employees, and women who work for some religiously-affiliated organizations – cannot use their health insurance to pay for abortions.14

income_cited-page-001

Race There is a toxic stereotype that women of color are sexually promiscuous baby-making machines, and there are complex structural determinants pertaining to differences in economics, racism, and opportunities in a socio-historical context.17 Susceptibility to teen pregnancy thus becomes another form of violence inflicted upon women of color in the longstanding narrative of American colonialism.

Location Most clinics are strategically located in towns with a dense population in order to serve as many women as possible. However, the demographic of women who struggle to access these locations are largely poor, White, rural, and may not have reliable access to transportation. There is no public transit from the cape to the closest clinic in Attleboro, and it takes over 10 hours to travel from the cape to Boston via multiple bus connections. For many teens, it may be out of the question to ask a parent or guardian to drive them to an abortion clinic.

density_cited-page-001

Family Current abortion and contraceptive laws for teens require women under 18 to have parental consent, or otherwise gain permission from a court.13 For many teenagers, this extra legal formality of consulting an authority figure about a decision regarding her own body may cause shame and discomfort. Even when someone’s health insurance does provide abortion care, women in abusive relationships or dangerous family situations may not be able to use it safely.

Before and after the operation, there is no standard for psychological care regarding an abortion. Women can experience a range of emotions that oscillate from relief to shame, empowerment to remorse. Sometimes these women live in families or communities where they do not feel safe speaking openly about these experiences, which contributes to an atmosphere of silence that reinforces the stigmatization of the subject.21

After women are explained the physical symptoms they might feel after an abortion, such as nausea or bleeding/spotting, they are told that they can spend as much time as they need alone before exiting the facility. But for weeks, even months, these women can be struck with feelings of isolation that are exacerbated by lack of social support, pre-existing psychiatric illnesses, and conservative perspectives on abortion.21

Women often say that they’ve only told only a few people about their experiences: a mother, a boyfriend, a best friend. Many women feel they have no other choice but to discuss their abortions anonymously, thus resorting to a myriad of online forums dedicated to psychological support. One post on the forum SoFeminine from the username Guiltygal reads:22

Hi how do i begin. well my due date is today and i had my termination in april at 9 weeks my drs have been no help in giving help with dealing with this so iv kinda kept this to myself past 9 months. I feel selfish for even crying over this as i went through with decision even though not one i wanted but as my boyfriend said as i suffer frm anorexia aswell if i cant look after myself how could i have cared for anyone else. i feel so alone in this i feel such a horrible bad person for what i have done and if anyone could please just give me a little hope id be very grateful. i feel so selfish an bad even asking for help i just feel like such a horrible person. : ( xx

Although women cannot see or know about who they are interacting with, these faceless symposiums construct a sense of solidarity in their struggle when they have nowhere else to turn. Over the Internet, they have a chance to be open, vulnerable, and honest while still protecting themselves from the dehumanizing gaze of society that makes speaking of abortion risky and even forbidden. These online forums thus become a defense mechanism for survival as well as a counter-narrative to society’s shameful double-stigmatization of mental illness and unplanned pregnancy.

Not only is the emotional and physical access of abortions strenuous enough already for women, there is an entire industry that is dedicated to terrorizing women who seek clinical help. A “Crisis Pregnancy Center”, otherwise known a fake women’s abortion clinic, is a clinic that is run by anti-abortion activists whose goal is to coerce or horrify women into giving birth. These clinics are often religiously-motivated, and attempt to indoctrinate women with medically-false propaganda. Many force women to spend time studying their ultrasounds, lie about how far along their pregnancies are, and show them rooms filled with baby toys and clothes. They promise an abortion, but then will book several appointments spanning across weeks until it is past the date where a woman is legally allowed to have an operation. Many have locations next door to real clinics so women can accidentally walk into the wrong one; others are located in rural places where no real women’s health clinics are present nearby. There is currently no law stating that these organizations must disclose their identities as fake hospitals, and 11 states actively fund these centers with tens of millions of federal and state tax dollars.23 24 25

fakeclinics_cited-page-001

From the mass stigmatization of unplanned pregnancies to the socioeconomic factors that bar women from making safe decisions about their bodies, these methods of oppression are different faces of the same violence. This violence is legitimized by the state and meant to prevent women from being able to gain freedom and control over the decisions that affect their bodies. Speaking out about individual experiences promotes a discourse about a culturally forbidden subject, and can unify women’s voices in their struggle for sovereignty.


Teen parenting predicts poor outcomes for mother and child, but interventions can help

If a pregnant teenager either cannot access resources to terminate her pregnancy or opts to raise the child, she faces an increased risk of dropping out of high school and of living in poverty. In order to support effective parenting, encourage educational pursuits, and achieve growth milestones in the child through infancy and early childhood, an organization called Healthy Families Massachusetts (HFM) engages young parents. This statewide program utilizes structured home visits for all first-time parents ages 20 and under, allowing trained professionals to provide support for young families during pregnancy and early childhood. During these visits, the professionals “teach parents about proper baby care, promote nurturing and attachment, practice effective parenting skills, and ensure parents have a solid understanding”27 while advising parents about professional pursuits, like going back to school or finding a job.

A team of researchers from Tufts University have formed the Tufts Interdisciplinary Evaluation Research (TIER) group, part of which is focused on developing and implementing the Massachusetts Healthy Families Evaluation (MHFE), which investigates the effectiveness of HFM. According to Dr. Jana Chaudhuri, Project Director of a longitudinal MHFE study of early childhood, Dr. Rebecca Fauth, Project Director of the MHFE, and Dr. Jayanthi Mistry, the Principal Investigator of the project, “[m]any of the young mothers who receive home visits from HFM workers face challenges even before they become pregnant, including growing up in poverty and living in chaotic households, and some have been physically or sexually abused … [a]s such, they often enter into parenthood facing a number of barriers that, if not addressed, may result in these mothers demonstrating less sensitive and responsive parenting, which could have unfavorable impacts on their children.” They emphasized that teen parents must grow up alongside the growth of their child:

Young mothers, especially those with difficult life circumstances, often are not well-prepared to simultaneously negotiate the developmental tasks of adolescence and parenthood.

The MHFE examined how well the barriers were addressed by comparing outcomes for young families who either did or did not receive the HFM intervention. Researchers collected data from phone interviews, in-person interviews, public administrative data, the HFM management information system, and the 2010 U.S. Census.34 From a sample of about 700 mothers and children, they found that mothers who received more home visits were “less likely to be reported to [The Department of Children and Families] for child maltreatment, more likely to use birth control, less likely to have a repeat pregnancy, and more likely to report being a victim of interpersonal violence,”34 although the direction of the relationship between home visits and these outcomes cannot be determined. Mothers in the group that received home visits exhibited fewer negative parenting behaviors, were more likely to attend college, were more likely to use condoms, and were less likely to engage in risky behaviors than those who did not receive home visits.

“In addition to HFM, teen parents need access to other social services and programs,” Chaudhuri, Fauth, and Mistry said, “including housing support, medical and mental health care, child care, and educational support programs, among other programs.  They not only need access, but also information about what various social service systems do and how they work, as well as advice and guidance about how to access and navigate these systems.”


We propose that the issue of teen pregnancy in Massachusetts be confronted through reform that examines this issue through an intersectional lens. Teen pregnancy is an issue of community health; the data makes it clear that women are receiving unequal access to healthcare, especially when they come from disadvantaged backgrounds or live in parts of Massachusetts where fewer healthcare facilities are available.

Pregnant teens must be regarded with humanity and respect for their autonomy while they navigate the difficult venture of growing up themselves as they care for a child.

Interventions, like those that Healthy Families Massachusetts provides for young mothers, have been shown to improve familial outcomes by encouraging higher educational pursuits and diminishing child-related stress in young parents. The implementation of these interventions for at-risk teen parents is promising for improvement in the quality of life of these women and their families. Policy changes to provide accurate information about resources currently available and reallocation of government resources to support women in need of healthcare should also be implemented. These resources are invaluable to provide women of all backgrounds with autonomy to make educated decisions about their bodies and provide an optimistic outcome for their families.


Citations

  1. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2013. National vital statistics reports; vol 64 no 1. Hyattsville, MD: National Center for Health Statistics. 2015.
  2. Kirby, D., Ph.D., & Lepore, G., B.A. (2007, November). Sexual Risk & Protective Factors [Scholarly project]. In The National Campaign. Retrieved November 18, 2015.
  3. Amy, E., RN. (2015, November 11). Interview with Eileen Amy, RN [Personal interview].
  4. Drop Out Rates Among Pregnant Teens. (2009). Retrieved January 17, 2016.
  5. National & State Data | The National Campaign. (2016). Retrieved January 17, 2016.
  6. Tamkins, T. (2004, March/April). Teenage Pregnancy Risk Rises with Childhood Exposure to Family Strife. Retrieved January 17, 2016.
  7. National Campaign to Prevent Teen Pregnancy. (2003). With One Voice 2003: America’s adults and teens sound off about teen pregnancy. Retrieved January 17, 2016.
  8. Jones, J., Mosher, W., & Daniels, K. (2010). Current Contraceptive Use in the United States, 2006–2010, and Changes in Patterns of Use Since 1995. National Health Statistics Report, 60. Retrieved January 16, 2016, from www.cdc.gov.
  9. American Teens’ Sexual & Reproductive Health. (2014, May 1). Retrieved January 17, 2016.
  10. Minors’ Access to Contraceptive Services. (2016). State Policies in Brief.
  11. General Requirements: Sex and HIV Education. (2016, January 1). Retrieved January 17, 2016.
  12. Sun, C. (2016, January 11). Live coverage: Planned Parenthood shooting responders, victims will be honored at Colorado Springs City Council meeting. The Gazette. Retrieved January 16, 2016.
  13. Shaw, J. (2016, September 26). Massachusetts Abortion Laws and How They Differ From Neighboring. NewsMax.com. Retrieved January 16, 2016.
  14. Facts About Funding for Abortion. (2013). Retrieved January 16, 2016.
  15. Abortion Providers in Massachusetts. (n.d.). Retrieved January 16, 2016.
  16. Rocheleau, M. (2015, December 18). A town-by-town look at income in Massachusetts. The Boston Globe. Retrieved January 16, 2016.
  17. Dutton, Z. (2014, September 22). Abortion’s Racial Gap. Retrieved January 16, 2016.
  18. Massachusetts Population and Racial and Ethnic Proportion. (2010). Retrieved January 16, 2016.
  19. Where do women obtain abortions? (2015). Retrieved January 16, 2016.
  20. Jones, R., & Jerman, J. (2013). How Far Did US Women Travel for Abortion Services in 2008? Journal of Women’s Health, 706-713.
  21. The Emotional Effects of Induced Abortion. (2014, February 1). Retrieved January 16, 2016.
  22. Guiltygal : Discussion Board Abortion. (2015, November 17). Retrieved January 22, 2016.
  23. Crisis Pregnancy Centers. (2014). Retrieved January 16, 2016.
  24. Ward, C., & Yarrow, A. (Directors). (2014). The Fake Abortion Clinics of America [Motion picture]. United States: Vice News.
  25. Access to Abortion Care in Massachusetts. (2011, October 1). Retrieved January 16, 2016.
  26. “Just Because You’re Pregnant”: Lies, Half-Truths, and Manipulation at Crisis Pregnancy Centers in Massachusetts. (2011). Retrieved January 16, 2016.
  27. About Healthy Families. (n.d.). Retrieved January 14, 2016, from http://childrenstrustma.org/our-programs/healthy-families.
  28. Expecting Success: How Policymakers and Educators Can Help Teen Parents Stay in School. (2010, March 1). Massachusetts Alliance on Teen Pregnancy.
  29. The Silent Epidemic: Perspectives of High School Dropouts. (2006, March 1). Bill & Melinda Gates Foundation.
  30. National Campaign to Prevent Teen and Unplanned Pregnancy. (2006) by the Numbers: The Public Costs of Childbearing. Retrieved November 2, 2015.
  31. National Campaign to Prevent Teen & Unplanned Pregnancy. (2014) Counting It Up: The Public Costs of Teen Childbearing in Massachusetts in 2010.
  32. National Campaign to Prevent Teen & Unplanned Pregnancy. (2014) Counting It Up: The Public Costs of Teen Childbearing in Massachusetts in 2010.
  33. Unpublished tabulations by the National Campaign to Prevent Teen and Unplanned Pregnancy. (2012) The National Educational Longitudinal Study of 2002 – 2006. The National Center for Educational Statistics.
  34. Tufts Interdisciplinary Evaluation Research. (2015).The Massachusetts Healthy Families Evaluation-2 (MHFE-2): A Randomized Controlled Trial of a Statewide Home Visiting Program for Young Parents. Final report to the Children’s Trust of Massachusetts. Medford, MA: Tufts University.
  35. Boonstra, H.D. (2014). What is behind the declines in teen pregnancy rates? Guttmacher Policy Review, 17(3), http://www.guttmacher.org/pubs/gpr/17/3/gpr170315.html.
  36. Defund Planned Parenthood Act of 2015, H.R. 3134, 114th Cong. (2015).

In this article, we were unable to address the option of adoption for teen mothers, although this experience is undoubtedly different from those of abortion and parenting already discussed. Future work in the field should evaluate the longitudinal effects of this decision and subsequent access to care for any health-related consequences.

Angie Lou on email2
Angie Lou
Lead Editor & Web Developer.
Angie Lou is a junior majoring in Computer Science and Mathematics with a minor in English. She can be reached angie.lou@tufts.edu.
Sarah Kalinowski
Lead Editor.
Sarah Kalinowski is a senior majoring in biopsychology and minoring in cognitive and brain sciences. She can be reached at sarah.kalinowski@tufts.edu.
Melissa Kain
Lead Editor.
Melissa Kain is a junior majoring in mathematics and Spanish and minoring in English. She can be reached at melissa.kain@tufts.edu.

Leave a Reply

Your email address will not be published. Required fields are marked *