Pregnancy Is Too Complicated for “Life Begins At X”

Robin Marty

Given my struggle to get pregnant, I suppose it was only expected that I found it so hard to become unpregnant, too. Several months after my D and C, I am still "pregnant."

This article is published as part of a series by Rewire and our colleagues in observance of the 37th anniversary of the Supreme Court decision on Roe v. Wade.

I was catching up on the live coverage of the America Life League meeting when the clinic called me to offer congratulations.  According to them, I was "almost ‘not pregnant’."

Considering what a struggle it had always been for me to get pregnant, I supposed it was only fair that I found it so hard to become unpregnant, too.  We spent a full year trying for our first child before we were lucky enough to conceive.  So it wasn’t so shocking when it took the same about of time to conceive our second.  The shock came later, at our first appointment, when we they couldn’t find a heartbeat.

We lost that potential life at 8 weeks 2 days, or just over six weeks after conception.  In the time that passed between that loss and the visit that showed us that it was gone, my body had soldiered on in pregnancy even though there was no longer a fetus, with my hcg levels increasing, pregnancy symptoms continuing, and my uterus expanding to a full 12 weeks.  Because my body was refusing to miscarry on its own, we had to schedule a D&C to have the "products of conception" removed.

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I was nearly 12 weeks pregnant, and just finishing my first trimester.  It was Halloween.

Your body goes through many different things after a pregnancy is removed, and no two situations are the same.  But for those of us with missed miscarriages, we have follow up appointments to make sure our bodies are returning to normal, tracking, among other things, the level of pregnancy hormone in our body to make sure it returns to normal.

Some offices define "pregnant" as any hcg level over 25.  Others, any level over 5.  When you are having a successful pregnancy, your level doubles roughly every 48 hours.  After a D&C, your body should have a drastic drop, although some don’t.  And your levels should decrease in half every 48 hours, although some don’t.

Mine didn’t, and still refuses to.  Now, nearly 12 weeks since the surgery, I am at 21.  I am still, technically, "pregnant."

I think of these timelines when I hear people touting the personhood amendment, or declaring that life begins the moment a sperm fertilizes an egg.  They are so definite that that is the moment life that a woman is "pregnant."  But when, then, does a woman become "not pregnant?"

Was it when the fetus lost its heartbeat?  In that case, I haven’t been pregnant in almost four months.

Was it when I had the D&C and it was removed?  Then I haven’t been pregnant since October.

Or is it when my body chemically has everything out of my system?  If so, then yes, I’m still pregnant even without anything growing inside of me.

I find it hard to understand how people can be certain that a fertilized egg at that precise moment becomes a life. It hasn’t implanted anywhere where it can grow in order to live.  It doesn’t have a heartbeat.  It hasn’t become something that can survive without assistance.  How does it now develop total rights that surpass even that of the woman carrying it?

If the end of a pregnancy can be this fluid, how can "this is the exact moment that a human begins and has rights?"  Pregnancy is far too complicated for that.

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.

News Law and Policy

Georgia GOP Approves $2 Million for Anti-Choice Pregnancy Centers

Teddy Wilson

Elizabeth Nash, a policy analyst at the Guttmacher Institute, said the Republican-backed measure "allows state funds to go to organizations providing women with incomplete information or outright misinformation.”

Georgia Gov. Nathan Deal (R) signed a bill Tuesday that provides $2 million in state funding for anti-choice crisis pregnancy centers (CPCs), reported the Associated Press.

SB 308, sponsored by state Sen. Renee Unterman (R-Buford), would establish a program through the Georgia Department of Public Health that will provide grants to organizations “whose mission and practice is to provide alternatives to abortion services to medically indigent women at no cost.”

The bill was passed in the house in a 103-52 vote and passed by the state senate in a 31-16 vote, mostly along partisan lines. Republicans hold majorities in both chambers. 

Deal signed the bill alongside anti-choice activists and lawmakers in a private ceremony and made no public statement, with the exception of a short Twitter post.

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The grants, which will be awarded annually to CPCs, are prohibited from funding services that “perform, promote, or act as a referral for an abortion.” 

To qualify for the grant, a CPC must provide pregnancy tests, counseling for pregnant people experiencing unplanned pregnancies, and “confidential and free pregnancy support services.”

The state legislature this year passed a budget that provided $2 million in initial funding for the state’s CPCs, which are often staffed by anti-choice activists dressed in lab coats. CPC grants can’t “exceed 85 percent of the annual revenue for the prior year of any provider,” according to the legislation.

A California investigation released last year showed that 91 percent of centers visited by investigators gave out misinformation about the effects of abortion care on a person’s physical and mental health. CPC workers quoted in the investigation charged that having an abortion would increase the risk of breast cancer, infertility, miscarriage, and/or depression that results in suicide—all of which has been debunked.

Unterman described the legislation as a “positive” response to allegations made by the anti-choice front group known as the Center for Medical Progress (CMP), which began publishing deceptively edited and surreptitiously recorded videos in 2015. CMP’s smear campaign, in coordination with Republican legislators, charged that Planned Parenthood violated laws governing the sale of fetal tissue.

The Georgia Department of Public Health investigated Planned Parenthood Southeast and four other abortion providers in the state. Officials found that the health-care organization did not violate any laws related to fetal tissue donation.

Emily Matson, executive director of Georgia Life Alliance, said in a statement that the new grant program will help expand nonprofit CPCs in the state.

There are about 70 CPCs in the state that could apply for the grants, Matson said. The state health department lists 50 organizations, provided to the department by the Georgia Life Alliance, that provide free ultrasounds for pregnant people.

Elizabeth Nash, a policy analyst at the Guttmacher Institute, told the Associated Press that providing financial support for anti-choice activists who run CPCs is nothing new for GOP-controlled state legislatures.

“The state should be ensuring women are getting the best, most accurate and relevant information,” Nash said. She added that the Republican-backed measure “allows state funds to go to organizations providing women with incomplete information or outright misinformation.”