In spite of the recent drop in the rate of unintended and unplanned pregnancy rates amongst the women of America, the rate of unplanned pregnancies remains disturbingly high. Amongst the most affected demographics, additionally, are teenagers and young adults. Besides, other at-risk groups such as racial minorities, the economically challenged and adolescent girls feature prominently in this statistic where more than half of all pregnancies in the United States of America are unplanned. This results in the scenario where a public health problem arises where there is a risk, among these populations, of reproductive health issues. These reproductive issues include but are not limited to a proportionately high rate of induced abortions, which then kick-start a vicious cycle of mental problems, cervical tears, economic difficulty, etc.
The reduced use of modern contraception methods often results in unwanted pregnancies. Populations, where minorities live, have seen a slow adoption of modern contraception methods such as the long-acting reversible contraception methods such as the IUDs and the implants. This slow adoption often results in them sticking to old-fashioned methods such as the daily combined oral contraceptive (COC) pills, which may not be as effective as the newer methods. Besides, the COC methods are more complicated to keep up with, since the dosages need to be carefully taken for the contraception to be effective. These are also often associated with side-effects and hormonal consequences, which add to the health and mental health issues experienced by the users that have stuck with them.
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As such, these ineffective methods of contraception would see a high rate of unwanted pregnancies, which on their own, will often affect the young mothers mentally and physically. That is not considering the social and economic consequences of carrying an unwanted pregnancy to term. In the majority of these communities, unwanted pregnancy would often be stigmatized, and the young mother labeled as a loose, sexually undisciplined woman (Odland, 2018). Besides, carrying an unplanned pregnancy has economic consequences in the sense that the baby needs to be cared for with resources that were not previously available. This, therefore, implies hard economic times on the young mother and her immediate family.
More often than not, an unplanned pregnancy is accompanied by the pressure to procure an abortion, especially in the communities where it is deemed an economic burden. These abortions are often carried out in illegal establishments that are not approved by the public health authorities of their respective cities. The abortion debate is an on-going public health conversation as a whole, with many states altogether banning the practice and terming it as illegal. Some other states, however, have allowed for medically approved abortions to be carried out, as long as the surrounding circumstances are either legally or medically convincing enough.
Data from various states in America, however, show that the more restrictions to abortion that there are, the more maternal deaths these states tend to experience. Those locations with the most number of restrictions on abortion procedures are, perhaps not coincidentally, also those with the highest rates of infant and maternal mortality. This is probably an indication that public health institutions around the world should make it easier for women to procure abortions in a legally and medically sound manner since these same women would opt for less legal and medically fit options if no proper abortion procedures are available. There is also a direct correlation between the number and types of abortion procedures that women go through, and the mental health of the same said women (Shu et al., 2016).
It is also worth noting that most of these women who go through the issues of reproductive health and mental health issues are also the most economically challenged since they more often than not live below the globally accepted poverty line. They usually do not have enough money for food, transportation, and housing. This also means that indirectly, the children that these women would raise would also be economically challenged, unhealthy, and not in the best mental shape. As a result of these revelations, it has become clear that the issues that affect the mental and reproductive health of women are, in turn, public health issues since they also, in a conjoined manner, affect the overall well-being of society. Children are also affected by the health of the mothers who take charge of nurturing them.
Young adult women and adolescent women who have unwanted pregnancies will often opt for unsafe abortions if they do not have access to safe abortions. Safe abortions are those that have been sanctioned by WHO standards, performed at an appropriate time, and by the proper medical professional using necessary medical procedures and equipment (Schwartz et al., 2015). Unsafe abortions, on the other hand, would often make the use of outdated methods, performed by unqualified quack individuals and in environments that are not conforming to the minimum health and medical standards as required by the WHO. Among the factors that amplify the occurrence of unsafe abortions are those such as; the high cost of legal abortions, unavailability of legal abortion professionals and services, the enacted of unfavorable restrictive laws concerning abortion, the stigma associated with the procedure of abortion, and the presence of healthcare providers who, out of a moral stance, object to the whole institution of abortion, regardless of circumstance.
Unsafe abortions will often lead to other complications, leave alone the deaths of both mother and baby that result from improperly carried out procedures. Any woman carrying an unplanned pregnancy, yet who does not have access to proper abortion services, stands at risk of an un-procedural abortion and all the risks of attached complications. Deaths and complications arising from unsafe abortion practices affect the women who live in economically disadvantaged backgrounds more (Faisal-Cury et al., 2017).
The Theory of Planned Behaviour
The theory of planned behavior is one step extended from the theory of reasoned action, though yet still intertwined. The theory of reasoned action dictates that people are likely to adopt positive behavior if their significant others or close friends have indicated an inclination to approve of the said behavior. This approval, therefore, results in a higher motivation on the part of the actor to perform specified acts or adopt certain habits. The theory of planned behavior and the method of reasoned action are both inter-related with the information integration theory, which dictates that the combination of new information on the part of the actor with already held opinions and thoughts will usually result in the formation of new attitudes and habits.
These theories aptly explain how the public health issue discussed earlier may be combated. In the present day and age, most women of child-bearing age use the combined oral contraceptive (COC) pill, as opposed to the long-acting reversible contraceptive (LARC) methods such as the implant and the IUDs. This resistance to the use of LARC methods is one of the critical factors that have resulted in the menace of early and unplanned teenage pregnancies. Whereas the adoption of LARC methods may be attributed to the theories of reasoned action and that of planned behavior, it is apparent that the effects of the adoption of these methods will yet take slightly longer than anticipated, to be felt (Parks & Peipert, 2016).
Aside from enacting legislation aimed at protecting vulnerable women from the perils of unwanted pregnancies and illegal; abortion procedures, other steps must be taken to combat this public health matter. The theory of reasons action says that a comprehensive drive towards the education of women and teenagers concerning sex education would be an excellent place to begin. This encompasses all training that involves the teaching of appropriate contraceptive methods that work, and relevant, legal procedures to take if an unplanned pregnancy occurs. Education of a section of the targeted demographic is likely to spread to other members of the population through the theory of reasoned action and the theory of planned behavior.
Modern methods of contraception must be reinforced in society. Society as a whole must move from the previously used COC methods to more advanced, yet more effective LARC methods. Just this shift results in a substantial reduction in the occurrences of unwanted pregnancies, which bear the risk of sparking a chain-reaction of events that put the whole system of public health at risk. The availability of proper methods of providing abortion would also be an appropriate measure put in place to counter the effects that arise from the existence of a parallel illegal abortion system that caters to the vulnerable demographics that would get an abortion regardless of the time of the system that exists to execute the abortion.
The deaths, health complications, and disabilities that arise from unplanned pregnancies and illegal abortions have a measurable economic impact. These events can be translated to social and economic costs that are directly transferrable to women, children, families, communities, and eventually entirely public health systems (Henry, 2019). In the year 2006, for instance, it is estimated that a total of approximately $550 million was used to treat the complications that arise from illegal abortions. This is money that would have otherwise used to improve the circumstances of these same communities. An additional $300 million would be required to fully bankroll the medical cost for treating the complications that arise from illegal, unsafe abortions.
Conclusion
On a global scale, the numbers of maternal mortality are constituted to a large extent of the numbers from abortion mortality. This means that the right amount of women who die from maternal complications can be directly attributed to death from abortion complications. Economic disadvantages, unqualified abortion providers, restrictive abortion laws, unsafe abortion procedures, and high mortality rates from abortions tend to happen within the same demographics. This calls for concerted public health efforts that start from providing befitting sexual health and reproductive health education to these affected communities. This would include modern means of contraception and other associated reproductive health education.
Good public health policy and a robust medical health ecosystem seem to be some of the best measures that would solve several of these coexisting problems, seemingly in one stroke. A good contraceptive health public policy, for instance, would help combat the vices of unplanned pregnancies from society, which is likely to deal a blow to the number of unsafe abortions that are undertaken in these communities. The low number of dangerous abortions continues with the chain of now-healthy women, mothers, children, families, and ultimately communities. Healthy societies, in turn, result in less money being spent on repairing the effects of illegal abortion complications and the impact of unplanned pregnancies, which in turn free up resources that could otherwise be redirected into making these communities better.
References
Faisal-Cury, A., Menezes, P. R., Quayle, J., & Matijasevich, A. (2017). Unplanned pregnancy and risk of maternal depression: secondary data analysis from a prospective pregnancy cohort. Psychology, health & medicine , 22 (1), 65-74.
Henry, L. M. (2019). An Overview of Sexual and Reproductive Health in the Context of Public Health Ethics. The Oxford Handbook of Public Health Ethics , 371.
Odland, J. (2018). Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility.
Parks, C., & Peipert, J. F. (2016). Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC). American journal of obstetrics and gynecology , 214 (6), 681-688.
Shu, C., Fu, A., Lu, J., Yin, M., Chen, Y., Qin, T., ... & Yin, P. (2016). Association between age at first sexual intercourse and knowledge, attitudes, and practices regarding reproductive health and unplanned pregnancy: a cross-sectional study. Public health , 135 , 104-113.
Schwartz, S., Papworth, E., Thiam-Niangoin, M., Abo, K., Drame, F., Diouf, D., ... & Baral, S. (2015). An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in Côte d'Ivoire. JAIDS Journal of Acquired Immune Deficiency Syndromes , 68 , S91-S98.
