A review of
the literature through Medlars shows that there have been many
opinions expressed on this subject but very little research. Zuravin
[1] studied 198 low income, female headed families enroled in
a child protective service because of child abuse and neglect.
They were compared with an equal number of age matched controls
to determine if unplanned child bearing and family size increases
the risk of abuse and neglect. According to this analysis, unplanned
child bearing increases the risk of child abuse but not child
neglect, while large family size increases the risk for both types
of maltreatment. Zuravin concluded that the effect of unplanned
child bearing on mistreatment is indirectly related through its
effect on family size. The study of 1400 low income mothers in
a pre-natal clinic done by Altimeir et al. [2] found that the
predominant antecedents of child abuse were unwanted pregnancy,
aggressive tendencies, aberrant childhood nurture, and disturbed
family relationships, but not lack of support appeared to be important
factors. Holman and Kanwar [3] reviewed the obstetric history
and early lives of 28 abused children. They found that the environmental
pressures which led to child abuse were reduced anti-natal care,
separation of mother and child during the neo-natal period, illness,
and poor features in the child. We studied the relationship between
the extent and type of abuse and the child's tendency to blame
themselves [4]. We found that even though they frequently attributed
the blame to themselves and often thought it was because they
were unwanted, how much the mother wanted her children was not
related to the extent of any type of abuse. It was also important
to recognize that the amount of wantedness varies throughout their
pregnancy, being lowest in the first trimester.
Attempts have
been made to show that "forced child bearing", ie. not
allowing women to have an abortion, results in children who have
higher rates of various difficulties. The problem with this study
is that is impossible to control for the aborted child since it
is dead and many other factors that are a part of the decision
to abort, ie. poor mental health, are not controlled for. Dytrych
et al. [5] state that "compulsory child bearing has varied
and sometimes unfavourable consequences for the subsequent life
of the child; including more illnesses and hospitalizations, poor
school marks and performance, worse peer relationships, all affecting
boys more than girls." They did not state in this study whether
the unwantedness of the pregnancy remained that way throughout
or whether there were a number of people who changed from not
wanting to wanting. Brett and Brett [6] point out that, with counselling,
45% of women change their mind about having an abortion, presumably
about wanting the child (please check this statement against
the abstract #23).
The problems
with studies on wantedness are that it is difficult to define,
hard to measure, and fluctuates almost daily. Lenoski [7] used
a number of reasonable criteria, including whether a woman bought
more maternity dresses, etc. He states that that plus the subjective
statements of parents suggest that almost all the victims of abuse
are unwanted. He states that, using objective criteria, other
studies substantiate wanting has also shown a high correlation
with the concept he indicates. Namely that the degree of expectation
in abusing parents appears to be more qualitative than quantitative
in nature. The more the child is wanted, the higher the expectations
and the more likely the child is to be disappointing. When the
child is disappointing to his parents, they will try to have their
expectations met by correcting the child, sometimes with harsh
discipline, or sometimes, because he is so disappointing, they
will avoid him.
No one has
yet proved that providing a variety of means to ensure that every
child is wanted has affected the abuse and neglect rate. There
is circumstantial evidence that it is quite the contrary. In Canadian
provinces where the abortion rate is the highest the abuse rate
is also the highest. There is an interesting increase in abuse
rate that corresponds with the introduction of liberalized abortion.
The contention that refused abortions result in abused and disturbed
children cannot be established because there is no way to compare
one child with a dead child. Not only that, there are many confounding
variables that would explain both the desire to abuse and to abort.
One of these variables we suspect may be partner support.
From our continuing
study of the causes and effects of child abuse and neglect we
have found that;
1) in less
than 5% of the cases does child abuse occur in one form. 95% of
children are affected by various combinations of abuse and neglect.
The most damaging ones include some form of neglect.
2) depending
on the type and severity of the child abuse and neglect, there
is a 30-50% chance the mistreatment will become transgenerational.
3) the best
explanation for the interactions is a triangle which involves
a perpetrator, victim, and observer. This triangle rotates with
time and circumstances.
4) children
tend to blame themselves to varying degrees, depending upon the
severity and type of abuse. They are most likely to blame themselves
for verbal and sexual abuse.
5) mistreatment
affects the child's self-perception and his outlook on the world.
It tends to make children suicidal, pessimistic, and negative.
Children who are physically abused tend to anticipate a violent
death.
6) when asked,
children tend to attribute mistreatment first to parental immaturity
and then to marital conflict when given a variety of choices regarding
causation.
7) when abuse
is preceded by neglect the impact is much greater. Neglect appears
to make children both more susceptible and more vulnerable to
mistreatment.
8) abuse is
not related to wantedness except in an inverse correlation. Wantedness
appears to change during the pregnancy and is lowest during the
first trimester.
9) women who
have had abortions appear to more frequently abuse and neglect
children. Women who have been mistreated as children are more
likely to have abortions.
10) the mother
being abused by her partner is a better predictor of child abuse
then the fact that she was abused as a child. Mother's tend to
be mistreated by their partner as they were abused as a child.
11) the most
important causes, as determined by a stepwise regression analysis
of the 66 factors we considered, were husband not being supportive,
lack of breast-feeding, and pregnancy losses.
In a multi-centre,
trans-cultural study of the effects of pregnancy loss on health
we have found that;
1) all kinds
of pregnancy loss interfere with physical and emotional health,
possibly mediated through the immune system.
2) abortion
appears to be a much more difficult type of loss to mourn and
has a much more deleterious impact on health.
3) the rates
of miscarriage and abortion are closely correlated with the amount
of partner support.
4) the effects
of pregnancy losses are cumulative.
5) if the number
of abortions are subtracted from teenage pregnancies, the 14-19
year old group have as many full term, normal birth weight, healthy
babies as any other age group, in fact, better than the 30+ age
group.
6) the factor
that seems to determine the high number of abortions in teenagers
is their very low rate of partner support.
We hypothesize
that;
1) any apparent
clinical connection between wantedness and child abuse is post-hock.
People associate the memory of abuse and couple it with the feeling
that they were neglected, and therefore unwanted as children.
2) any apparent
research connection between child abuse and unwantedness probably
has a confounding variable of partner support which determines
both.
3) wanting
children may contribute to the problem of mistreatment because;
a) higher expectations
are placed on them, therefore they are more disappointing and
more frequently disciplined.
b) being a
chosen child creates a great burden.
c) being a
wanted child and surviving when others don't results in a survivor
syndrome which includes diminished self worth, survival guilt,
persistent desire to please, and high levels of anxiety.
4) it contributes
to selected feticide which raises in the minds of many children
questions about their being wanted.
Methodology
As part of
an ongoing study of the causes and effects of childhood mistreatment,
we have been collecting data on children in a variety of settings
including a clinical private practice, a young offenders centre,
a psychiatric unit for children and adolescents, and a regular
high school. We have also collected data on adults mistreated
as children. These ratings of themselves and each other, with
those provided by the staff on visual analog scales (v.a.s) for
frequency, duration, extent, self blame, damaging effect, etc.,
have been tested for validity and reliability and, because of
its format, it retains a high response rate from the subjects.
The blank questions and blank v.a.s. provide data that is coded
and analyzed at the Academic Computing Services of the University
of Calgary.
Results
Table 1 indicates
that wantedness changes during the pregnancy and is lowest in
the first trimester. It appears that wantedness is not related
to the extent of abuse. Table 2 indicates that wantedness is related
to the amount of spousal support.
Table 3 and
4 show that the relationship between wantedness and child abuse
and support of the partner and child abuse. It appears that wantedness
is more closely correlated with neglect and neglect with partner
support.
Figure 1 and
2 indicate the three most important causes, from the child's point
of view, of his mistreatment. It appears that children most frequently
ascribe immaturity of parents as the most important cause.
Table 5 indicates
mothers tend to respond with anxiety, anger, sadness, or helplessness
to varying degrees to different types of mistreatment. Physical
neglect seems to correlate closely with mother's anxious, sad,
or helpless response to the child's cry.
Table 6 shows
the results of a stepwise regression analysis of the 66 factors
considered as possibly related to mistreatment. It indicates that,
among the most prevalent factors, lack of breast-feeding, lack
of supportive husband, and losses are among the most important
causes.
Table 7 shows
the correlations between the amount of touch and breast-feeding.
Table 8 shows the connections between how cuddly a child is and
how often it may be mistreated. Table 9 indicates the connection
between childhood mistreatment and marital status. Single parents
are more likely to abuse or neglect their children.
When given
an opportunity to respond to a picture of an abused and neglected
child, children are most likely to read into it what they have
experienced themselves. We have also found that when neglect precedes
abuse it makes a child more vulnerable and susceptible. Table
10 indicates the different rates of pregnancy outcome between
an average group of physicians in a Canadian city and the Christian
Medical and Dental Society (C.M.D.S) physicians across the country.
Table 11 shows the distribution of responses to the questions
"how well has your mother or father looked after you?"
and "how was your childhood?" Table 12 indicates factors
determined by a stepwise analysis of variants associated with
more or less abuse. Family breakup and parental maturity appear
to be considered important causes.
Discussion
Contrary to
some studies and other's assessment of a self-evident truth, we
found that child abuse is not caused by being unwanted. Any connection
is best explained by the lack of partner support, which tends
to make a woman both want to have an abortion and abuse her child.
It appears
that everybody is ambivalent about everything almost all of the
time. This universal expression of undecidedness is possibly an
expression of freedom of choice. The ambivalence is most prominent
during crisis (chiros), a time of potential change. Pregnancy
is such a crisis because it necessitates an expansion of the whole
system into which the infant is born. The mother's body must expand
and her mind must incorporate another entity. This crisis of incorporation
involves every member of the family and the family's network.
Because the mother is a key figure, she must be supported. Otherwise
her ambivalence about deciding for herself or for her infant and
family becomes heightened. This survival dilemma tilts toward
narcissism, and thus the infant is seen as a parasite and is destroyed.
During the
early stages of pregnancy there is the greatest range. The hormones
are most intense and the mother is most vulnerable to doubts and
persuasion by people who ostensibly have her best interests at
heart. All of society, in some form, is involved in the mother
and family's crisis. "Can we afford to feed another mouth",
or "can we afford not to have another fighter or bearer of
children.
There are probably
in excess of 50 factors that must be dealt with if a family is
to make a clear decision about continuing a pregnancy. There is
insufficient time and there are too many pressures to make a well
reasoned choice. The choices are emotional and depend upon the
amount of partner support and the mother's reaction to the child's
helpless cry. That reaction is both innate and learned. It is
modified by conditioned passivity, how well her helpless cry was
responded to, and how well she is supported, ie. not angry at
being neglected by spouse. The response is also determined by
the quality of the infant's cry. It is an urgent, high pitched
cry if the child is neglected, and can be combative and demanding
if the child has been abused.
The unexpected
finding that women who have had abortions are more likely to abuse
their children is related to the fact she is more likely to be
anxious during the pregnancy and depressed after it if she has
lost an infant, particularly by abortion. Abortion appears to
have a greater impact because;
1) she has
contributed to the loss she must now grieve.
2) she doesn't
have an opportunity to hold, examine, and incorporate the body
in her being.
3) she has
dehumanized the infant and it is not supposed to be a real event,
even though she feels it in her mind and body.
4) she is made
to feel awkward for wanting to talk about this particular kind
of loss.
5) there are
few people interested in talking about pregnancy losses (particularly
those from abortion) and even fewer who are trained to do it.
Mothers expect
to be nurtured during their pregnancy and become very disillusioned
and bitter when they are not. When they are not nurtured by a
partner they expect vicarious gratification from the child while
they nurture it. Unfortunately, the child finds increasingly high
demands and decreasingly little appreciation that she can vicariously
enjoy. The mother expects partner support both for herself and
the infant. She wants to be, in some respects, nurtured as the
infant is nurtured. It is hard for her to believe that she will
not ever receive the kind of nurturing she needed, nor become
the person she could have been.
To produce
only wanted children compounds the problems of child abuse and
neglect because;
1) it results
in a survivor syndrome. The features of this are existential guilt,
a sense of impending doom, difficulties in making attachments
and commitments.... This affects all the siblings in the family
and, when any of these become apparent, it makes it more difficult
for them to want to have children to nurture and guide.
2) wanted children
are considered to be intrinsically unworthy of being alive. When
they feel unworthy they don't feel value others or in the environment.
They become hedonistic, self-destructive, and are less likely
to look after their neighbours or their environment. If the baby
feels worthless it is not going to value those around it.
3) it is impossible
to consider all the issues during an untimely pregnancy. Mothers
are not likely to obtain informed consent. There is no time to
work through all their conflicts, and therefore the issue to continue
or not continue the pregnancy tends be decided on the basis of
rights, or how the mother feels at the moment is often swayed
by self-interested people.
4) insisting
on every child being wanted diminishes the amount of partner support.
Partners are not likely to become attached to an unborn baby if
they are afraid of losing it. No one attaches when there is a
possibility of having to face the pain of loss. In addition, partners
who have no right to restrain a woman who wants an abortion feel
helpless. This results in anger and a rejection of the spouse.
5) wanted children
are more likely to be neglected because they are disappointing.
They may be given lots of tools and toys, but the neglect makes
them more vulnerable and susceptible to abuse. They are more likely
to be immature.
There is no
simple cure for this cycle of increasing amounts of abuse and
abortion. However, these could be tried. Clinicians and government
should make every effort to improve partner support. With partner
support there is less likely to be abortions and miscarriages.
The mother is more likely to bond to her child, breast feed, touch,
and respond to its helpless cry appropriately.
It is essential
for bonding that the parents grieve previous pregnancy losses.
This involves dealing with a variety of deep seated conflicts,
some of which stem from the mother's early life.
When it is
not possible to have a partner, surrogate partners, such as family
physicians, can improve the sense the mother is being looked after
and will encourage her to maintain her pregnancy.
It is vital
that every child be considered welcome whether they are wanted
or not.
