Unwantedness and Child Abuse

Posted by on Jul 31, 1993 in Science

Philip G. Ney MD FRCP(C)

© 1993

Introduction

For many years it has been stated that the first right of a child is to be wanted. The logic was if every child was wanted they would not be neglected and abused. Although this appears to be self-evident truth, since it affects such a vast number of people one would think there would be some research to test this hypothesis. This is especially true since the corollary is that if the child is not wanted he has no right to be. This in fact has become the policy in much of the world.

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.

References

1. Zuravin S.J. Unplanned childbearing and family size: their relationship to child neglect and abuse. Fam. Plann. Perspect. 23(4), 155-61, Jul-Aug, 1991.

2. Altemeir W.A. 3d, O’Connor S., Vietze P.M., Sandler H.M. and Sherrod K.B. Antecedents of child abuse. J. Pediatr. 100(5), 823-9, May, 1982.

3. Holman R.R. and Kanwar S. Early life of the “battered child”. Arch. Dis. Child. 50(1), 78-80, Jan, 1975.

4. Ney P.G., Moore C., McPhee J. and Trought P. Child abuse: A study of the child’s perspective. Child Abuse Negl. 10, 511-518, 1986.

5. Dytrych Z., Matejcek Z., Schuller V., David H.P. and Friedman H.L. Children born to women denied abortion. Fam. Plann. Perspect. 7(4), 165-71, Jul-Aug, 1975.

6. Brett A. and Brett W. Outcome and management of crisis pregnancy counselling. N. Z. Med. J. 105(926), 7-9, Jan 22, 1992.

7. Lenoski E.F., Child Abuse, presented to Senator Mondale, Chairman, U.S. Senate Select Committee for Children and Youth, Congressional Record, June, 1973.