“Adoption is just not for me”: How abortion patients in Michigan and New Mexico factor adoption into their pregnancy outcome decisions

Abstract

Objectives

In public discourses in the United States, adoption is often suggested as a less objectionable, equal substitute for abortion, despite this pregnancy outcome occurring much less frequently than the outcomes of abortion and parenting. This qualitative study explores whether and how abortion patients weighed adoption as part of their pregnancy decisions and, for those who did, identifies factors that contributed to their ultimate decision against adoption.

Study design

We interviewed 29 abortion patients from 6 facilities in Michigan and New Mexico in 2015. We conducted a thematic analysis using both deductive and inductive approaches to describe participants’ perspectives, preferences, and experiences regarding the consideration of adoption for their pregnancy.

Results

Participants’ reasons why adoption was not an appropriate option for their pregnancy were grounded in their ideas of the roles and responsibilities of parenting and fell into three themes. First, participants described continuing the pregnancy and giving birth as inseparable from the decision to parent. Second, choosing adoption would represent an irresponsible abnegation of parental duty. Third, adoption could put their child’s safety and well-being at risk.

Conclusions

Adoption was not an equally acceptable substitute for abortion among abortion patients. For them, adoption was a decision that represented taking on, and then abdicating, the role of parent. This made adoption a particularly unsuitable choice for their pregnancy.

Implications

Rhetoric suggesting that adoption is an equal alternative to abortion does not reflect the experiences, preferences, or values of how abortion patients assess what options are appropriate for their pregnancy.

1. Introduction

Although there are three options with regard to a pregnancy outcome decision (parenting, abortion, or adoption) [1], national lifetime incidence rates of these outcomes among reproductive-aged women1 in the United States vary starkly. While 84% of United States women will give birth in their lifetime [2], and approximately one in four women will have an abortion in her lifetime [3], only 1% will formally place a child for adoption [4]. The relative infrequency of adoption compared with abortion suggests that it is either inaccessible or undesirable for most people who do not want, or are unable, to be pregnant or parent.

Previous research has also shown that women do not necessarily weigh their pregnancy outcome options equally. While some arrive at a certain and relatively immediate decision about whether to continue their pregnancy (including to parent or not) without the need for in-depth consideration of alternatives [5], [6], research suggests that those who spend more time weighing their options are often choosing between parenting and adoption or parenting and abortion, but not seriously considering the full triad [7], [8], [9].

There is limited research on how the option of placing a child for formal adoption factors into abortion patients’ pregnancy decision. One qualitative study of reasons for choosing abortion among 38 abortion patients found that one in four spontaneously brought up that they had rejected adoption as an option, citing that it would be emotionally distressing [10]. Another qualitative study examining adoption considerations among 16 abortion patients found that they were aware of adoption but not interested in it because “they felt it was not right for them, their partner would not be interested, they had health reasons for not wanting to carry to term, or they believed there were already enough children in need of homes”(p 139) [9].

In this qualitative study, we describe how abortion patients weighed adoption as part of their decision and the factors that contributed to their assessment of the suitability of adoption as a choice for their pregnancy outcome.

2. Methods

2.1. Sample and data collection

We use data from a study designed (by LFF, MK, JJ, and NB) with the primary aim to examine barriers to abortion care among abortion patients who traveled to obtain care and the secondary aim to examine the consideration of parenting and adoption within pregnancy decision-making among abortion patients. [11]. We conducted semi-structured in-depth interviews between January and February of 2015 with 29 abortion patients across six facilitates in Michigan and New Mexico. Eligible patients were 18 or older and had traveled from outside of the interview state or from over 100 miles within the interview state.

To collect data for the secondary aim, we asked two open-ended questions, followed by probes to elicit further details. We first asked about the decision-making process to have an abortion. Later in the interview, we asked participants specifically to describe whether and how they considered abortion, parenting, and adoption. Additionally, we asked about previous experiences with adoption or receiving information or counseling about adoption during a past pregnancy and attitudes towards adoption in general and open adoption, specifically. We piloted the in-depth interview guide with six abortion patients obtaining care in New York City.

Clinic staff identified eligible patients and referred those interested to the onsite research team. We (LFF, JJ, NB, and MK) conducted interviews in English, lasting approximately 1 hour, in private rooms. We were not familiar with the specific geographic contexts within which we conducted interviews; this latter point was explicitly addressed at the start of each interview when we stated to participants that we were from a research institute in New York City and considered them too be experts on their own lives and much more familiar with their local context than we were. All interviewers are cis-gender women with training in qualitive interviewing and data analysis and substantive expertise in abortion service delivery and access. Additionally, LFF is white, a parent and has a bachelor’s degree; JJ is white and has a master’s degree in public health, NB is Black and has a master’s degree in psychology; MK is white and has a doctorate of public health. We obtained consent from all study participants. At the end of the interview, participants filled out a questionnaire on sociodemographic characteristics and received $50 cash as remuneration. Our organization’s federally registered Institutional Review Board approved the study protocol.

2.2. Data management and analysis

We audio recorded and transcribed in-depth interviews verbatim. We developed an initial coding scheme based on the interview guide and existing literature (LFF, JJ, NB, and MK) which we iteratively updated throughout the coding process. Four research team members independently double-coded several transcripts and then met to resolve differences through discussion and development of new codes (LFF, JJ, NB, and MK). These discussions included how our subjective experiences, social identities, and positionalities might influence codes, their interpretations, and the underlying assumptions that informed them. After this step, we coded all remaining transcripts (LFF, JJ, and NB). We used NVivo 10 (QSR International Pty Ltd) to organize the data, code transcripts, and generate code reports.

For this analysis, we focused on codes related to abortion patients’ pregnancy decision-making, consideration of adoption in this process, and attitudes about adoption. One researcher (LFF) analyzed the data to assess respondents’ decision-making processes and to identify themes within their descriptions of these processes. We then conducted a more targeted thematic analysis focused on these codes to identify themes relevant to patients’ consideration of adoption (LF, LFF, and MK). We created a matrix to group participants’ responses according to these themes, which allowed us to inductively identify sub-themes related to adoption and pregnancy decision-making, and analyze whether, how, and to what extent each participant brought up each theme (LF). We used these matrices to draft analytics memos with further analysis of each of these themes. (LF). One author (LF, a white and Hispanic, cis-gender woman, with graduate training in qualitative analysis, more than 10 years of experience conducting research on abortion access, and who has experienced barriers to obtaining abortion care) drafted the manuscript further interpreting, presenting and contextualizing our findings, with all other authors commenting on each draft.

Jones et al. [10] found that most of the abortion patients they interviewed that brought up reasons for rejecting adoption were women who already had children, so we grouped themes in our matrix by whether the participant had previously given birth to examine whether there were thematic patterns based on this experience. We present findings using exemplary quotes to illustrate each theme.

3. Results

3.1. Sample characteristics

Demographic characteristics are presented in the Table 1. The majority of the sample were in their 20s (19 of the 29), reported incomes ≤200% of the federal poverty level (n = 22), and had at least some college education (n = 19). Just over two-thirds had previously given birth (n = 20).

Table 1.

Demographic characteristics of abortion patients in Michigan and New Mexico in a qualitative study of the consideration of adoption in their pregnancy decision (n = 29), 2015

Characteristic	Total (n = 29)
Age-group
18–19	2
20–24	11
25–29	8
30–34	4
35–44	4
Race/ethnicity
Hispanic	10
White	10
Black	7
Other	2
Family income as % of federal poverty level
<100%	14
100–199	8
≥200	7
Educational attainment
<High school	1
High school graduate/General Educational Development credential	9
Some college/associate degree	14
College graduate	5
Number of prior births
0	9
1	6
≥2	14
Interview state
Michigan	15
New Mexico	14

3.2. Overall consideration of adoption as pregnancy outcome

When asked to describe their pregnancy decision-making process, 17 participants described choosing between only abortion and parenting, 10 described considering all three options of abortion, adoption, and parenting, and two rejected the decision-making construct and described considering no options to weigh, at any point, aside from abortion. When explicitly asked how they weighed parenting, abortion, and adoption later in the interview, the choice between having an abortion and parenting became even more dominant: 21 women reported that they weighed abortion against parenting, five reported that they had only considered abortion, two women reported weighing all three options, and one reported that she weighed abortion against adoption. This shift reveals that while many of these abortion patients broadly considered a set of options, when asked to describe each choice specifically, the ones that they considered more realistic or appropriate for their pregnancy were more focused.

Several participants described conversations about their pregnancy options in which adoption was discussed with others, such as a clinician, partner, friend, or family member. Three participants visited a crisis pregnancy center (CPC) to obtain a pregnancy test or ultrasound for their pregnancy; one participant explicitly noted doing so because the services were free. All three described feeling “pushed” (a 21-year-old with no previous births, who reported only abortion as a possible choice for their pregnancy but later discussed having contemplated then deciding against adoption) or “persuaded” (a 28-year-old with no previous births, who reported having chosen between parenting and abortion but later described having considered adoption) toward adoption by CPC staff and feeling frustrated or having to exercise patience by “tuning out” because they were not interested in adoption. The 21-year-old with no previous births said:

[The CPC staff] were like “Well can you go away for a little bit and have the baby and put it up for adoption?” I said “No, I can’t carry it full-term. You are not understanding.” I just kind of wanted to get up and just leave to be honest.

Two participants considered adoption because the circumstances of their pregnancy had changed. A 38-year-old with one child considered adoption as a “plan B,” even identifying a potential couple that she had been friends with for years as a “reasonable” adoptive home should she be unable to obtain an abortion. However, she had no plans to raise this possibility with the couple unless she were denied abortion care, and she said would not consider adoption if it were to strangers. A 20-year-old with one child who weighed adoption against abortion described her pregnancy as originally being wanted but when she experienced extreme family violence perpetrated by the man involved in her pregnancy, she discussed how best to proceed with the pregnancy—including adoption—with her obstetrician–gynecologist and mother. Both participants only contemplated the idea of adoption when they perceived that their access to, or ability to obtain, their originally preferred pregnancy resolution was in question.

No participants indicated that not choosing adoption had to do with insufficient access to adoption information or services or because they lacked enough social support to consider it. Indeed, four participants described receiving information or being offered a conversation about adoption in a clinical setting and declining to explore it further because they already knew that they were not interested in it.

3.3. Reasons for not choosing adoption

Participants described reasons for deciding against adoption that were grounded in their ideas of the roles and responsibilities of parenting. These parenting-related reasons reflected three main themes. First, and most commonly, participants described continuing the pregnancy and giving birth as inseparable from the decision to parent (n = 24). Second, choosing adoption would represent an irresponsible abnegation of parental duty (n = 12). Third, adoption could put their child’s safety and well-being at risk (n = 11). We found no salient differences in these reasons according to whether a participant had previously given birth; those who had done so sometimes grounded their perspectives in their parenting experiences while those who had not talked about parenting in the abstract. For most participants, their narratives reflected an interwoven understanding of these reasons; indeed, 19 of the 25 participants who mentioned any of the three main themes related to reasons for not choosing adoption raised more than one of them and often at the same time.

Taken together, these themes indicate that for these abortion patients, adoption represented taking on, and then abdicating, the role of parent.

3.3.1. Continuing the pregnancy is inseparable from the decision to parent

Many participants did not describe adoption and parenting as opposite or distinct pregnancy outcomes. Rather, they framed continuing a pregnancy and placing a child for adoption as a decision to become a parent. Some described pregnancy as the beginning of the formation of a parent–child bond (n = 15). They predicted they would become emotionally attached, bonded, or grow to love the baby if they continued the pregnancy and gave birth, and rejected the possibility of adoption because of the profound emotional pain and heartbreak they anticipated would occur when it came time to place the child in adoption. For example, one 24-year-old with two previous births said:

I feel like adoption is worse than abortion -- so much more worse because any woman who has been pregnant before and carried their child for nine months, it’s an experience and you kind of – you bond with your belly and you feel the kicks. So there is some sort of connection there already and for you to go through the birthing process and deliver your child into this world and then just see him or her with another family, I think it’s absolutely heartbreaking…I couldn’t do it.

Participants also described the act of continuing the pregnancy and giving birth—including the risks, physical discomforts, and emotional changes—as the irrevocable entry point to parenting (n = 12). A 33-year-old with two previous births said:

I never considered adoption ever. If I was going to have this baby then, I’m it’s mom. I don’t ever think I could carry a child for nine months and feel it kick and give it up to somebody, ever. Because it is my child and…I personally just feel like I could not carry a child for nine months and then adopt -- If I had to give it up to someone else. There’s just no way.

3.3.2. Adoption would be an abnegation of personal responsibility and parental duty

For some, adoption was not an acceptable option because it conflicted with the value they placed on taking responsibility for oneself or one’s “own problems” or represented the specific abnegation of their duty as a parent through either having a child and refusing to parent or passing the child on to others to care for (n = 14). A 26-year-old with no previous births said:

I think [adoption] would be probably the most irresponsible thing for me personally to do…not irresponsible but just the most detrimental for me. I don’t think I could carry a child to term, deliver it and then kind of just hand it to someone else. I think at that time, if I am making that decision to keep the baby, I think it’s then up to me to be the parent… That would be the worst. That would be more detrimental than this is to me, personally.

Three participants discussed how this parental duty eliminated the possibility of adoption for them because they feared or knew they would have a child that would be disabled. This fear arose from the specific circumstances of their pregnancies, in particular: having used drugs and alcohol before knowing they were pregnant, fearing their child might inherit violent tendencies of the man involved in the pregnancy, or for a 25-year-old with two previous births, having received a diagnosis of abnormal fetal development. The latter participant expressed this sense of responsibility as follows:

If you don’t want it, give it up for adoption, like that’s how I’ve always felt, but it’s different because like I said, this whole experience for me has changed my perspective on everything because even adoption at this point isn’t an option, because if I can’t take care of this child, who is going to say that somebody else can? Like what if this baby does have to have a colostomy bag and a catheter, and it’s never going to be able to walk. So I am going to institutionalize this child and it’s going to sit in a room pretty much its whole life? That’s not a life to live. I can do better than that.

3.3.3. Adoption would potentially put their child’s health and well-being at risk

In the previous quote, the participant’s perspective that their responsibility to “do better” than adoption was linked to the third theme, in which for some participants (n = 11), adoption was not an option because of the risk of jeopardizing the safety and well-being of their child. They perceived a potential harm of adoption in the possibility that their child might not go to a “good family” but rather be raised in an abusive, neglectful, or unloving home. As a 31-year-old with two previous births expressed:

I don’t know if I’m selfish or not, but adoption scares me. I’m like, I don’t want to just give my little.baby, you know, after I see this baby born and healthy and crying and stuff and just pass it to a stranger and no telling how the life might -- I mean, they might have money, whatever, but there’s people out here that’s crazy as well. They’ll harm your children and harm their own kids and it’s a lot of people that still do crazy stuff but live really good, you know. So I think I just -- me, it either is abortion or I’ll just be the parent because it’s my child, yeah.

Some participants raised concerns about the potential psychological harm to their child of being adopted, such as feeling abandoned, unloved, carrying a profound or unresolved longing to know who their birth mother is, or always wondering why their birth parents did not want them. For example, a 25-year-old with no previous births said:

The thought that you bear the child and that someone else is taking care of it, and that-- pretty much thinking about the child growing up, and having different mental problems, and stages, and going through stages in life knowing that they have a parent out there that didn’t want them or something.

Participants noted the challenges associated with having no control over any unsafe conditions or bad parenting decisions their child would be subject to in an adoptive home, having handed off those responsibilities to adoptive parents. Indeed, in responding specifically to the idea of open adoption, no participant indicated that this format would make adoption a more suitable option for them personally. A few expanded on this by describing how relinquishing of their child in open adoption could exacerbate painful feelings around the loss of control over the parenting role.

4. Discussion

We found that participants considered adoption a particularly unsuitable choice for them. In addition, our findings reveal that reasons for deciding against adoption largely had to do with participants’ conceptualization of what it means to be a loving, responsible parent. Many considered continuing a pregnancy to birth as a beginning stage of parenting, with the accompanying emotional connections and responsibilities implied by this role. Choosing adoption was perceived as setting them on a path toward severing an established parental bond and as a choice that simultaneously relinquished their parental control while retaining some form of parental identity. They foresaw that adoption would result in psychic pain from severing established bonds and feared it would not be a responsible, loving or safe choice for the resultant child, violating societal narratives of what it means to be a “good mother” [12], [13] in ways they found unacceptable.

These results are consistent with other research finding that the majority of abortion patients are not interested in adoption [9], [14] and have high certainty about their abortion decision [5], [14], [15]. Moreover, our participants’ prediction that adoption would be a negative experience for them is corroborated by study findings among some birth mothers describing their negative or mixed experience with choosing adoption [8], [9].

A strength of this study is that participants were asked about their pregnancy decision in an open-ended manner and later prompted to reflect on their consideration of abortion, adoption, and parenting specifically, providing a chance for richer responses about adoption. We also asked about participants’ knowledge of, and attitudes towards, open adoption, so we could examine whether or how that specific modality factored into their decision.

Given the study’s eligibility criterion of patients who traveled for abortion care, our sample includes some patients who may be considered highly motivated to obtain such care and therefore may not reflect all abortion patients’ adoption considerations. However, the perspectives of these patients may be particularly valuable to understand if adoption is leveraged politically or legally as a reason for passing or upholding abortion bans. Abortion bans force patients to travel long distances for abortion care or continue a pregnancy if they cannot do so [16], [17], both of which place great burdens on them precisely because they have chosen to obtain an abortion and do not want to parent or place their child for adoption.

We draw on data from interviews conducted in 2015 to understand adoption considerations among abortion patients; while there are no clear reasons why these considerations would have changed since that time, we cannot rule out the extent to which more national attention on the increases in abortion restrictions since then may have differentially shaped abortion patients’ pregnancy outcome attitudes and decisions today. Finally, although our participants had remarkably similar motivations for not choosing adoption across demographic characteristics, we did not purposively sample or design this study to understand how adoption attitudes might differ by these. Thus, our study was not able to delve into how legacies of coercive removal of children from Black, Indigenous and immigrant parents may influence considerations of adoption among abortion patients from these and, indeed, all communities [18]. Similarly, this study was conducted in English only. Adoption experiences and perspectives among United States abortion patients with other primary languages are largely unstudied and should be explored in future research.

Advocacy efforts against abortion often suggest adoption is a less objectionable and equally acceptable substitute for pregnant people who cannot or do not want to parent [8], [19], [20], and many states allocate public funds to antiabortion CPCs that promote adoption as a suitable choice for this same group of pregnant people [21], [22], [23]. This rationale for restricting abortion care ignores the physical, emotional, and social risks and burdens of continuing a pregnancy and giving birth, which adoption does not circumvent [24]. It also ignores the perspectives and preferences of pregnant women, transgender men, and gender nonbinary individuals themselves, especially those who have chosen abortion. We found that abortion patients felt that continuing their pregnancy and placing the resulting baby for adoption would be in violation of their values about what it means to be a parent and have negative consequences as a result. This study builds on others’ qualitative work demonstrating that abortion patients are aware of but uninterested in adoption to describe abortion patients’ multiple reasons, grounded in their personal circumstances, values, and assessment of adoption’s negative effects, for why they reject adoption as a reasonable or realistic option for their pregnancy.