Research articles

By Dr. Philip Ney , Dr. Marie A Peeters-ney , Dr. Tak Fung , Dr. Claudia Sheils
Corresponding Author Dr. Philip Ney
Dept. of Psychology, Mount Joy College, - Canada
Submitting Author Dr. Philip Ney
Other Authors Dr. Marie A Peeters-ney
Mount Joy College,Epidemiology, - Canada

Dr. Tak Fung
Dept Mathematics & Statistics, - Canada

Dr. Claudia Sheils
Mount Joy College,Research, - Canada


Partner, Adolescent, Pregnancy, Full term, Miscarriage, Abortion, Support, Preterm

Ney P, Peeters-ney MA, Fung T, Sheils C. How Partner Support of an Adolescent Affects Her Pregnancy Outcome. WebmedCentral PUBLIC HEALTH 2013;4(2):WMC004076
doi: 10.9754/journal.wmc.2013.004076

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 26 Feb 2013 06:58:57 PM GMT
Published on: 28 Feb 2013 07:05:24 AM GMT


To investigate any connection between partner support and pregnancy outcome, self administered questionnaires were given to the first thirty women of child bearing age that came in to the office of their family doctor on a particular day. If the partner is present and not supportive the miscarriage rate is more than double and the abortion rate four times greater than if the partner is present & supportive. For four pregnancies the best predictor of outcome is the outcome of the first pregnancy. Fifty five percent of teenagers have partner support compared to 90 % for those 33 years and more. Partner support appeared to be the fourth most important factor in determining the rate of breast feeding. In 94% there is no significant change in partner support from one pregnancy to the next. It appears that if miscarried and aborted pregnancies are not included in the calculations, adolescents have the same percentage of normal birth weight full term babies as other age groups.


Psychologists and veterinarians have found that the quality of care and support given to the pregnant female determines the quality of the pregnancy, the type of delivery and the  health of the newborn.  Our earlier paper described the relationship between pregnancy outcome and general health (1). In this paper we report on the apparent relationship between partner support and pregnancy outcome, especially for adolescents. 

The search of literature found few articles directly addressing the effect of partner support  or lack of it, on pregnancies.  The majority of the items recovered by the search terms pregnancy outcome and partner support, considered the long term effects of intimate partner violence (IPV) on a mother’s health, pregnancy outcome and future pregnancies.  (2,3,4,5,6 )  The association of IPV and poor pregnancy outcome is complex. The study of 680 postpartum women in Manitoba, Canada, found that abused women were significantly more likely to be younger, use illicit drugs, have poor support from partner and move frequently (7). Using data from the 26 state Pregnancy Risk Assessment Monitoring System (n=118,576) Silverman, Decker, Reed and Raj (8) found that women experiencing IPV before and during pregnancy are at risk for poor maternal and infant health outcomes.  A study of a random sample of 2391 women in Auckland, New Zealand (9) found that both induced and spontaneous abortion were significantly associated with IPV.  The violence of partners has detrimental effects on almost all parameters. In the Wakiso district of Uganda, pregnant adolescents faced many kinds of domestic violence. “They were psychologically violated by parents, partners and the community within which they lived.”(10).  

For a long time it has been suspected that stress to a mother will be associated with poor pregnancy outcome. However the relationship between these two variables is convoluted. A population based cohort of 1,188, 822 men and women in Denmark (13), found that those with psychopathology in relatives and/or partners  were  at a higher risk for postpartum mental disorders. Another study at the University of Aarhus (14) found that there was no strong association between prenatal stress and epilepsy in the child’s first decade of life.  Sixteen hundred sixty-two participants in project VIVA of Boston (16) gave evidence that financial hardships and unwanted pregnancy  are associated with antenatal and postpartum depressive symptoms. The difficulty in this study is that an important factor they assessed , wantedness is an effervescent property, changing from day to day, even from hour to hour in the same day, depending on mood, finances, partner support etc. A study from Oxford (17) found that high levels of prenatal stressors did not have an increased risk of behavioural problems in the children at two years but they did at four years.

Reime, Schucking and Wenzlaff (18) in their study of  8857 women, used bivariate and multivariate logistic regression models to analyze the results of their findings.  Adolescents with previous births had higher risks of perinatal and neonatal mortality.  Adolescents with previous abortion had a higher risk for stillbirth and preterm births.  However, adjusting for maternal nationality, partner status, smoking, prenatal care, and prepregnancy, adolescents with a previous birth were at a higher risk of perinatal and neonatal mortality.  Adolescents with previous abortion had a higher risk for very low birth weight than nulliparae teenagers.   Of these women studied in Saarbrucken, Germany from 1990 to 1999, 7845 were nulliparous, 801 had one birth and 211 had one previous induced abortion. The study could be faulted on the fact that it appeared only 2.5% of the sample had an abortion which would tend to indicate the possibility of under-reporting.   

Data obtained from the “ Listening to Mothers Project”, found that mothers without partners were at a higher risk than unmarried mothers with partners for Caesarean Section. (19)  A study in Dunedin, New Zealand (20) found that the risk of inadequate prenatal care and preterm birth were increased when partners did not share intention or when neither partner intended the pregnancy.   The risk of premature birth was particularly high when the partners were unmarried and either or both did not intend the pregnancy.    Yet in Spain (21) it was found that unplanned pregnancies did not increase the risk of pregnancy depression either in the women or the men in a sample of 669 men and 687 women.  (Escribe-Aguir V).   Apart from the quality of the pregnancy and the health of the newborn, it appears that partner support is an important variable determining the outcome of a pregnancy.

There are contradictory findings in the many studies on the effect of various kinds of social support during pregnancy and delivery  Casper and Hogan (25) found that although in young mothers  access to family did not effect their pre- and post-natal health practices, yet if they lived with a sexual partner or husband they were more likely to seek pre-natal care and avoid the use of alcohol during pregnancy.  Curiously, being near their family seemed to diminish the probability of breast-feeding.  The beneficial effects of partner proximity were particularly on birth weight and the level of depressive symptomatology. From1985 to 1988, there was a two-fold decrease in the low birth weight of babies enrolled in an urban prenatal clinic as ascertained in a study at Howard University (26). There have been many studies attempting to improve the outcome of pregnancy by providing professional support. The study at the University of Colorado (28) (Olds) on 594 urban, primarily Afro-American, economically disadvantaged women found that one could reduce the cost of Medicaid and aid to families by $12,300 with a program that cost $11,511. However there was no statistically significantly program effects on the mother’s marriage or partnership with the child’s biological father, intimate partner violence, alcohol or other drug use, arrest, incarceration, psychological distress or reports of child foster care placement. A small study in Ann Arbor, Michigan (29) evaluated a peer-centered prenatal care program  for adolescent mothers. Those in the experimental group had lower rates of low birth weight (Ford K.)

The effects of various kinds of support and encouragement during labour seem to have differing effects, depending on how the outcome is measured.  Chalmers and Wolman (30) found that support given by trained or lay untrained female supporters had the most consistently positive effect on obstetric and psychosocial outcome for women in South Africa.  Their studies of partner support yielded contradictory findings.  Klaus and Kennel (31) found that the presence of a supportive companion during labour and delivery shortened labour and reduced the need for caesarean section.   

If a family member or partner is unable to be present and supportive during pregnancy and delivery, would substitutes be beneficial. There is accumulating evidence that the problems of low birth weight, child abuse and neglect, childhood injuries, unattended and closely spaced pregnancy can be reduced with comprehensive programs of pre-natal and infancy home visit by nurses.   Bryce, Stanley and Garner (33) did a  controlled study of 1970 pregnant women with poor obstetric history in three public hospitals in Western Australia. They assigned approximately half to the program group and the other half to a control group. The program group, in addition to the normal anti-natal care, had social support consisting of home visits and telephone calls by midwives.  They concluded that the results of the trial showed little evidence of the effectiveness of social support interventions in the prevention of pre-term birth in women with poor obstetric histories.   A study of African-American women in the District of Columbia found that low birth weight and preterm births was associated with intimate partner violence but this could be reduced using an integrated behavioural intervention (34)

Tamburrino et al. (35) provided surveys to a sample of 150 women, 81 of which were returned.  They found that in addition to multiple abortions, risk factors for post-abortion dysphoria were: psychiatric illness, lack of family support, ambivalence, and feeling of being coerced into an abortion.  Baker and Khasiani (36) found that for women in Kenya, being unmarried and unemployed contributed to the decision to abort. In China, a 3 arm randomized trial on 1800 women, found that by involving the husbands in family planning, the number of pregnancies and abortions were reduced (37) (Wang 2, 1/3). 

There is conflicting evidence as to how the pregnancy outcome effects continuing partner support.  Barnett, Freudenberg and Wille (40) studied 92 patients seeking socially indicated abortions and who had a stable partner at the time.  They were interviewed one year later and there was not a significantly higher number of separations in the abortion as compared with the control group.  A study in London found that mothers who had a stillbirth were more likely to experience subsequent partnership breakdown (41) (Turton).       

There are  persistent reports of mental health problems following abortion.  Furgusson, Horwood and Ridder (42) found that young post abortion women who were part of their longitudinal research in Christchurch, New Zealand, had elevated rates of depression, anxiety, suicidal behaviour and substance abuse. Our study (1) showed that unresolved grief from any type of pregnancy loss could interfere with continuing health. The deleterious on effect on health of an abortion was significantly greater than that of miscarriage or a stillborn baby.


This study was part of ongoing research to determine the effects of pregnancy loss on the health of women and their families, and possible factors that contribute to various kinds of pregnancy loss. In our earlier study conducted in conjunction with the College of Family Physicians of Canada, the receptionists of family doctors in Victoria, BC were asked to give a questionnaire to the first thirty women of child bearing age or older who walked into the practice on a particular week. Each questionnaire began with assurances of confidentiality and proper treatment regardless of the subject’s participation, together with an explanation of how to respond to the questions. The questionnaire has been checked for reliability and validity.  It consists of a number of visual analog scales asking the subjects about their health. There is also a grid on which subjects indicate one of eight possible outcomes for up to nine pregnancies, the supportiveness of partners, questions regarding their physical and emotional health before, during and after pregnancy, and demographic questions regarding age, number of living children, marital status etc. To validate the subject’s estimate of their health, data from a sub-sample was used to compare the physician’s estimate of health, the patient’s estimate of their own health, and an independent researcher checking the files of the physicians. Estimates of general health indicate that in 84 % of the cases the researcher’s estimate was within two points of the patient’s assessment, and the doctor made a rating within one point of the patient’s in 44 % of the cases. While any scale giving a global rating of physical or emotional health is subjective, the data indicates there is a reasonably good correlation between the patient’s estimate of their health and that of professional observers.


It appeared that the lack of partner support was significantly associated with higher rates of abortion and miscarriage.  Compared to women whose partner was present and supportive, those whose partner was absent, had a rate of abortion six times greater in the first pregnancy and more than 17 times greater in the second pregnancy (Illustration 1). There is a four times higher rate for abortion in the first pregnancy and seven times higher rate in the second pregnancy if the partner is present but not supportive. If the partner is present in the first pregnancy and not supportive, the miscarriage rate is 2.1 times greater and 1.5 times greater in the second pregnancy than if the partner is present and supportive. The absence of a partner appeared not to make a significant difference to the miscarriage rate.

A logistic regression of this data (Illustration 2) indicated that the most important factors which are associated with whether a woman will abort her first pregnancy, in descending order, are: partner not present or supportive, young age, not married, low objection to abortion. Data in Illustration 3 indicates that only 54.5 % of teenage women have partner support whereas women 20 year plus have 80 % or greater support. This appears to be as true for the second pregnancy as it for the first (Illustration 4). The effect seems to continue, at least to the sixth pregnancy and possibly beyond.

In addition to the above factors, we found that the closest correlations and possibly the best predictor of the next pregnancy’s outcome is what occurred in the first pregnancy (Illustration 5). If the first pregnancy ends in a full term normal birth weight child, there is a 76.9 % chance the same will occur in the second pregnancy. If the first pregnancy results in miscarriage, that is the 2nd most likely outcome in the second. The same is true for abortion, low birth weight and prematurity. This effect continues for four pregnancies We also found the miscarriage rate following an abortion compared to full term pregnancy was 1.5 to 1 and following a miscarriage 2.3 to 1.

In the 14-19 year old group, if aborted pregnancies are not included in the calculation, 77.2 % have normal birth weight, full term babies as compared to 78.0 % in the 20-25 year age bracket, 75.8 % in the 26-30 year olds, and 73.8% in the 31+ age group (Illustration 6)  We found that the rate of various pregnancy losses varied with age.  Among teenagers, 50.4 % were full term, 12.5 %miscarriage, and abortion 26.8 %.  The rate of miscarriages increased and the rate of abortions diminished with age.

From an analysis using a logistic regression, it appears that partner support is significantly associated with a full term pregnancies outcome. In the third pregnancy, lack of partner support in that pregnancy and the pregnancy before were associated with a pregnancy loss.  (Illustration 7). The adverse effect of a previous pregnancy loss in the first pregnancy on the health of the mother is also associated with pregnancy loss in  pregnancies 2-4 (Illustration 8). Using a multiple regression (Illustration 9) we found that the most important variables associated with the subject’s present health are: the quality of her family life, a loss of her first pregnancy and poor partner support.

Partner support, among other factors, is important in the likelihood of breast-feeding after the first pregnancy.  Out of the 29 variables considered by a logistic regression, the factors most closely associated with increasing the likelihood of breast-feeding are: 1) the child was a full term, normal birth weight, or full term, low birth weight, or preemie, 2) there was better emotional health during the pregnancy, 3) the patient was older in the first pregnancy, 4) she had more partner support, and 5) the partner was present at the birth of the first child.  For the second pregnancy the factors most closely associated with breast feeding are: the first pregnancy outcome, the amount of partner support during the second pregnancy, whether the partner was present at the birth, and whether the baby was breastfed at the first pregnancy.  It appears that the rates of breast feeding increase after a miscarriage but not after an abortion.

In most instances there is no change in the amount of partner support between the pregnancies, ie. those that didn’t have partner support in the first pregnancy don’t seem to have it for later pregnancies. Regardless of the outcome, in 94.4 % of the instances there is no change in the amount of partner support.  

Partner support and previous losses appear to be the factors most closely associated with the outcomes of the third pregnancy (Illustration 10)

We used Cox’s proportional hazard model to assess the effect of variables on survival function, IE. the time between pregnancies one and two. We found the less partner support after the first pregnancy, the smaller the hazard and hence the longer the time interval between pregnancies one and two. If the first pregnancy is miscarried, the hazard function is larger and thus the shorter the interval between pregnancies one and two.


Partner support seems to be affected by a previous pregnancy loss and also seems to contribute to losses in a cyclic manner. The woman’s emotional and physical health also appears to be affected by partner support, both during and after the pregnancy. It is not surprising that women are more likely to breast-feed if they have partner support. All of these factors seem to indicate that for optimum health, good pregnancy outcome, and breast-feeding, a woman needs to be supported by a committed partner who understands her needs and nurtures her. 

Our evidence supports the hypothesis that pregnancy losses have a deleterious effect on maternal general health. The possible mechanisms include: 1) the pregnancy is un-mourned, 2) there is an increased level of depression which may affect the immune system, making the mother more vulnerable to infections and other diseases, 3) a loss, particularly during the first pregnancy, results in increased anxiety in the second pregnancy. Conflicts that result in anxiety consume energy and may limit the person’s ability to reason clearly and make correct decisions. Psychological conflict consumes energy and may make a person vulnerable to illness in a number of ways. Conflicts tend also to make a person misinterpret or distort critical input and make it difficult to make wise decisions, have useful communication and socially appropriate behaviour.

There is evidence that lack of partner support contributes to the loss of a pregnancy and implies that the converse is true. Pregnancy is more likely to be maintained when there is partner support.  There are probably psychological, ethological and hormonal reasons for this. A pregnant woman is more likely to be financially and emotionally supported by a partner. It seems from the studies we cited that the partner can do this better than other members of the family or professionals.  Protection against intruders is an indispensible component of avian parental care. Carefully monitored by video camera, it appears that the male Great Reed Warbler defends its mate’s nest against the parasitic Cockoo. (43) (Pozgayova 5,2/8) The female is responsible for nest checking and egg ejection behaviours.   Mediated by prolactin and androgen, male gerbils show high levels of parental behaviour toward their pups after copulation and co-habitation with the pregnant female. If the pups were taken away and then replaced, the female gerbil showed a significant elevation of prolactin levels one hour later but the males did not. (44)  (Brown)

Our data indicates that women are more likely to lose their pregnancies without the support of the male partner. Social behaviours including courtship, parenting and aggression depend primarily upon two factors: A social signal to trigger the behaviour and the hormonal milieu that facilitates or permits it. In the white throated sparrow, hearing the male’s song induces more expressions of interest but only in birds with estrodial levels typical of the breeding season.(45)  (Maney)  Similarly in humans the attraction to a male face is greater during the follicular phase of the menstrual cycle. When pregnancy is possible, women have a superior inhibitory brain function and heightened detection of inhibitory failure when processing male stimuli indicating an interaction between hormonal influences and stimulus specific effects.(46) (Roberts)   During their follicular versus their luteal phase, women demonstrate increased activation in the right medial orbital frontal cortex suggesting increased positive appraisal. (47) (Rupp). The adult Zebra Finch maintain lifelong pair bonds.  Plasma cortico-sterone was elevated during periods of mate separation. These reduced to baseline upon reunion with the pair mate but not upon repairing with a new opposite sex partner.  Remage-Healey, Adkins-Regan and Romero (48) found these alterations in behaviour during separation and reunion were consistent with monogamous pair bond maintenance. 

Functional connectivity between the amygdala, the pre-frontal cortical area and the thalamus while responding to angry facial expressions was significantly stronger in women than in men.(49)  (Ohrmann). Women appear to be especially sensitive and responsive to negative and threatening stimuli which are mediated by hormonal changes. This is probably most true during the early stages of pregnancy.  Thus the threat of abandonment by her partner may easily precipitate anxiety in the woman and a decision to abort her child to prevent this recurrence of abandonment she experienced as a child. We found that of all the factors that we studied, childhood neglect is the one that is most closely associated with a woman’s decision to abort. The expression of anger or the threat of abandonment creates high levels of anxiety in women facilitating a decision to abort.

During acute grief, the subjects in an experiment conducted by Najib, Lorberbaum, Kose, Bohning and George (50) showed brain activity changes in the cerebellum, anterior temporal cortex, insula, anterior cingulate and prefrontal cortex. Subjects with greater baseline grief showed greater decreases in all these regions except the cerebellum. It is possible that a previous loss results in neuro-hormonal changes that make it more likely that a loss will reoccur.  It has been noted that women need assistance to deal with their loss following a miscarriage. (51)  (Brier). In one study of 341 couple randomly assigned to nursing self-care or combined caring, the broadest positive impact on couple’s resolution of grief and depression following a miscarriage occurred with nursing care 52). (Swanson). Broen, Noum, Bodtker, Ekeberg (53) studied women two years after a miscarriage or abortion and found the short term emotional reactions to miscarriage appear to be larger than of the women who had an abortion. They reported significantly more avoidance of thoughts and feelings related to an abortion. It may be that grieving a miscarriage is less complicated and thus quicker than grieving an abortion which is associated with more conflicts. (54) (Prommanart). Kersting et al (55) found that women who had a termination for fetal abnormality showed greater activation in the middle and posterior cingulate gyrus in viewing a happy baby face.  Since there are more conflicts associated with abortion, it is more likely to result in “comorbid complicated grief” which was found to contribute to a greater severity and poor functioning in uni-polar depressed patients. (56). A complicated grief may contribute to difficulty in bonding to a subsequent child and a tendency to re-enact the trauma of their mother’s abortion in their own lives.

It is possible that men born to women doing stressful work are less able to support their partners.  It was found that the male bowerbird has greater success in attracting females if he was larger and he “painted” his bower more elaborately.(57) (Robson) The California mouse is less available for “bi-parental investment” when there are fewer resources available. The offspring reared under high foraging demand conditions weighed less at weaning, were more fearful in the open field and showed profound deficit in both novel object and place recognition(58). It has been found (59) that prenatal stress may induce “behavioural demasculinization and/or feminization” in human male offspring during adulthood. When pregnant rats were subjected to  immobilization or unavoidable electric shock or rapid eye movement sleep deprivation or immersion in cold water, the male offspring of the REMd group displayed a major impairment in masculine behaviour greater than that observed within the immobilization group. “Stress during pregnancy can impair biological and behavioural responses”. Garcia states “that many of these responses are not only different between males and females but opposite” (60). (Brunton and Sternthal and Buss and Bergman and Schaffer), Ruckstuhl,(61 62,63,64) If these Ruckstuhl KE, Colijn GP, Amiot V, Vinish E, Mother’s Occupation and Sex Ratio at Birth. BMC Public Health. 2010 May 23;10:269 findings Ruckstuhl KE, Colijn GP, Amiot V, Vinish E, Mother’s Occupation and Sex Ratio at Birth. BMC Public Health. 2010 May 23;10:269 are as true for men, it would raise the question of what is the effect of stress on women during their pregnancy. Affirmative action favouring women seeking employment and the courts precluding male involvement in decisions regarding pregnancy outcome (64) (Dyer) may contribute to loss of partner support, increased stress, possible feminization of the males and less partner support during pregnancy in the next generation. 

If there was a loss in a previous pregnancy, it may result in a conflict that cannot be easily resolved during the next pregnancy. Thus there is an attempt to re-enact the conflict ie. to abort or not to abort.  Although this re-enactment of the very difficult conflicts surrounding what to do with a pregnancy, is common yet people seldom gain more insight from it(65). This mechanism may help explain why tragic pregnancy history repeats so often.

Compared to other pregnancy losses, abortions may be more difficult to mourn because of intense ambivalence and conflicts.

The law, which provides a man no legal right to restrain his partner if she wishes to abort their pregnancy, discourages partner support. If our data is correct and if there is an interest in diminishing abortion rates, then there is a need to increase the amount of partner support. This may require legislation that returns some opportunity for partners to help determine what happens to each pregnancy. 

The results from our data on child abuse indicate that there is a relationship between the rates of abortion and child abuse (63), ie. those who have had an abortion are statistically more likely to abuse and neglect their children, and those who have been abused and neglected are more likely to have an abortion. Women who have been neglected particularly need partner support. Women neglected in their childhood seem to have a certain perverse propensity to pick partners who are unsupportive. When the partners threaten to abandon her or leave, this triggers a re-enactment of a woman’s earlier parental neglect and a resurgence of all the pain and anger associated with it.  Any coercion by the partner to abort must be felt by the woman as a double tragedy. She is not supported when she should be and she is pressured just when she needs opportunity to work through her ambivalence. 

The need to improve partner support is also emphasized because of the connection between partner support and breast-feeding. Breast-feeding improves the health of the infant and provides some protection from further pregnancy. When both partners seek to nurture their infant, the likelihood of good outcomes of all kinds are increased. Concerned physicians may make up for lack of partner support, but it is important that they do not take over so much that they inhibit the interest of the partner in caring for his pregnant girlfriend or spouse.

It appears that without partner support there is an increased likelihood of both miscarriages and abortions. It is possible that a pregnant woman’s partner can create an optimum supportive environment so that the mother’s natural neuro-hormonal mechanisms are better geared to maintaining rather than miscarrying her pregnancy. The effect of poor partner support on the abortion rate is more complex. When they are not attached to the fetus, men are less likely to support his/her mother.  He may also have suppressed hostility felt toward women because of female power in this regard. Thus a vicious cycle ensues. Men with “no rights” are less likely to support their partners during pregnancy. Because of the diminished partner support, a woman is more likely to miscarry or abort. Men who sense their partner may abort this child without their awareness or consent, are less supportive.

It appears from our data that the best predictor of future pregnancy is the outcome of the first.  Miscarriages and abortions tend to repeat with a significantly increased likelihood. Although very few people would approve of teenagers having babies, it should be born in mind that the outcome of any teenager’s pregnancy will significantly affect the outcome of her future pregnancies. Since teenagers so often lack partner support, and are more likely to abort their babies, some consideration should be given to how best to increase their partner’s support.


In our study we confirmed the hypothesis that pregnancy outcome was adversely effected by the lack of partner support. We found that the amount of partner support varied according to the age of the mother and the outcomes of previous pregnancies. Although women in their teens much less often than older women have partner support, it appears they are just as capable of having full term normal pregnancies. Since the outcome of the first pregnancy predisposes women to similar outcomes in later pregnancies, it may not be wise to abort the first. The underlying reasons may be social, neuro-chemical or an instance of humanity’s perverse propensity to re-enact their unresolved emotional conflicts in an attempt to learn from them.

If there was a loss in a previous pregnancy, it may result in conflicts that cannot be resolved during the next pregnancy. Thus there may be an attempt to re-enact the conflicts by revisiting in their minds the difficult dilemma to abort or not to abort. Although the re-enactment is common, it is seldom provides additional insight.

Pregnancy losses, particularly abortions, may be difficult to mourn and resolve because of the ambivalence and conflict.  Losses that are promoted or wished for are more difficult to grieve.  If a society does not consider that a miscarriage or abortion is a real loss for which grieving is required and support given, post pregnancy loss women are less likely to mourn, even though they may feel a need to do so. There are few people who are qualified to assist people in dealing with the pregnancy losses. The topic regarding abortion seems too controversial to make it possible to easily deal with this type of loss. A person may be too embarrassed, ashamed, or guilty to talk about a loss that she was taught was not supposed to affect her. Thus it is possible that a vicious cycle ensues in which, because of the intense conflict, the patient is under greater pressure and not in as good a psycho-physiological state to maintain a pregnancy.  This second loss contributes to the basic conflict and thus increases the possibility of a loss in the next pregnancy.

When it appears that there is economic recession due to population implosion, the number of countries are increasingly interested in ways to prevent pregnancy loss. This study may help in formulating successful strategies to do this.


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