Reproductive decision-making, prenatal attachment and early parenting

Reproductive control has been viewed as a means of empowering women, supporting the improvement of their psychological wellbeing and physical health. There is a tension between meeting women’s individual reproductive rights and the need for couples to decide on the presence, timing, spacing and number of children. Decision-making in partner relationships is likely to be affected by the values and norms which govern the relationship and the history of that relationship as well as cultural, religious and other individual factors. The papers in this edition of the journal reflect a range of associated reproductive and parenting issues.

Women may play the primary role in the decision-making process for obvious reasons. However, it seems that childbearing and rearing decisions are often made jointly or though compromise between partners. In the case of vasectomy, the paper by Terry and Braun in this edition of the journal provides examples of shared decision-making and also of ‘pre-emptive’ vasectomies, with participants framing both types of decision-making and the choices associated with this procedure in a positive light.

It is important to understand the processes involved when women or men make decisions regarding reproductive behaviour and how the decisions made or the decision-making processes affect women’s health and self-image and also that of their partner. This is true for both wanted and unwanted pregnancy. What does a woman do when her own ideas regarding decision-making in relation to pregnancy and antenatal screening differ from those of her partner and significant others? How does this affect her self- image, and how she sees others, including the partner?

Decisions relating to abortion and pregnancy can be a part of a collaborative joint communicative process, a unilateral decision made openly or surreptitiously by one partner that may depend on the nature of the particular power relationship that predominates in the couple or family. The paper by Canário, Figueiredo and Ricou describes the psychological impact of different types of abortion on women and their partners up to six months afterwards. After marked effects at one month, an improvement in emotional wellbeing over time was evident, moderated to some extent by the quality of the couple relationship, with relatively little difference between those couples experiencing elective abortion and those for whom it was less of a choice. However, in the longer term, in the context of subsequent pregnancies there may be other impacts. Other researchers have focused just on those women not having an active choice, namely those having a spontaneous abortion (Séjourné, Callahan, & Chabrol, 2010), finding that availability of support outside the couple relationship is quite variable and that using a brief early intervention may contribute to better adjustment and a reduction to distress as shown by improved psychological wellbeing at six months.

The objectives of a number of studies published in the journal have included understanding the experiences, attitudes and decisions women make in exercising their reproductive choices in pregnancy more broadly, and the effects those decisions have on women’s health and wellbeing (Green, Snowden, & Statham et al., 1993).

With increasing pregnancy there is growing awareness of the baby and a developing relationship. At the same time when antenatal screening is taking place, another range of possibilities come in to play. Here to the role of partner support needs to be considered. The paper by Bryant, Green and Hewison describes an attitudinal ambivalence and uncertainty in prenatal testing and termination intentions in relation to the possibility of Down’s syndrome and suggests that ambivalence about screening for the condition was associated with a desire to make diagnostic testing and termination decisions with a significant other.

The reality of the baby in the latter stages of pregnancy is substantial and the issue of prenatal attachment is one that Bouchard describes and explores this aspect of pregnancy in this edition, also in the context of the partner relationship and partner attachment to the growing baby. However, Bouchard also considers the parents’ relationship with their own parents and finds some interesting differences, with women’s strong prenatal attachment to their baby more likely to be linked with the quality of their partner relationship; for men this was also true, but only for those who were also strongly attached to their own parents. Another paper, by Della Vedova et al., also focuses on prenatal attachment and the maternal wellbeing in late pregnancy with first time mothers experiencing the transition to parenthood.

Increasing family size and complexity also impacts on wellbeing, identity and resources. The factors associated with second childbirth intention, the value of children and decision-making in relation to further pregnancies is described in a Korean study by Park and Cho in which the psychological, emotional and practical benefits of having children are explored.

The baby, once born, presents with needs which have to be addressed and which may conflict or at least not match with parents’ expectations, perceptions or previous experience. The papers on parenting in this edition reflect very different aspects of early parent and infant behaviour, nevertheless important ones as far as the wellbeing of both parents and children is concerned: differences interaction with mothers with serious mental health problems and the effect on mothers of having young children with sleep problems.