CHAPTER 15:The Psychology of Agency in

Childbearing

Introduction

• Women now have tremendous agency in childbearing, due to:– Changing societal expectations– Increasing acceptance of a range of paths toward

parenthood– Advances in reproductive technology and

maternal-fetal medicine

Introduction

• Decisions surrounding reproductive health events can be stressful for women and their partners.

• There can be significant emotional responses associated with the decisions or events themselves.

Factors Associated With Expanded Decision Making

• Societal Changes– Greater acceptance of a range of family units– Trend of delayed childbearing

• Advances in Reproductive Medicine– Contraceptive options– Developments in fertility treatments– Prenatal diagnostic testing

Decisions Related to the Initiation of Pregnancy or Parenting

• Choosing to Be Child-Free– Voluntarily childless– Temporarily child-free– Involuntarily childless

• Use of Assisted Reproductive Technology (ART) to Become Pregnant– Infertility– Single women– Women in same-sex relationships

Decisions Related to the Initiation of Pregnancy or Parenting

• Treatment-Related Stressors/Decision-Making Considerations– Treatment outcome– Financial considerations– Psychosocial stressors

• Adoption– Stressors related to adoption

Agency Surrounding the Ending of Pregnancies

• Induced Abortion– Therapeutic abortion– Elective abortion

Agency Surrounding the Ending of Pregnancies

• Perinatal Loss– Risk factors and etiology– Emotional aspects– Subsequent pregnancies– Coping following loss– Cultural considerations

Agency Around Childbearing That Assists Others to Have Children

• Egg Donation– Enables women to become pregnant using

another woman’s eggs

• Surrogacy– Traditional surrogacy vs. gestational surrogacy

• Relinquishment of a Biological Child– Planned adoption of a woman’s offspring within

the first month following birth

Conclusions

• Women’s choices regarding childbearing and motherhood have clearly expanded.

• Important considerations:– Individual context– Psychosocial stressors– Psychosocial settings