This quarter we’re sharing takeaways from the article, “Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort,” published in December 2020 in the Internation Journal of of Environmental Research and Public Health, which shows that Adverse Childhood Experiences (ACEs) influence family planning and potential adolescent pregnancies. The research was conducted by Dr. Megan Flaviano and Dr. Emily Harville with a sample of 1,482 women living in southeastern Louisiana. We chose this article this quarter due to the historic moment we are living through in regards to reproductive rights and freedom, especially for women living in the American South, as we find it important to understand the circumstances, context and reality of folks’ lives to understand the decisions they may decide to make around their own health. And in this case, the research helps us see the clear links between childhood trauma and people’s behaviors later in life, as well as what is necessary to address the needs of women in southeast Louisiana.

What are Adverse Childhood Experiences (ACEs)?

If you’ve interacted with IWES before, you may have seen us use the term Adverse Childhood Experiences, or ACEs for short. As a refresher, ACEs refer to three kinds of adversity that children faced in the home; physical and emotional abuse, neglect, and household dysfunction. The term was coined in 1995 during a pivotal study by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) that widened the view of what trauma was and who may be experiencing trauma. In a previous piece on trauma-informed schools, we mentioned that our understanding of trauma went from the soldier on the battleground (which was then known as “shellshock”) to the child at home. 

With over 25 years of new research on the varied impacts of ACEs following that initial study, including our own here at IWES, we now understand how ACEs permeate all aspects of life – on the individual and the community levels, even the societal level. Research, including the original 1995 Kaiser study, has shown that it is more common than we thought for people to have experienced ACEs, particularly a high number of ACEs. Additionally, high ACEs are linked to “poor medical outcomes and health behaviors.” Specifically, when it comes to maternal and child health, ACEs are associated with “adverse birth outcomes, unintended pregnancy, early [puberty], and risky reproductive health behavior.”¹ Since ACEs can have an impact on someone’s overall mental health and well-being, they can also impact reproductive decision-making. Among the 1,482 women sampled, those with three or more ACEs had over two times the odds of wanting future children. That data point can seem innocuous, but when we tie it in with what we know about the higher maternal risks and long-term outcomes for those with high ACEs, we can see that there are many risks and potentially negative outcomes for both mother and child(ren). 

Where can we go next? 

With any research, it is important we have other studies that we can pull from to back up the information. Luckily, this research builds upon what we already know from past research that aims to show that early traumatic experiences in life can later lead to negative and unhealthy behaviors. Now that we have research that research shows a clear link specifically between high ACEs and family planning, we can begin to explore the “how” and “why.” One question we propose is,

“How can we create better sexual health education now that we know that ACEs can influence family planning and early pregnancies?” 

As mentioned in their article, having trauma-informed programs and sexual health education are important to help people, both youth and adults, understand their own mental, physical, and sexual health, and provide them with the tools and knowledge to make decisions that are best for them, their families, and their communities. On the flip side, as practitioners and those creating the programs, the researchers say it well: “How past traumas affect reproductive health can yield important information to better care for female patients across life stages in a trauma-informed care approach.” Within systems and institutions, such as the healthcare system, changes can be made to be trauma-informed and meet people where they are with our new information (i.e. understanding that you may be working in a population with specific vulnerabilities or risks). 

As the researchers highlighted, it is also crucial to have data that look at the social context of a population. Each place and group has different needs, and data can help us see the nuance of our varied communities so that we can adapt our programming to the specific needs of different populations we work with. With this, we can better work toward helping our communities to thrive with the understanding of how ACEs influence women’s reproductive health and contribute to adolescent pregnancies.

[1] You can find some articles on past research on ACEs and maternal health that the researchers cited here (2018), here (2015), and here (2019), as well as in their publication references.