Select Page

Understanding adoption and pregnancy decision-making

by Gretchen Sisson, PhD


The decisions women make about pregnancy and childbearing are often the subject of intense political scrutiny and debate. Frequently, these conversations present adoption as a panacea for social challenges of all stripes, including teen pregnancy, young motherhood, parenting in poverty and, of course, abortion. This understanding of adoption presumes that women can, should or do weigh all of their pregnancy choices equally, and often goes so far as to frame adoption as the preferred outcome to either parenting in challenging circumstances, or having an abortion. But this is not—nor has it ever been—how most women make adoption decisions. My research makes clear how women actually weigh their options when pregnant, and suggests how they could be better supported as they make these life-changing decisions.

Historically, before abortion was widely available legally, women who placed or relinquished babies for adoption were overwhelmingly coerced into doing so. During the “Baby Scoop Era,” which lasted from the end of World War II in 1945 to the 1973 decision of Roe v. Wade, 1.5 million infants in the United States were placed for non-family adoptions, with over 170,000 placed in the peak year of 1970. These Baby Scoop mothers report being traumatized by their adoption experiences. Many were sent away from their families to give birth in secret; few were even allowed to hold their children after delivery. Of course, these adoptions were closed, and birth mothers did not receive any information about their children as they grew. Importantly, these birth mothers were overwhelmingly white women, and adoption was viewed as redemptive, a way for them to undo the “sin” of nonmarital sex and childbearing. In contrast, communities of color held long-established traditions of single motherhood: Women of color raised their children, but were shamed for doing so, not having access to the same socially-constructed “redemption” as their white counterparts. The decisions of all these women were constrained by different forms of powerlessness over their own reproductive choices, as derived from their gender, their youth, their unwed status, their economic dependence and their race.

The legalization of abortion, then, gave some women another way to resolve their unintended pregnancies. Post-Roe, the number of adoptions steadily declined, while the number of abortions rose to a peak during the 1980s and early 1990s, then began a decline that continues to this day. Today, there are approximately 1.1 million abortions every year in the United States, and an estimated 14,000 private domestic infant adoption placements. (This estimate does not include public or foster care options, cases in which parental rights are terminated; it only applies to voluntary termination of parental rights for a newborn, as that is the most direct way to examine adoption as a decision made during pregnancy.)

It is easy to look at these patterns and argue that the increase in abortions is responsible for the decline in adoptions. For some women, this is true: It is estimated that the spread of legal abortion lowered the adoption placement rate for infants born to white women by about 35% between 1970 (the peak year) and 1975. However, access to legal abortions had no significant impact on the adoption rate for infants born to women of color. Thus, immediately post-Roe, the women who were more likely to end pregnancies that previously would have led to adoption placements were the women who, pre-Roe, were most likely to face coercive adoptions. In neither case, then, were these women choosing adoption; the women five years later just had access to another option.

The declining adoption rate is also related to other social factors. For example, increased employment rates among women lowers adoption rates, most likely because women are more able to pursue and achieve economic independence.

Looking at the numbers today—1.1 million abortions, compared to 14,000 adoptions—it is clear that most American women, when faced with an unintended pregnancy, pursue abortion rather than adoption. My research seeks to understand how these women weigh their pregnancy options. Are they choosing between abortion and adoption? Might women considering abortion be interested in learning more about adoption, and vice versa?

The answer is no. I have found that women are rarely choosing between abortion and adoption: Women who want to get abortions are aware of but uninterested in adoption; most women who choose adoption do not seriously consider abortion.

In one study, my colleagues and I examined adoption placement rates among women who wanted an abortion but were turned away from accessing abortion care because they were too far along in their pregnancies. One week after being turned away, only 14% of women said they were considering adoption; the rest were either still trying to access abortion care or had chosen to parent. Ultimately, of the women who gave birth, 91% of the women chose to parent. Thus, even among this sample of women highly motivated to avoid parenthood, as evidence by their abortion seeking, adoption was infrequently considered and chosen.

In another study, I interviewed birth mothers who had placed infants for adoption about whether they considered or tried to get an abortion. Most of them did not. A few considered it briefly, but felt abortion was too expensive or inaccessible; a few more found themselves in the same situation as the women described above: They were too far along to access abortion. But the majority of birth mothers did not think about getting an abortion. Many of these women felt bonded with their pregnancies from an early stage and had no interest in ending them. (For a few, this was attributed to anti-abortion beliefs, but not very many.) Most birth mothers hoped and planned to parent, but those plans were disrupted when the support (both emotional and financial) they anticipated from their families and partners failed to come through. However, birth mothers who considered abortion, however briefly, had more positive feelings about their adoption placement afterward. By having the opportunity to rule out abortion, they felt more confident in their choice to move forward with the adoption.

When considered together, these studies suggest that women are most often choosing between either abortion and parenting or adoption and parenting, and rarely between adoption and abortion. Many birth mothers consider adoption when their parenting plans are thwarted; most women seeking abortion choose parenting, rather than adoption, when their access to abortion is denied. The fact that 9% of women denied abortion care choose adoption, when only approximately 1% of all women will do so over the course of their reproductive lives, further supports the idea that adoption is chosen more frequently when there are fewer real or perceived options available. For both groups of women, adoption was rarely the preferred course of action; it emerged as a solution when women felt they had few other choices.

This pattern is reflected in research from the Donaldson Adoption Institute (DAI) on birth parents’ option counseling during pregnancy. It found that 80% of birth parents reported financial concerns as a reason for placement, and about half of birth mothers were socially isolated, without family or friends from whom they could draw support. The report similarly found that almost 90% of birth mothers considered parenting, and about 40% considered abortion (although it does not clarify what “consideration” means). The DAI study also surveyed adoption professionals, and found that 32% percent never discuss abortion with prospective birth parents. Many professionals also indicated that they are not allowed to discuss abortion with clients, and that they were strongly motivated to encourage women to continue their pregnancies and place their children for adoption. (In contrast, many states require that women seeking abortion are advised on adoption, and that abortion providers must supply referrals to adoption agencies.)

Practices such as these uphold the idea that many women are actively choosing between abortion and adoption, and create motivations in service providers to influence that choice. Yet, this misses the mark on how women actually understand pregnancy decisions. If anti-abortion advocates are interested in preventing abortions, it might be a better strategy to make parenting more accessible (rather than rely on a politically motivated promotion of adoption). Further, if adoption advocates want to ensure better long-term outcomes for birth mothers, comprehensive options counseling—which includes an appropriate discussion of abortion—will help ensure that birth mothers feel confident and less constrained in their choice. An ethical practice of adoption requires a shift of power, to ensure that women feel all pregnancy options are available for them and to allow them to make the best choice for themselves.

Gretchen Sisson, PhD, is a qualitative sociologist at Advancing New Standards in Reproductive Health (ANSIRH) in the Department of Obstetrics, Gynecology, and Reproductive Science at the University of California, San Francisco. Her research focuses on the constructions and representations of contemporary parenthood including abortion and reproductive decision-making, adoption and birth motherhood, and teen pregnancy and young parenthood.




Madden, E., et al. (2017). Understanding Options Counseling in Adoption: A Qualitative Analysis of Birth Parents and Professionals. Donaldson Adoption Institute.


Madden, E., et al. (2016). Understanding Options Counseling Experiences in Adoption: A Quantitative Analysis of Birth Parents and Professionals. Donaldson Adoption Institute.


Sisson, G. (2015). “Choosing Life: Birth Mothers on Abortion and Reproductive Choice.” Women’s Health Issues 25(4), 349-354.


Sisson, G., Ralph, L., Gould, H., Foster, D. (2016). “Adoption Decision Making among Women Seeking Abortion.” Women’s Health Issues 27(2), 136-144.

More Posts to Explore

What I Wish I Had Known

2014 When we asked Pact members what they wish they had known before they adopted, we weren’t sure what kind of response we would get. The feedback we received, overwhelming in volume, was primarily from white parents parenting children of color. Clear themes emerged,...

read more

“Mom, I have something to tell you…”

by Beth Hall 2014 Mom… Hey, sweetie! Mom, I have something to tell you. For those of you who have adult children old enough to live away from home, you will no doubt recognize the fear these words put into the hearts of parents. Is anything wrong? No, no, at least I...

read more