Subsequent Births to Teenage Mothers
Douglas J. Besharov
This is the second in a series of
televised sessions on welfare reform and social policy.
The first session of the series, held on February 6, was
titled "Welfare Reform: What Happens After Time
Limits, Sanctions, and Diversion?"
Health and Human Services Secretary
Donna Shalala keynoted that session. The panelists were
Jason DeParle of the New York Times, Judy Gueron of
Manpower Demonstration Research Corporation (MDRC), Ron
Haskins of the House of Representatives' Ways and Means
Committee, Lawrence Mead of NYU, and Donald Winstead of
the Florida Department of Children and Families. Copies
of their remarks can be found on our website.
Besides our audience in Washington, the
session was carried via a satellite downlink system, like
the one we are using today, to over 200 sites in about 25
states. We estimated a viewing audience of social welfare
researchers, practitioners, and students of between 2,000
and 5,000.
Today's topic is "Preventing
Second Births to Teenage Mothers." The session has
two goals: (1) to emphasize the importance of preventing
repeat births to unwed mothers, and (2) to highlight a
promising intervention.
Teenage childbearing is a serious
social problem, especially if the birth is out of
wedlock. In 1979-85, 30 percent of all teen mothers were
on welfare within one year of the birth of their first
child; 50 percent within five years, according to the
Congressional Budget Office. The figures are even more
startling for out-of-wedlock births: 50 percent of unwed
teen mothers were on welfare within one year, 77 percent
within five years.
Although these figures reflect the
serious nature of teen parenthood, it is extremely
important to remember that not all teen mothers become
long-term welfare dependent. Many stay in school (or
return), get jobs, perhaps marry, and lead full,
productive lives.
But that is what makes the prevention
of subsequent births so important. Another child adds
household and child care expenses, not to mention the
responsibilities of child rearing--that are further
obstacles to self-sufficiency. As the Alan Guttmacher
Institute notes, "Closely spaced births early in a
woman's life . . . increase her welfare dependency."
Yet, we seem to do a very poor job of
discouraging teen mothers from having subsequent unwed
births. As Kristin Moore will explain shortly, of all
births to teenagers in 1996, 18 percent were second
births and 4 percent were third or higher order births.
So, nearly one-fourth of births to teenagers are higher
order births.
According to Rebecca Maynard, also on
our first panel, in the Teenage Parent Demonstrations,
about one-quarter of teenagers on welfare were pregnant
again within one year, fully half within two years.
Three-quarters of these pregnancies resulted in births.
In response, the new welfare law,
Temporary Assistance for Needy Families (TANF), contains
a number of provisions designed to reduce the number of
births to women on welfare, including some specifically
targeted toward teen mothers.
The most important of TANF's
fertility-related rules, as indicated on overhead #1,
are:
TANF funds can be used to
support "prepregnancy" family planning;
States are allowed to impose
family caps; and
Bonuses will be given to
states that most decrease the "illegitimacy
ratio," that is, reduce out-of-wedlock births
without increasing abortions. ($20 million a year is
available to five states.
In addition to the foregoing
fertility-related rules, some TANF rules relate directly
to teenagers. The major ones are depicted on overhead #2:
Teens must live in an
adult-supervised setting;
Teens must be in a school or
training program;
$50 million per year is
available to states for abstinence-only education;
and
States can require
non-custodial teen parents to "fulfill community
work obligations."
Our June 5 session of the Welfare
Reform Academy will focus specifically on these
provisions and their implementation. I hope that you can
join us then.
As I mentioned, the second purpose of
today's session is to highlight a promising intervention.
As many of you may know, the
evaluations of most welfare-oriented interventions have
shown disappointing results with regard to subsequent
births.
In New Chance, evaluated by MDRC, the
proportion of teenagers who had a repeat birth within 18
months was nearly identical for the experimental and
control groups (28 percent versus 26 percent), even
though family planning services were required and were an
important part of the intervention in some sites. In the
Teenage Parent Demonstrations, evaluated by Mathematica
Policy Research, about one-third of both the experimental
and control groups had experienced a subsequent birth
within two years of entering the program.
These and similar disappointing results
have fostered a growing feeling that "nothing
works" to prevent subsequent births.
Worse, there is a tendency to blame the
young mothers for the programs' failures, on the ground
that their social situation or personal dysfunction
prevent programs from helping them. But it is equally
possible that the program took the wrong approach to
intervention. After all, we do not blame the patient for
not recovering when the physician prescribes the wrong
medicine.
That is why the session will also
highlight an alternate intervention: "home
visitation." David Olds, originally from the
University of Rochester, has conducted scientifically
rigorous, random-assignment experiments in Elmira, New
York and Memphis, Tennessee. His 15-year follow-up of the
Elmira clients found that the mothers randomly assigned
to the home visitor program had 31 percent fewer
subsequent births than those in the control group.
(Similar results are emerging from his Memphis
experiment.)
Although his research is relatively
well known in the child welfare field, because the birth
reductions along with other factors are associated with
less child abuse, it has received little attention in the
welfare world.
Home visitation is certainly not a
silver bullet that will eradicate subsequent
out-of-wedlock births. Moreover, many questions about the
research findings remain unresolved. For example, the
high quality of the program (compared to what might be
expected in day-to-day practice) limits the
generalizability of the results.
But the larger point, which we hope
will emerge loud and clear at this session, is that
preventing subsequent births is not impossible--and that
it may be the "message" that we give to the
young mothers that is at fault.
According to Nicholas Zill of Westat,
Inc., in 1993, the mean number of children ever born to
mothers on welfare was higher than for mothers who were
not receiving assistance. As overhead #3 shows, he found
that: "In 1993, data from the Census Bureau's Survey
of Income and Program Participation showed that the mean
number of children ever born to women under 45 was 2.59
for women who were currently receiving welfare versus
2.12 for those not receiving welfare." Among older
women ages 40 to 44, the gap is larger: 3.41 versus 2.38.
More telling for our purposes today, in
1988, mothers on welfare reported to the National Survey
of Family Growth that their ideal number of children was
3.0, compared to 2.7 for all other mothers (including
poor mothers not on welfare), and 2.5 for non-poor
mothers. (See overhead #4.)
This, in turn, raises questions about
the efficacy of interventions that do not try to change
these behaviors and attitudes, and that, instead, are
nonjudgmental and value neutral. For example, New Chance
and the Teenage Parent Demonstrations were essentially
nonjudgmental. According to Robert Granger, a vice
president at MDRC, the message New Chance mothers
received was, "think about having another
child."
The home visitation program developed
by David Olds, on the other hand, relies on clear
behavioral messages delivered by public health nurses:
"Try not to get pregnant again. Having fewer
children is in your best interest and that of your
family."
In an oversimplified manner, overhead
#5 presents this dichotomy:
Informational/Nonjudgmental/Value
Neutral
vs.
Authoritative/Value Driven
The latter, as David Olds would say,
seeks to "promote change by providing a vision of
the future."
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