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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


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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