Services and Programs for Pregnant and Parenting Youth

by

Naomi Farber

• LAST REVIEWED: 26 May 2016
• LAST MODIFIED: 26 May 2016
• DOI: 10.1093/obo/9780195389678-0238

Introduction

The rates both of pregnancy and birth among adolescents in the United States have declined steadily and dramatically since their peak in the early 1990s. These decreases occurred among adolescents of all ethnic and racial backgrounds, across all states. Reflecting success of the intense, multifaceted efforts at prevention mounted by public and private sectors of American society, in 2013 the teen birth rate was a modern historical low of twenty-seven births per one thousand girls ages fifteen–nineteen, and in 2010 the pregnancy rate was fifty-seven pregnancies per one thousand teen girls (National Campaign to Prevent Teen and Unplanned Pregnancy (cited under General Resources, 2015 report). These rates constitute reductions of 51 percent and 57 percent, respectively, over the past twenty-five years and are unequivocally positive developments in the health and well-being of American youth. Nevertheless, there remain continuing and glaring categorical disparities among teens in the incidence of early pregnancy and parenthood. For example, despite within-group decreases, the incidence of pregnancy among non-Hispanic black, Hispanic, and American Indian youth is significantly above the overall national rate, and in the early 21st century there is attention to the high levels of risky sexual activity among girls in foster care, who are twice as likely to give birth as those in the general population of teens. Births to teens in rural counties are now almost 30 percent higher than in urban or suburban communities and account for about 20 percent of all births to teens. Once a teen has a child, she is by definition among those youth at the highest risk of pregnancy. The challenge of reducing these young people’s likelihood of early childbearing is particularly daunting because the same conditions that contribute to their risk of the first pregnancy also contribute significantly to their likelihood of experiencing the most worrisome adult outcomes that are correlated with, though not necessarily caused by, early parenthood, including subsequent pregnancy. Consequently, the current priority in services to pregnant and parenting teens is, and should be, directed toward addressing needs directly associated with the challenges these young families face based on their social and economic disadvantage. This article thus focuses on programs for pregnant and parenting teens and their children who risk experiencing the same sources of vulnerability across generations that accounted for their high risk of early pregnancy and parenthood in the first place. A few programs have a singular focus of intervention, such as reducing the time before teen mothers have a subsequent pregnancy. Most programs, however, have a wider range of objectives addressing a variety of educational, economic, social, and psychological needs that attend becoming a young parent.

Adolescent Pregnancy and Parenthood

Not long ago, Sarah Brown, then director of the National Campaign to Prevent Teen and Unplanned Pregnancy, observed we may already have achieved the “easy wins” in bringing down rates of pregnancy and childbearing among American youth. Underlying that assertion was acknowledgement that the United States has achieved some measure of success in stemming the dramatic increase in early pregnancy and childbearing that resulted mainly from youth engaging in risky and unprotected sex, the consequence of a lack of contraceptive and sexual-health knowledge and skills. While most youth have weathered the sweeping social changes in sexual mores by using contraception effectively or by not being sexually active, preventing pregnancy among the adolescents for whom the diverse costs to them and to the larger society are the highest requires a particular understanding of the motivation for their risky sexual behavior and the continuing salience of these motivations for subsequent difficulties when teens become parents. Furstenberg 1976; Furstenberg, et al. 1987; and Furstenberg 2007 report selected problematic outcomes among a group of poor teen mothers and their firstborn children over the course of twenty years in the famous Baltimore study. Frank Furstenberg argues that, within the context of heterogeneous life trajectories, the teen mothers who fare most poorly over their lives are those who are not able to overcome the disadvantages they suffered prior as well as subsequent to early motherhood; they then pass on the difficulties associated with long-term poverty to their children. While findings in Hoffman and Maynard 2008 support this conclusion of variation among the life chances of teen mothers, the authors in this edited volume also find that giving birth before age eighteen does pose some independent risk for young parents and their children. Musick 1993, a peerless—and timeless—exposition on the implications of poor young mothers’ developmental needs being unmet, provides rich psychological insight into the socioeconomic dimensions of poverty among teen mothers. Adding to the too-thin literature on the significance of mental health difficulties among many young mothers is both Whiteley and Brown 2010, a clinical discussion of their psychosocial complexities, and Hodgkinson, et al. 2013, a review of the prevalence of and interventions directed toward mental health needs of disadvantaged teen mothers. Bunting and McAuley 2004 draws attention to the varied types of social and family support and their later value to young mothers’ well-being. Finally, Boutte-Queen and Cheung 2001 analyzes the teen living requirement imposed by the Temporary Assistance for Needy Families (TANF) program, providing crucial attention to the deep impact of the policy environment on how well poor young parents fare.

• Boutte-Queen, N. M., and M. Cheung. 2001. The TANF co-residence requirement for custodial teen parents: Implications for promoting social justice. Journal of Poverty 5.4: 51–65.

  DOI: 10.1300/J134v05n04_03

  Examines the teen living requirement imposed by the TANF legislation under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Barriers faced by teens seeking assistance, legal issues across the United States, and implications for promoting social justice are discussed.

• Bunting, L., and C. McAuley. 2004. Research review: Teenage pregnancy and motherhood; The contribution of support. Child & Family Social Work 9.2: 207–215.

  DOI: 10.1111/j.1365-2206.2004.00328.x

  Provides a critical analysis of research on the role of family, partner, and peer support in the United States and the United Kingdom. Overall, the literature suggests that families, partners, and peers tend to provide different, but complementary, forms of support for teenage mothers, which, on the whole, appear to contribute to more-positive outcomes for young mothers.

• Furstenberg, F. F. 1976. Unplanned parenthood: The social consequences of teenage childbearing. New York: Free Press.

  This is the first book in the classic trilogy by Furstenberg, reporting on his seminal research with adolescent mothers in the Baltimore study, beginning in the mid-1960s. A group of teen mothers were interviewed first while they were pregnant, and then over the subsequent three decades. The research follows the teen mothers through early adulthood to the point of being “midlife matriarchs” and examines a range of social, emotional, economic, educational, and familial outcomes.

• Furstenberg, F. F. 2007. Destinies of the disadvantaged: The politics of teen childbearing. New York: Russell Sage Foundation.

  Furstenberg argues that young mothers’ challenges to achieving successful adulthood ultimately are attributable to the deep disadvantages of poverty rather than to the age of childbearing. Integrating the findings from his and others’ research with a historical review of relevant policies, Furstenberg asserts that the appropriate focus of prevention reduces poverty and enhances opportunity for healthy child development. This trilogy provides a well-regarded empirical foundation and an essential perspective on adolescent pregnancy by a leader in the field.

• Furstenberg, F. F., J. Brooks-Gunn, and S. P. Morgan. 1987. Adolescent mothers in later life. Human Development in Cultural and Historical Contexts. Cambridge, UK: Cambridge Univ. Press.

  DOI: 10.1017/CBO9780511752810

  The second book of Furstenberg’s trilogy follows the Baltimore teen mothers through early adulthood to the point of being “midlife matriarchs” and examines a range of social, emotional, economic, educational, and familial outcomes. The study also examines selected outcomes for the “next generation,” the firstborn children of the study’s teen mothers. He finds multiple forms of disadvantage among many of the teen mothers and their children over their life course, but importantly he finds significant variability in these outcomes and selected factors that contribute to these diverse trajectories.

• Hodgkinson, S., L. Beers, C. Southammakosane, and A. Lewin. 2013. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics 133.1: 114–122.

  DOI: 10.1542/peds.2013-0927

  Reviews current literature on prevalence and range of adverse mental health outcomes and environmental sources of disadvantage among young mothers. Provides useful summary of approaches to mental health interventions for teen mothers, in the context of integrating mental health services into primary medical care settings.

• Hoffman, S. D., and R. A. Maynard, eds. 2008. Kids having kids: Economic costs & social consequences of teen pregnancy. 2d ed. Washington, DC: Urban Institute Press.

  This edited volume brings together sophisticated analysis of important data on a wide range of consequences of teen births for mothers, fathers, and their children, as well as costs to the larger society. Important conclusions are that while significant economic costs of teen childbearing are borne by the public, there are troubling consequences of childbearing before age eighteen related to the health, education, and numerous psychosocial indicators of well-being for teen parents and their children.

• Musick, J. S. 1993. Young, poor, and pregnant: The psychology of teenage motherhood. New Haven, CT: Yale Univ. Press.

  Drawing on developmental theory and the author’s clinical experience with the Ounce of Prevention program in Chicago, Musick makes a singular contribution to understanding teenage motherhood among poor, urban young women in terms of identity development in the context of emotional and economic deprivation. The book provides compelling insight into the challenges of successful prevention programs with highly disadvantaged adolescents.

• Whiteley, L., and L. Brown. 2010. Clinical perspective: Understanding psychosocial complexities of pregnant and parenting teens. Brown University Child and Adolescent Behavior Letter 26.6: 1–6.

  This case study article examines the psychosocial complexities among pregnant and parenting teens. It considers the history of psychiatric disorder, and how sexual abuse and substance abuse could be the causes of unintended pregnancy. The social support from the father of the baby is identified as a factor that could help reduce depression in the adolescent mother. Moreover, a case is presented wherein a fifteen-year-old pregnant teen has undergone intensive psychiatric care.