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Tuesday, September 25, 2012

Poor Girls' Dilemma: Poverty Leads to Teen Pregnancy

Are you ready for some good news and bad news?

Let's look at the good news first:
The rate of U.S. teenagers becoming mothers is declining rapidly, according to a new report published by the Centers for Disease Control and Prevention (CDC). The average teen birth rate decreased 9 percent from 2009 to 2010, reaching an all time low of 34.3 births per 1,000 women aged 15 to 19. That's a 44 percent drop from 1991 to 2010. There were less teenage mothers in 2010 than any year since 1946. (Michelle Castillo, “U.S. Teen Pregnancy Rates at an All-time Low Across All Ethnicities,” CBS News, April 10 2012)
Now, let's swallow the bad news:

But the fact remains the United States’ teen-pregnancy rate is still the highest in the world among developed nations.

For years, scholars and social scientists have wrestled with this question regarding teen pregnancy: Which came first, the baby or the welfare check?

Conventional wisdom had it in that order; a teenage girl has a baby young and out of wedlock, and it becomes the event that starts her slide into poverty. Presidential Candidate Mitt Romney even told the graduating class at Liberty University this spring that "for those who graduate from high school, get a full-time job, and marry before they have their first child, the probability that they will be poor is 2 percent. But, if those things are absent, 76 percent will be poor." He was giving voice to that conventional assessment.

But more studies show that
 it's existing poverty that
leads to childbearing,
not the other way around.

Melissa S. Kearney and Phillip B. Levine, whose paper on the subject in the Spring 2012 Journal of Economic Perspectives drew attention for its conclusion that the conventional wisdom that teen childbearing causes young women to slide into poverty has the cart before the horse.

They argue that a lack of economic prospects leads teens to pregnancy.

“Teen childbearing is a symptom of underlying circumstances,” said Kearney, a professor at the University of Maryland. “Young, non-marital childbearing is certainly something that perpetuates poverty generation to generation,” but poverty is often the goad to childbearing in the first place. “If you’re poor and live in an unequal place, you’re more likely to wind up pregnant,” she explained.

(Melissa S. Kearney, and Phillip B. Levine. "Why Is the Teen Birth Rate in the United States So High and Why Does It Matter?" Journal of Economic Perspectives, 26:2 2012)

Kearney and Levine provide some statistical examples of “unequal places.” Consider that U.S. teens are two and a half times as likely to give birth as compared to teens in Canada, around four times as likely as teens in Germany or Norway, and almost ten times as likely as teens in Switzerland.

Then, consider that a teenage girl in Mississippi is four times more likely to give birth than a teenage girl in New Hampshire—and 15 times more likely to give birth as a teen compared to a teenage girl in Switzerland.

Their research examines teen birth rates alongside pregnancy, abortion, and "shotgun" marriage rates as well as the antecedent behaviors of sexual activity and contraceptive use. The findings demonstrate that variation in income inequality across U.S. states and developed countries can explain a sizable share of the geographic variation in teen childbearing.

Kearney continues:

"Our view is that teen childbearing is so high
in the United States because of underlying
social and economic problems.
It reflects a decision among a set of girls
to "drop-out" of the economic mainstream;
they choose non-marital motherhood
 at a young age instead of investing
in their own economic progress
because they feel they have
little chance of advancement.”
“Choice” is this case does not mean all teen girls actually do carefully consider life choices before picking non-marital motherhood. Instead, the economists' view of “choice” is that all people make groups of choices every day – say, choices about exercise and calories consumed – that make certain outcomes more likely.
Decisions that are not well-considered, or that raise the risk of undesired side effects, still have a large ingredient of choice. For example, we typically view those who drive drunk as having made a "choice." And, this is a very bad choice made by many every day that can have catastrophic consequences.
Yet, what happens when these girls take the risk to have babies? Kearney says evidence shows that teen childbearing is explained by the low economic trajectory but it is not an additional cause of later difficulties in life.

Surprisingly, teen birth itself does not appear
to have much direct economic consequence.

Asenath Andrews, 27 year veteran principal at Catherine Ferguson Academy, a Detroit charter school, agrees. Lots of girl from all levels of society get pregnant as teenagers, she said, but the poorest ones are most likely to bear children.

"The best prevention model is certainty of opportunity," she said. "The people who are best at contraception are women, 22-35, in career-path jobs." But, she added, longitudinal studies have shown that girls in the same family, one of whom gives birth as a teen and the other doesn’t, don’t have radically different outcomes, which discounts childbearing alone as a poverty driver. (Nancy Derringer, “Poverty, Then Pregnancy for Teen Mothers,” Bridge Magazine, August 9 2012)

(Click to enlarge.)

Kearney said it makes more sense to think of teen childbearing as "a symptom of underlying circumstances," i.e. inequality."

"If girls perceive their chances at long-term
economic success to be sufficiently low
even if they do ‘play by the rules,’
then early childbearing is more likely to be chosen,"
 Kearney and Levine speculate in their paper.

Could it be that teen girls suffering from social and economic problems need “reason” for a better life, and this lack of belief in their capability of breaking out of an impoverished lifestyle makes the risk of having babies during their teen years more acceptable?

In other words, adults can preach to these young girls all they want about abstinence, contraception, religion, and all the horrors of teen pregnancy. These methods might work with those on the margin, but certainly, according to statistics, they aren't working for all. In the case of many teen girls, the words fall on deaf, hopeless ears because these teens are “blind” to future success. Their state of poverty leads to childbearing; childbearing does not necessarily lead to poverty.

Some Ideas For Improvement

Kearney says all girls need to see a path to a better life. But, for large numbers of teenagers living near the bottom of the income ladder, “They don’t really see a cost to becoming a mom. They don’t plan to go to college. The odds of finding a good man to marry are very bad.”

Complicating this is the fact that teen childbearing runs in families.

One strategy is to place these at-risk girls with support groups containing other teenagers who understand the tough road the girls must follow

Carrie Terry, adolescent and school health manager at the Michigan Department of Community Health points to PREP, the Personal Responsibility Education Program, as a promising source of preventive information in areas where the problem is more acute, mostly larger urban areas.

PREP is part of the Affordable Care Act of 2010. It offers a new opportunity—federal funding for science-based sex education that includes information on abstinence and contraception. Until 2010, the only dedicated federal funding for sex education was for abstinence-only-until-marriage programs. These programs censor vital information from young people, who have the right to complete, accurate information that will allow them to make informed decisions about their sexual health. PREP includes the following stipulations:
  • Programs should target young people between the ages of 10-19.
  • Programs should have as their goal the prevention of unplanned pregnancy and STIs, including HIV.
  • Programs should teach about abstinence, contraception, and condoms as ways to prevent unplanned pregnancy and the transmission of STIs.
  • Programs must include content on at least three adult preparation subjects, including healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills.
Terry repeats a mantra among those
who work with at-risk teenagers:
"The best contraceptive for kids is hope."

To conclude, please read these words from Laurie Schwab Zabin PhD., the founding director of the Bill and Melinda Gates Institute for Population and Reproductive Health and a professor of Population, Family and Reproductive Health:

In the U.S. today—as in most Western countries—sex in mid-teens is almost universal. It is common in all economic, social, ethnic, racial and geographic sectors and across most religious groups. Here, more than 70 percent of youth are sexually active by age 19....

In many pockets of poverty and deprivation, sex starts even younger and teen motherhood is common. It's not just that services are lacking in the neediest neighborhoods. For many adolescents, even the best sex education and medical service are only a start. These girls may not actively want to have a child—they tell us they don't—but pregnancy happens if you don't care enough, or feel empowered enough, to prevent it. Without hope for their futures, too many young people have nothing to lose.
If they see no future, they see nothing at risk. High aspirations are characteristic of youth. It's adolescents' realistic expectations—not their dreams—that we need to change. Programs can only alter their vision of the future if they're powerful enough to change that reality—and to give our young people a credible reason to hope.
After a lifetime in the field, I see family planning playing an exciting role in meeting this challenge. In urban ghettos at home or in the rim cities of the developing world, adolescents—in fact, women of all ages—have limited control over their lives. Into that circle of frustration, control of their own reproduction can bring a sense of empowerment that may, and often does, spill over into the rest of their lives.
Knowing that hope provides such empowerment keeps those of us in the field going strong. Maybe, hope is our best incentive.”
(Laurie Schwab Zabin PhD., “The Best Contraceptive,” John Hopkins Public Health Magazine, Special Issue, 2008)
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