Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing (1987) / Chapter Skim
Currently Skimming:
7 Interventions for Pregnant and Parenting Adolescents
7 Interventions for Pregnant and Parenting Adolescents
Pages 189-230
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From page 189... ...
. ~ ms chapter aescnbes interventions of five general types: · those that provide abortion sentences; · those that provide prenatal and pennatal health care services; · those that pronde economic support; · those that improve the somai, emotional, and cognitive development of the children of teenage mothers; · those that enhance the life options of teenage parents.
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From page 190... ...
Among the numerous programs that are in operation, many provide specialized services to meet short-term health, financial, and social service needs (e.g., prenatal care, nutrition sentences, income supports)
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From page 191... ...
abortion providers offer contraceptive services as wed. A quarter of family planning clinics pronde abortion services at the same site or at another site in the same agency (Chamie et a]
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From page 192... ...
In addition, 93 percent routinely pronde a post-abortion clime visit. In recent years, several states have passed legislation requiring parental consent or a judicial bypass of parental consent (i.e., minors can petition courts to allow the procedure without parental consent)
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From page 193... ...
Alan Guttmacher Institute researchers conclude that many young women do not have access to abortion services, even though services have expanded dramatically in this country since 1973. In 1980, 6 percent of U.S.
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From page 194... ...
Parental notification and parental consent statutes enacted in a number of states in recent years similarly appear to increase the likelihood that a pregnant teenager will delay obtaining an abortion, thereby increasing the possible health risks (Donovan, 1983~. Although there are no outcome studies available on notice statutes, Melton "d Pliner (1986)
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From page 195... ...
It is unknown whether the parental consent statutes are increasing the numbers of unwanted children born to teenagers (Melton and Pliner, 1986) , and no research has systematically examined the psycholog~cal effects of ehesejudicial procedures on the minors who go through them.
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From page 196... ...
The male perspective on abortion seems to be important in itself and also because the attitudes and reactions of male partners are likely to affect the young women undergoing the procedure. PROGRAMS THAT PROVIDE HEALTH CARE SERVICES The health care needs of pregnant girls and of young mothers and their babies are numerous A vanety of specialized sernces to fill those needs exist, including prenatal care and delivery, pediatric care, family planning and reproductive health care, nutritional services, and health education (e.g., first aid, nutrition, sex education, and hygiene)
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From page 197... ...
Many are prowded through public health departments, university hospitals, freestanding clinics, school-based clinics, and youth-serving agencies as wed as by private physicians. Some of these Institutions provide prenatal care as a special service; others sense pregnant adolescents in the context of more comprehensive programs.
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From page 198... ...
However, they usually need to present a parent's Medicaid card at the clinic, and many teenagers delay the initiation of care rather than confront their parents with their pregnancy before it is obvious. For adolescents living in households that do not receive AT:DC and who are unwilling or unable tO obtain their parents' support for prenatal care, most generally leave home and establish separate households if they want to receive Medica~-subsidized care (Gold and Kenney, 1985~.
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From page 199... ...
The St. Paul, Minn., school-based clinics demonstrated favorable outcomes: in 1982 the proportion of pregnant teenagers at these clinics who began prenatal care in the first trimester was very high, 94 percent, compared with slightly over half among a comparable national sample of white teenage mothers (Hofferth, Vol.
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From page 200... ...
Teenagers, especially poor nonwhite and minority teenagers, are at greater risk of inadequate prenatal care than other groups in the population. As a result, many special programs aimed at educating them about the benefits of care and at getting pregnant girls involved in regular care have been initiated, either as specialized services or as components of comprehensive care programs.
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From page 201... ...
Many comprehensive care programs for pregnant and parenting teenagers have also included nutrition education and services as components of their service package. Others have linked their program participants to local WIC services.
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From page 202... ...
transportation tO prenatal care and well-child ViSitS; (3) home visits by a nurse dunug pregnancy in addition to transportation and screening; and (4)
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From page 203... ...
Contraceptive services, as described in Chapter 6, are available to adolescent girls through a variety of programs and organizations regardless of whether they have already had a birth. In addition, most comprehensive care programs for pregnant and parenting teenagers have made reducing the number of repeat pregnancies a major goal.
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From page 204... ...
(1973) , and the Project Redirection programs, evaluated by the Manpower Demonstration Research Corporation, raise an interesting issue concerning the duration of effects from comprehensive care programs.
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From page 205... ...
Total welfare and health costs or teenage cnllduear~g were est~mated at $8.5 billion in 1975 for AFDC, food stamps, and Medicaid expenditures for prenatal care and delivery (Moore et al., 1981)
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From page 206... ...
While the presence of one child presents significant obstacles to social and economic opportunities for adolescent parents, having several children further lowers their chances of becoming economically self-sufEcient (Rivera-Casale et al., 19841. Nevertheless, it is important to keep in mind that not all teenage mothers go on welfare, and many of those who must do not remain dependent indefinitely.
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From page 207... ...
Not all fathers of children born to teenage mothers are teenagers themselves; yet even among fathers in their twenties, many are unable or unwilling to provide financial support. For these reasons, child support payments from male partners are likely to be small and erratic, and enforcement of child support obligations, among young fathers especially, has been limited (Rivera-Casale et al., 1984~.
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From page 208... ...
PROGRAMS THAT ENHANCE THE DEVELOPMENT OF TlIE CHILDREN OF ADOLESCENT MOTHERS Beyond the numerous health risks that children of adolescent parents face, they are also at risk of social, emotional, and cognitive pencils. Teenage mothers, as we have seen, tend to be poor, tmmamed, and less well-educated than later childbearers.
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From page 209... ...
91. In response to these conditions, several types of intenrentions have been initiated to enhance the development of the children of adolescent parents, Including child care programs, parenting education programs, special programs for fathers, an]
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From page 210... ...
Many of the on-site child care programs require that adolescent parents spend a portion of their time each day or each week in the child care center to gain expenence in caring for their own children as well as other children at different ages and different developmental stages. Child care providers in these settings typically counsel and instruct young parent volunteers on basic care and feeding, infant and toddler stimulation, parent-child ir~teractions, and recognition of health and developmental diffiluities.
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From page 211... ...
Parenting programs are pronded by hospitals and family clinics, general somal service and youth-serving agencies, and privately organized parent educanon and support organizations. In addition, most comprehensive care programs for pregnant and parenting teenagers devote sign ficant attention to parenting education, whether school-based, hospital-based, or community agency-based (Burt et al., 1984; Nickel and Delaney 1985; McArlarney, 1977; Badger et al., 1976~.
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From page 212... ...
Similarly, the Rochester Adolescent Maternity Project (RAMP) in Rochester, N.Y., was onginally designedly to prevent developmental delays in infants by teaching adolescent parents how to stimulate their infants.
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From page 213... ...
Parenthood Programsfor Young Men Concern that parenting education has all too often focused on the adolescent mother has led to several new small-scale programs that focus particular attention on nurturing the role of the adolescent father. As Parke and Neville (Vol.
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From page 214... ...
These services may include crisis intervention, emergency shelter, and legal assistance Typically these services are available through public agencies that serve teenagers as a part of a larger at-risk target population. However, many comprehensive care programs for pregnant and parenting adolescents provide necessary referral and follow-up tO get teenagers to those public agencies that can offer emergency help and ensure that they receive the services they Ileed.
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From page 215... ...
Because most comprehensive care programs handle emergency services by referral, their evaluations do not address questions concerning the outcomes, quality, or responsiveness of the outside agenaes to which program participants were referred (Quint and Riccio, 1985~. In sum, we know very little about these services as they are used by pregnant and parenting teenagers.
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From page 216... ...
Life Skills Training Courses that instruct teenagers on basic aspects of daily life have been incorporated into several alternative school programs for adolescent parents and into some regular secondary school course offenugs. They are also inclucled ~ many comprehensive care programs.
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From page 217... ...
In addition, many alternative school programs provide special instruction in sex education, health and hygiene, life plar~ning' life skills training, parenting education, andjob training' all of which are geared tO the special needs of these students. Most programs include on-site child care, and these facilities senre as parenting education laboratones for new and expectant mothers, as well as providing services that make it possible for young mothers tO continue their education.
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From page 218... ...
found that passive attitudes or resistance to alternative programs on the part of school officials can significantly hamper the effectiveness ofthese types of intenrentior~s. She also questions the extent to which alternative school programs in some communities have pronded a vehicle to exclude adolescent mothers and mothers-to-be from regular school programs.
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From page 219... ...
, nor have they shown much effect on fertility behavior (Simms, 1985~. Among comprehensive care programs for pregnant and parenting teenagers, employment versus employability goals have been controversial.
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From page 220... ...
These findings support the notion that family-based care in the adolescent's family of origin, with relatives, OF with a supportive foster family may be beneficial tO the young single mother and her child (Klerman, 1983; Furstenberg and Crawford, 1978; Zitner and Miller, 1980~. The potential bereft of family support for pregnant and parenting teenagers has stimulated numerous efforts to encourage and strengthen family caret Most ofthese have involved the inclusion of grandparents or other family members in existing agency programs for adolescent mothers through home nsits, interviews and follow-up, and special group activities for families.
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From page 221... ...
Among these approaches are mentonng programs that use trained adult community voinnteers as role models tO help them overcome the Ninety of personal and social difficulties that their pregnant and impending parenthood create. The most visible of these interventions has been the community women component of Project Redirection, in which volunteers who were not professional caseworkers were drawn from the community, trained, and assigned tO participants when they enrolled in the program.
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From page 222... ...
Comprehensive Care Programs During the late 1970s, there was growing public and professional awareness that most pregnant and parenting teenagers have multiple needs and that many of the sernces they required were "fragmented, inefficient, and inadequate" (Forbush, 1978~. In response, comprehensive care programs became the preferred approach for assisting the target pop~anon, many of whom come from severely econom~caby disadvantaged backgrounds.
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From page 223... ...
ection, supported jointly by the Ford Foundation and the U.S. Department of Labor and evaluated by the American institute for Research and the Manpower Demonstration Research Corporation; · The Too Early Childbearing Network, supported by the Charles Stewart Mott Foundation, evaluated by Deborah Walker of Harvard University and Anita Mitchell of the Southwest Regional Laboratory; · The Adolescent Family Life Comprehensive Care Projects supported by the federal Office of Adolescent Pregnancy Programs and evaluated by the Urban Institute; · The Adolescent Pregnancy Projects, also supported by the OAPP and evaluated by IRB Associates; · The Young Mothers Program, operated by the Yale-New Haven Hospital and evaluated by Lorraine Klerman, then at Brandeis University, and James Tekel, then at Yale University; · The Prenatal/Early Infancy Project, operated by the University of Rochester School of Medicine and evaluated by the program staff; · The Johns Hopkins Adolescent Pregnancy Program, operated by the Johns Hopkins University Hospital and evaluated by the program staff; · The St.
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From page 224... ...
Second, two of the programs had their most positive effects on their most disadvantaged participants, suggesting that those in greatest need may denve the greatest beneDt from comprehensive care programs (Olds et al., 1983; Polit-O'Hara et al., 1984~. Other programs, however, had difficulty reaching the youngest teenagers, regarded by many as the population ~ greatest need (McAnarney and Bayer, 19811.
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From page 225... ...
Fifth, comprehensive care programs are costly. Data on costs were not available for all of these programs, and they vary depending on the mix of services and the locality.
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From page 226... ...
However, they conclude that few localities possess these resources, and effective comprehensive care programs can be developed and maintained only under exceptional circumstances. In sum, the existing research and evaluation literature on comprehensive Cave programs provides little evidence that these interventions con
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From page 227... ...
Adoption services generally include education and counsei~g for the birth mother during her pregnancy (and sometimes afterward) , prenatal care, nutrition services if they are needed, obstetrical care for labor and
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From page 228... ...
be referred to a public or private adoption agency by a family planning clinic or other facility that provides pregnancy testing and counseling. Most adoption agencies arrange and refer clients to the necessary health and social sernces they require dunug pregnancy, labor, and delivery but do not usually pronde these services on-site.
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From page 229... ...
Among those for which outcome info' citation is available, there is some evidence of positive short-term ejects on targeted goals: sing; · The availability of abortion services effectively prevents childbear · Prenatal care can produce healthy outcomes for the young mother and her baby; . · Nutntion services can help reduce the~cidence of low birthweight; · RegllIar preventive pediatric care can improve the health of infants and young children; · Contraceptive services c" Increase birth control use and coni~nuation; · income support can improve the economic well-being of disadvantaged adolescent families, both those living independently and those Ming in someone else's household; · Child care seances can facilitate young mothers' return to school or entry into thejob market; · Parenting education can improve teenage parents' knowledge of Plant and child development and child care and can prevent early developmental delays In their children;
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From page 230... ...
Evaluations of comprehensive care programs have not analyzed the impact of separate service components on teenagers' capability and motivation to overcome the problems associated with early childbeanng. Thus, there is little basis for judging which aspects of these programs, either singly or in combination, have the greatest promise for producing positive outcomes.
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