The Study, the Context, and the Findings in Brief
Early pregnancy and childbearing remain pressing concerns in the United States. Each year, 7.5 percent of all 15- to 19-year-old women become pregnant (Alan Guttmacher Institute 2006). In 2004, these pregnancies resulted in 422,000 births among teenagers, 80 percent of which were first births (Martin et al. 2006).1
Despite a 36 percent drop in the teen pregnancy rate between 1990 and 2002 (the most recent data available) and a 33 percent decline in the teen fertility rate between 1991 and 2004, the United States still has the highest teen pregnancy and birth rates in the industrialized world. Rates of teen pregnancy and birth in the United States are still two to six times higher than those in most of Western Europe, including France, Holland, Denmark, and Sweden (Singh and Darroch 2000; UNICEF 2001).
Adolescent childbearing has long been associated with adverse consequences for teen mothers, fathers, and their children. The earliest literature placed the responsibility for these adverse outcomes almost exclusively on the teenage birth itself. Campbell (1968) famously wrote, “When a 16 year old girl has a child…90 percent of her life's script is written for her.” Two decades later, a National Research Council report, Risking the Future concluded, “Women who become parents as teenagers are at greater risk of social and economic disadvantage throughout their lives than those who delay childbearing” (Hayes 1987, 138). President Clinton echoed this perspective in his 1995 State of the Union address, when he declared, with some understandable political hyperbole, that teen pregnancy is “our most serious social problem.”
Social scientists, while acknowledging the poor economic circumstances of teen mothers and their families, have examined the causal relationship more closely, attempting to determine to what extent the adverse outcomes are attributable to teen pregnancy itself, rather than to the wider environment in which most of these pregnancies and the subsequent childrearing take place.2
The young women who become teen mothers often face many disadvantages arising from the families and communities in which they live. Their families often have lower average incomes, their communities may have fewer public amenities and support systems, and their public school systems may be weaker. Each disadvantage, including the early age of the mother’s first birth, contributes uniquely to the poorer outcomes for these women and their children. If too much weight is assigned to giving birth as a teen, there is a very real risk of overstating what can be accomplished by a delay in the age at first birth.
In 1997, a group of researchers organized by the Robin Hood Foundation published Kids Having Kids, the first comprehensive effort to identify the consequences of teen births for the mothers, the fathers, and for the children themselves. It examined a very wide range of outcomes: earnings of fathers; education, earnings, employment, welfare use, fertility, and marriage of mothers; and health care, foster care, educational attainment, and even incarceration for the children as adolescents and adults. The researchers took great care to distinguish as clearly as possible the causal impact of a teen birth itself from the effects of other risk factors that could contribute to poor outcomes. Disentangling the various factors associated with adolescent childbearing and its consequences in this way is extremely important for any policy discussion about the expected benefits of investing in pregnancy prevention and about the needs for other potential supports to overcome the challenges faced by young mothers and their children.
Unlike most previous research, which compared teenage (under age 20) mothers with those who delayed childbearing until age 20 or later, the first edition of Kids Having Kids focused on adolescent women who give birth at age 18 or younger. It placed primary importance on assessing the likely consequences of delaying their childbearing for an average of about four years, or until the would-be teen mothers reached age 20 to 21. The focus on young teens reflected the strong public concern about the high rate of childbearing among those under age 18, the vast majority of which resulted from unplanned pregnancies. Still school age, almost certain to be unmarried, even less likely to be prepared for parenthood, these very young mothers highlight the most visible and concerning dimensions of teenage pregnancy and parenthood. The decision to estimate the benefits for would-be teen mothers of delaying childbearing until age 20 or 21 was based on a judgment that a delay this long plausibly could be achieved and, if so, would address most of the major public concerns over teenage parenting.
This second edition of Kids Having Kids returns to the same central issue a decade later: What is the impact of a teen birth on outcomes for mothers, fathers, and especially the children? What would be the benefits of delaying first births? What are the costs of adolescent childbearing to the mothers, to the taxpayers, and to society as a whole? How have the impacts of a teen birth changed in the intervening decade since Kids Having Kids was first published?
This edition covers the same topics as the first, in the same order. In addition, a new chapter (11) reviews the teen pregnancy intervention literature. All chapters except one have been revised and updated either by the original authors (in the cases of chapters 5, 6, 7, and 10) or by other scholars (in the cases of chapters 2, 8, and 9), or by both the original authors and another scholar (3). Chapter 4, on the impacts of adolescent childbearing for fathers of children born to teen mothers, has not been updated because more recent or better data to allow improved estimates were unavailable.
Unlike the first edition of Kids Having Kids, this edition focuses on the consequences of all adolescent childbearing, taking care to report separately the findings pertaining to young teen mothers (defined as those who have their first child before they turn age 18) and older teen mothers (defined as those who have their first child at age 18 or 19).
Policy Context
All the analyses presented in this volume attempt to isolate the causal impact of a teen birth on the many outcomes of interest. The causal role corresponds to this thought experiment: “If we could change a young woman’s age at first birth, but not change anything else about her, what impact would that have on her subsequent life outcomes and the life outcomes of her children?” The resulting impact of a teen birth is referred to as its net effect—that is, its effect net of the impact of other risk factors that are not changed. The net effect represents a causal impact, not just a correlation. The results reported in this volume are as close to net impacts as possible given data limitations.
In order to estimate the net effect of teenage childbearing, it is necessary to compare young women who are as similar as possible in all respects except for the age at which they first had a birth. This comparison is done using various statistical techniques that control for or adjust for all the other risk factors that contribute to the outcome being studied. The specific way in which this is done varies from study to study, depending on the data source used and the measures of family and community risk factors available in that data. The result is equivalent to finding the average difference in outcomes between young women who are identical except for the ages at which they had a first birth.
Findings in Brief
Kids Having Kids consists of a background study of trends in adolescent childbearing, seven coordinated studies that each focus on a particular dimension of the consequences of adolescent childbearing, a summative assessment of the costs of teen births based on the measured consequences, and a review of what is known about the effectiveness of pregnancy prevention intervention strategies. Each study of the consequences of adolescent childbearing uses the best available dataset to address that particular set of questions (table 1.1). Each study also uses statistical analyses to control for various non-pregnancy-related factors that might affect outcomes (table 1.2). The review of intervention effectiveness is based on a systematic review of evidence through early 2006.
Trends in Fertility and Sexual Activity (Chapter 2)
In 1997, when the first edition of Kids Having Kids was published, the United States had just seen a decade of unsettling changes in the teen birth rate. Between 1986 and 1991, the teen birth rate rose five years in a row, reversing three decades of steady decline and rising nearly 25 percent in the process. Then, just as suddenly, it began to fall. By 1996, the teen birth rate was down 13 percent from its 1991 peak, but it still stood more than 10 percent above its 1986 level (Martin et al. 2006).
The teen birth rate has continued to fall steadily and presently is about 33 percent below its 1991 peak. Fertility rates have fallen for all age groups and all racial and ethnic groups, with especially sharp declines for younger teenagers and non-Hispanic black teenagers. Recently published data show a 2005 fertility rate for 15- to 19-year-olds of 40.4 births per 1,000, which is the lowest rate ever recorded for U.S. teens in the 65 years for which consistent data are available (Hamilton, Martin, and Ventura 2006). This is a 2 percent decline from the 2004 rate, and, notably, the decline is concentrated entirely among 15–17-year-olds. The 2004–05 decline of .07 births per 1,000 is larger than the decrease between 2003 and 2004 (.05 births per 1,000) but about half the size of the annual changes from 2000 to 2003 (1.9 births per 1,000). This pattern may suggest that the decline in the teen birth rate is abating.3
The rest of the fertility picture for teenagers in the United States is much more mixed. Despite recent declines, the fertility rate among U.S. teens remains well above rates in western Europe and in other countries with a comparable level of economic development (Singh and Darroch 2000). Further, the proportion of teen births that are outside marriage, which had remained essentially unchanged between 1998 and 2001, has increased slowly but steadily since then. Presently, over 84 percent of teenage childbearing is nonmarital (Hamilton, Martin, and Ventura 2007).
In recent years, lower proportions of teenagers have been reporting having ever had sexual intercourse than was the case in 1995 (Abma et al. 2004). While the declines have been observed among males of all ages, the same is not true for females. In recent years, most teenagers report not being sexually active, defined as having had sex within the past month or three months
Contraceptive use is far from perfect among sexually active teenagers as a group, especially at first intercourse and among younger teens. Yet, the percentage using contraception has increased, and there have been increases in consistency of condom use and in the use of such long-acting contraceptives as DepoProvera®. Recent evidence suggests that higher rates of contraceptive use and use of more effective modes of contraception are a major factor in the declining pregnancy rates (Santelli et al. 2007). Abortion has declined by about a third from its peak in the late 1980s. Currently, about 3 in 10 teenage pregnancies (28 percent) end in abortion (Ventura et al. 2006).
Consequences for the Mothers (Chapter 3)
In the first edition of Kids Having Kids, V. Joseph Hotz, Susan Williams McElroy, and Seth G. Sanders examined the impact of a teenage birth on a wide range of outcomes for the mothers—education, employment, earnings, fertility, and marriage, among others. Part 1 of this chapter reports this original research with updated data through 1993. The authors use an innovative research approach that compares teenage mothers not with women who did not have a teenage birth, but with young women whose first teenage pregnancy ended in a miscarriage. Since miscarriage is largely a random event that results in a delay of age at first birth, a comparison of outcomes for teens whose first pregnancy ended in a birth with outcomes for teens whose first pregnancy ended in a miscarriage should, the authors argue, provide an unbiased estimate of the causal impact of a teen birth.
Using data through 1993, the authors find that a teen birth is not a negative causal factor in the outcomes they examine. Indeed, Hotz and colleagues conclude that adolescent childbearing, properly analyzed, is actually beneficial to the teen mothers over a wide range of outcomes: young women who have an early birth earn more, marry men who earn higher incomes, and receive less support from welfare through their mid-20s to early 30s than if they delay their childbearing until their early 20s. The negative impacts of adolescent childbearing are limited to high school graduation rates and to the number of years teen mothers spend as single parents.
Hotz, McElroy, and Sanders’ re-analyses support the basic findings of their chapter in the first edition of Kids Having Kids, although most effects are slightly weaker than reported in 1997. The authors continue to conclude that adolescent childbearing is not an important causal factor in the poorer adult outcomes of women who were teen mothers.
In part 2 of this chapter, Hoffman further updates Hotz, McElroy, and Sanders’ analysis using data through 2000, when all the young women were in their mid-30s. His analyses of data for the same period as Hotz and colleagues yields findings roughly consistent with theirs, although Hoffman’s findings are typically less positive and, in the case of postsecondary schooling, quite negative.
Importantly, these conclusions are based most heavily on the experience of women in the sample who entered their teen years in the early 1970s, because only these mothers had reached their mid-30s in the timeframe included in the analyses of Hotz, McElroy and Sanders. With the addition of the longer-term follow-up data for the sample members who entered their teens in the mid- to late 1970s, Hoffman finds weaker positive effects than Hotz and colleagues and some stronger negative effects.
Hoffman also finds some tentative evidence that the effects of a teen birth may be becoming more negative. He examines teen birth impacts separately for earlier and later cohorts of teen mothers in order to reconcile the differences in the findings between his sample and that used by Hotz, McElroy and Sanders. Across the full range of outcomes examined, Hoffman finds evidence that the effects of an early teen birth differ for the earlier and later cohorts of teen mothers. The positive or benign effects found by Hotz and colleagues hold only for the older cohorts, while the effects are far more negative for the younger cohorts. However, because these estimates are based on relatively small samples and have large associated standard errors, this analysis should be interpreted conservatively.
Costs and Consequences for the Fathers (Chapter 4)
Chapter 4 focuses on two perspectives when assessing the consequences of teenage parenting for fathers. The first is the fathers’ perspective: what are the consequences for men who father children when they are themselves teenagers? The second is the mothers’ perspective: what resources are potentially available from their partners, and how do these resources vary with the age at which the women become mothers?
Although men who have children as young teenagers begin their careers having higher incomes and working more hours than do those who delay parenthood, men who wait to have a child have higher levels of education, earn more, and work more hours by the time they reach their late 20s. The important question for policy is how much this difference has to do with the differences in the characteristics of those who become young fathers and those who do not, and how much is the result of the birth and whether the man assumes responsibility for the child by marrying the mother.
Michael Brien and Robert Willis find that when differences in the characteristics of the fathers are accounted for, fathering a child only modestly affects the educational achievement and earnings trajectories of fathers. There does, however, seem to be a substantial “marriage penalty” for those who choose to take responsibility for their children by marrying the mothers. After controlling for the characteristics of the fathers, those who marry the mothers of their children appear to work more in order to provide for their children they have chosen to support.
Looking at the implications for men who father children of teen mothers, the authors find evidence that, if these fathers were to have delayed childbearing, they would have had substantially higher incomes over their lifetimes. Importantly, this would result in an expectation that those who opt not to marry the mothers of their children would have greater capacity to contribute child support if they had waited until the mothers were older.
Outcomes for Children from Kindergarten through Adolescence (Chapter 5)
This chapter uses recent nationally representative data to update the portrait of the consequences of teen childbearing for the health, development, and welfare of children and adolescents. This chapter examines a broad set of outcomes in five domains: cognitive development and academic achievement, behavioral outcomes, home environment, relationship outcomes, and physical health and well-being. The analysis uses two large national datasets: the Early Childhood Longitudinal Study, Kindergarten Cohort (ECLS-K) to examine outcomes for children at kindergarten entry, and the National Longitudinal Survey of Youth, 1997 Cohort (NLSY97) to look at outcomes during adolescence.
Jennifer S. Manlove, Elizabeth Terry-Humen, Lisa A. Mincieli, and Kristin A. Moore examine outcomes for children of teen parents and compare these outcomes with those for children born to older mothers. As in the previous edition of Kids Having Kids, the authors find that children of teenage mothers fare poorly compared with other children. However, much of the difference is explained by factors other than adolescent childbearing. Compared with children whose mothers begin parenting at age 20 to 21, children of teen mothers are much more likely to be low birth weight, have lower health assessment scores, have lower cognitive attainment and proficiency scores at kindergarten entry, and exhibit more behavior problems. Adolescent children have significantly lower academic achievement as measured by performance on standardized tests, and they are at higher risk of not completing high school. Generally, these differences are most pronounced for the children born to women who have their first child before age 18.
For example, compared with children whose mothers begin parenting at age 20 to 21, children of teen mothers have lower standardized test scores at kindergarten entry, and adolescent daughters of teen mothers are less likely to graduate from high school, net of controls. In addition, children of teen mothers exhibit more behavior problems, and children of the youngest teen mothers are more likely to be low birth weight. Adolescent children of teen mothers are also more likely to be married or cohabiting at a young age and are more likely to have a teen birth themselves.
These adverse effects for children are most pronounced for those outcomes measured at kindergarten. However, unlike chapter 5 in the previous edition of Kids Having Kids, which found more pronounced differences for the children born to women who have their first child before age 18, this chapter finds similarly poor outcomes among children of younger and older teen mothers. The authors suggest that this similarity may result, in part, from the different living situations of younger and older teen mothers. These findings suggest that it will take more than convincing teen mothers to delay childbearing for a few years to eliminate the myriad disadvantages their children face relative to children whose mothers choose to begin parenting in their 20s or later.
Children’s Health and Health Care (Chapter 6)
In the first edition of Kids Having Kids, Barbara Wolfe and Maria Perozek examined the impact of a teenage birth on the health and health care use of children through age 14 using data on child health and medical expenditures data as of 1987. They found that young teen childbearing, in particular, significantly affected the proportion of children who were reported to be in excellent health and the proportions with acute or chronic conditions. Children of teen mothers also had higher health system use rates, and a larger fraction of their health care costs were paid by the public sector.
For this edition, Wolfe and Emilie McHugh update the analysis using 2002 child health and medical expenditure data. This newer study finds that children of young teen mothers are slightly more likely to have chronic medical conditions but less likely to have acute conditions. Their mothers are about as likely to report their children are in “excellent” health and are no more likely to report their children are in “fair or poor” health. Children of young teen mothers are less likely to see a medical provider than the children of older mothers. On average, from age 1 to 14, the children of teen mothers age 17 and younger receive less health care spending than the children of older mothers, but the difference is not particularly large. It is unclear whether the differences reflect genuine differences in health or differences in use of the health care system. Thus, it is not possible to know whether the lower health care expenditures are good or bad for the children involved.
Children of younger mothers rely more heavily on publicly provided health care than children of older mothers.4
An estimated 60 percent of the health care of children age 1 through 14 whose mothers were under age 18 when they had their first child is provided through these sources, compared with 50 percent for children of mothers who were 20 or 21 at first birth. The average child of a young teen mother uses almost $145 more in publicly provided health care annually than the child of a woman who had her first birth at age 20 or 21.
The updated analysis also examines the health and medical expenditures of children born to older teen mothers (age 18 and 19). From birth to age 14, these children are, on average, about as healthy as the children of nonteen mothers. Like the children of young teen mothers, they are slightly more likely to report having chronic medical conditions than the children of nonteen mothers but are less likely to report acute conditions. Their mothers are also about as likely to report the children are in “excellent” health and no more likely to report the children are in “fair or poor” health.
Average total health expenditures for infants confirm this health disparity: expenditures for infants (0 to 1 year) are 75 percent higher than for infants of nonteen mothers. This expenditure pattern does not, however, persist; as a result, from age 1 to 14, these children have average annual health expenditures only slightly higher than those for the children of mothers who have a first birth at age 20 or 21. As always, health expenditure differences may reflect differences in access and use as well as differences in health.
The children of older teen mothers actually receive a larger share of their health expenditures through public programs than do the children of younger teen mothers and nonteen mothers. Sixty-three percent of their health expenditures are paid for by public programs, primarily Medicaid and the State Children’s Health Insurance Program, compared with 50 percent for children of mothers who were 20 or 21 at first birth and 60 percent for the children of younger teen mothers. Eighty-four percent of health care expenses for children age 0 to 1 of older teen mothers are provided through these programs.
Child Abuse, Neglect, and Foster Care Placement (Chapter 7)
This innovative chapter uses administrative records from Illinois, where a state database links births to administrative records of incidents of abuse or neglect and foster care placement. The analysis in the first edition of Kids Having Kids examined the experience of children born between 1982 and 1988 using data through 1992. The updated analysis for this edition examines abuse or neglect and foster care placements through 2005 for children born between 1989 and 1998.
In 2004, 532,000 children were in foster care and nearly 5.5 million children were referred to state and local authorities for suspicion of abuse and neglect. According to an Urban Institute study of federal, state, and local spending on child welfare, total federal spending on programs to support foster care, adoption, and other activities amounted to $11.6 billion; state and local spending added another $11.6 billion (Scarcella et al. 2006). Most of this money—probably 90 percent or more—was spent on foster care, adoption, and related services.
Having a child placed in foster care is a relatively rare event. However, young teen mothers are 2.2 times more likely (3.1 percent versus 1.4 percent) to have a child placed in foster care during the first five years after a birth than women who had a first birth at age 20 to 21. Young teen mothers are also twice as likely to have a reported case of child abuse or neglect as are women who had a first birth at age 20 to 21. Almost 1 in 10 children of young teen mothers were reported for abuse or neglect, compared with 1 in 20 for children of mothers age 20 to 21. After controlling for several other risk factors that also affect these outcomes, delaying a birth from age 17 or earlier to age 20 to 21 would lower the foster care placement rate for these women by a third, while instances of abuse and neglect would fall by almost 40 percent.
Children born to mothers age 18 to 19 at first birth are 33 percent more likely to be in foster care and 39 percent more likely to have a report of abuse or neglect during the first five years after birth than children born to mothers age 20 or 21. After adjusting for various risk factors, children of mothers age 18 to 19 at first birth are 13 percent more likely to be in foster care and 24 percent more likely to be the subject of a report of abuse or neglect than otherwise similar children born to mothers age 20 to 21.
This study is unique in its ability to analyze statistically the determinants of abuse and neglect reports and of foster care placement. Yet, it also is important to appreciate the limitations of this study. It is limited to one state, albeit one whose demographic profile is fairly similar to that of the nation. Further, because the analysis is based on administrative records, it lacks detailed information on other risk factors that could be important causes of abuse, neglect, or foster care placements. The reported effects may reflect correlation, rather than causal impacts.
Incarceration among Children of Teen Mothers (Chapter 8)
In the first edition of Kids Having Kids, Jeffrey Grogger examined the impact of a teen birth on the probability that an adult child would be incarcerated. Grogger used data from the National Longitudinal Survey of Youth, 1979 Cohort (NLSY-79) to examine this issue by following a cohort of young men age 14–21 as of 1979 until 1991, when they were age 26 to 33. These men were born between 1958 and 1965, when teenage births were far more common than today and when the great majority of such births were in two-parent families.5
Using various empirical techniques, Grogger estimated the causal impact of a teenage birth. Based on his most rigorous and conservative technique, he estimated that a delay in age at first birth from 16 to 20.5 would reduce the probability of incarceration of the sons by 11.8 percent and, in turn, would reduce the overall incarceration rate by 3.5 percent. Grogger’s analysis is included as part 1 of this chapter.
This second edition adds updated results based on data through 2002, when the men are in their late 30s and early 40s (Scher and Hoffman, part 2). This extension depicts each respondent’s criminal history more completely and allows the authors to analyze the impact of a teen birth on total cumulated prison time through a larger portion of an individual’s lifetime as well as on the probability of ever being in prison. The updated results are generally consistent, but slightly stronger, than those of Grogger.
The sons of young teen mothers are more than twice as likely to spend time in prison as are the sons of mothers who delay childbearing until their early 20s. Nearly 14 percent of the sons of adolescent mothers have been in prison by their late 30s, compared with 6 percent of the sons of mothers age 20–21. By that same age, the sons of teen mothers have spent an average of 0.57 years in prison, more than 2.5 times longer than the average prison time of sons of women who had a first birth at age 20–21.
Based on a very conservative estimate, delaying a teen birth to age 20 to 21 would reduce the probability of a son’s incarceration by 10.6 percent and reduce the average years spent incarcerated by 13.4 percent. In turn, this would reduce the total prison population by approximately 4.0 percent.
The sons of mothers who were age 18 or 19 at their birth also have an elevated risk of spending time in prison. These men are 40 percent more likely to ever have been in prison, and they spend, on average, about 30 percent more time in prison through age 40 than the sons of mothers who delayed childbearing until their early 20s. Controlling for other risk factors, a delay in their mother’s age at their birth would reduce their likelihood of incarceration by 5.8 percent and reduce their average years of incarceration by 6.7 percent.
The Life Chances of the Children of Teen Mothers (Chapter 9)
In the first edition of Kids Having Kids, Robert Haveman, Barbara Wolfe, and Elaine Peterson examined the impact of a teen birth on three outcomes for young adults: educational attainment, having a teen birth (for young women only), and being economically inactive at age 24. The authors’ analysis was based on a sample of children born between 1962 and 1968. Teen births in those years were far more common than today and far more likely to occur among married teens. Outcomes for the children were measured as of 1988, when they were age 20–26. Haveman and colleagues’ analyses found substantial impacts of a teenage birth on each outcome, even after controlling for detailed individual and neighborhood characteristics. This original chapter is included in this edition as chapter 9, part 1.
In part 2, Saul Hoffman and Lauren Sue Scher use data from the NLSY79 Young Adult Sample through 2002. These young adults were born between 1970 and 1981, 8 to 13 years later than in the original analysis, and the outcomes, measured as of 2002, are substantially more recent. As such, the revised analysis provides far more timely information.
The updated analysis shows that the daughters of young teen mothers are far more likely to become teen mothers themselves than if their mothers had delayed childbearing. After accounting for other risk factors such as family background and academic ability, it is estimated that a daughter’s risk of having a birth would fall by almost 60 percent, from 33 to just 14 percent, if a would-be teen mother delayed childbearing until her early 20s. This translates into the potential to decrease the number of teen births by more than 27,000 a year.
If these young teen mothers delayed their first births until age 20 or 21, it is estimated that their children’s high school graduation rate would rise to 73 percent, an increase of 10 percent. Further, after adjusting for other risk factors, the children of young teen mothers complete an average of about a quarter-year less education, which means preventing teen births would result in an estimated 35,000 adolescents a year completing one more year of schooling than they otherwise would have.
Most of the observed difference in high school graduation rates for children of older teen mothers compared with other children is attributable to factors other than teen motherhood.
The estimates in this chapter suggest that high school graduation rates for the children of older teen mothers would increase by 1 percentage point if their mothers delayed their first births to at least age 20, and the graduation rates of younger teen mothers would remain about the same.
Being the daughter of an older teen mother has a strong net effect, even after accounting for other risk factors such as family background and academic ability. If a young woman’s mother delayed her own first birth to age 20–21, her daughter’s risk of having a teen birth would fall by one-third, from 17 percent to 11 percent.
Adding Up the Costs (Chapter 10)
The cost analysis chapter develops from the separate component studies an overall assessment of the economic consequences of adolescent childbearing from the perspective of three interest groups—the teen parents, the taxpayers who are responsible for public policies and support programs, and society as a whole. This analysis focuses on the consequences of teen childbearing in four broad domains: (1) economic productivity of mothers, fathers, and adult children; (2) private transfers and taxes; (3) public assistance from various sources; and (4) other consequences, including children’s health, welfare, and criminal behavior.
In each case, the analysis measures the consequences of adolescent childbearing by comparing observed outcomes for teen mothers (as well as their spouses, the fathers of their children, and their children) with predicted outcomes assuming that these mothers delayed childbearing until age 20 to 21. The particular consequences of teen childbearing are estimated based on the results reported in chapters 2–9 and supplemental analyses provided by those chapters’ authors. Then, these individual cost components are integrated into aggregate cost estimates following an analytic framework commonly applied in benefit-cost evaluations that applies clearly defined assumptions about the period over which costs are measured, the rate of time preference or discounting, and the costs (or shadow prices) associated with various consequences of teen childbearing not measured directly in dollars.
According to the analysis, the economic costs of adolescent childbearing are borne by the taxpayers and by the rest of society, not by the teen mothers themselves. Over their first 15 years of parenthood, women who become parents before age 18 can expect to have net incomes from all sources, including various forms of public assistance averaging about $1,600 more a year than would be expected if they delayed childbearing until age 20 to 21. In contrast, those who become parents at age 18 or 19 have average net incomes that are just over $300 more a year than would be expected if they delayed childbearing (figure 1.1).
In a steady state with the annual number of first-time teenage mothers mirroring the current level of 336,783, the average annual cost to U.S. taxpayers of teen childbearing is an estimated $7.3 billion annually, or $1,445 per teenage mother a year over 15 years (figure 1.2). A major source of these costs is the forgone income and consumption taxes resulting from the lower earnings of the teen mothers and the fathers of their children ($3 billion). However, even larger costs are associated with the poor social and economic outcomes for children born to teen mothers. As a result of their lower productivity, children born to teen parents contribute an estimated $2.5 billion less annually in income and consumption taxes than if their mothers delayed childbearing. In addition, teen childbearing results in an estimated $1.58 billion more annually in taxpayer expenditures for medical assistance of children, $2 billion more to support foster care costs, and $1.84 billion more to build and maintain prisons.
The costs to society are estimated to be nearly four times as large as those borne by taxpayers—$5,502 per teen mother a year. This means that, in a steady state, if all would-be teen mothers would delay childbearing until their early 20s, society would have nearly $28 billion annually to direct to other uses (figure 10.2). Most (about 80 percent) of this sum would derive from the higher productivity of the fathers of children born to teen mothers and the higher productivity of the children themselves. However, the mothers’ productivity also would be higher, and fewer resources would be diverted for children’s health care needs, foster care, and incarceration of juvenile and adult offenders.
The Effectiveness of Teenage Pregnancy Prevention Programs (Chapter 11)
While knowing the consequences of teen childbearing is an important first step, it is of limited value unless it is possible to design and implement programs that influence teens to delay the onset of sexual activity or use contraception more effectively. Many programs for teens have been implemented, and some have been rigorously evaluated. Although there have been many prior reviews of the research, the reviews have applied widely different standards for searching and synthesizing the evidence and, consequently, arrive at quite different conclusions. To help resolve the inconsistencies and produce a concise, scientifically defensible summary of program evaluations, this edition of Kids Having Kids includes a chapter on teenage intervention programs by Lauren Sue Scher. This chapter summarizes the results of a systematic review of evidence regarding program effectiveness based on the findings from 38 randomized trials identified in published and unpublished literature. More than 37,000 teenagers and young adults participated in the studies.
The intervention programs Scher considers fall into four broad categories: clinic-based programs that provide various general reproductive services including check-ups and distribution of contraceptives; sex education programs, often called “comprehensive sex education” or “abstinence plus,” that emphasize abstinence and/or contraception; multicomponent and/or youth development programs that aim to reduce various risky behaviors (for example, sexual behaviors or alcohol/drug use); and comprehensive community-based programs that bring together multiple stakeholders across communities (for example, schools, community and faith-based institutions, housing developments) and institute multiple strategies.
Outcomes that have been rigorously evaluated include sexual experience rates, consistent use of contraception among sexually active teens, and pregnancy rates.
The most promising results are for the more intensive, multicomponent youth development programs that serve higher-risk adolescents. These programs appear particularly successful in reducing pregnancy risk and pregnancy rates. Unfortunately, very few rigorous evaluations of such programs are available, and further replication and evaluation is warranted. The evidence to date is not strong enough to determine whether clinic-based, one-time consultations reduce sexual risk-taking. Only four evaluation studies are available, and none of the core outcome differences between control and treatment group are statistically significant. Similarly, rigorous evaluation of abstinence-focused sex education programs does not find evidence that these programs change the likelihood that youth will initiate having sex or that they will be more or less likely to have sex without using contraception. These programs are, however, not representative of the newer abstinence-based programs that have recently emerged, such as those funded under the Title V, Section 510 abstinence education monies (Maynard et al. 2005). None of these interventions took place within the past decade, and most used a very limited intervention.
Finally, taken as a group, there is no consistent overall evidence that sex education programs alter the likelihood that teens are sexually active, use contraception effectively, or become (or get someone) pregnant. However, some individual studies have found positive program effects, particularly related to increased contraception use. The nature of the programs included within this category varies greatly, as do the size, direction, and statistical significance of the impact estimates for the various programs.
Basic Messages
The final two chapters provide a good summary of the book’s four basic messages. The first is that the economic costs for the mothers of bearing children as teenagers are small. Rather, the consequences for mothers are nonmonetary and often not observable for several years following the birth of their first child. Kids who have kids are more likely to substitute a GED for a traditional high school diploma and are less likely to continue their education. They will have more children on average over fewer years, and will spend more time as a single parent. At the same time, they work somewhat more hours than expected if they delayed childbearing.
The second message from this book is that there are myriad consequences for the children of mothers who begin parenting as teenagers. They are more likely to live in a single-parent home and a poorer-quality home, to spend more time in child care, to be the subject of abuse or neglect, and to spend time incarcerated than if their mothers had delayed childbearing.
The third message is that adolescent childbearing, particular before age 18, has significant adverse consequences for the children. These consequences cost taxpayers and society enough to merit close policy attention.
The final message is that we should look beyond the range of pregnancy prevention intervention programs commonly adopted by school districts and community-based organizations to address the incidence and associated consequences of teenage childbearing. Many factors likely have contributed to the substantial declines in teenage pregnancy and birth rates in recent years. These include the changing social norms around sex among young and unmarried individuals that have been promoted through governmental agencies and nongovernmental organizations such as the National Campaign to Prevent Teen Pregnancy with varying degrees of emphasis on reducing teen sexual activity and births, reducing nonmarital births, and preventing the spread of HIV/Aids and other sexually transmitted infections. Improvements in contraceptive technology and expanded efforts to raise access to contraceptive services have also been important, as has the shift in welfare policy, beginning in the early 1990s, that required low-income parents to assume greater responsibility for the financial support of themselves and their children, while offering them greater assistance in doing so.6
It seems prudent to build on these successes, while continuing efforts to develop more effective prevention services targeted at vulnerable youth.
Notes
1. The most recent pregnancy data are for 2002, when 760,000 teenagers became pregnant (Alan Guttmacher Institute 2006). Preliminary fertility estimates for 2005 show 421,123 births to teens, of which 414,406 were to girls age 15–19 and 6,717 were to girls age 10–14 (Hamilton et al. 2006). We focus on 2004 fertility information because it was the latest final version available when this chapter was written and when the cost estimates reported in chapter 10 were finalized.
2. Important early contributors to this literature include Furstenberg, Brooks-Gunn, and Morgan (1987); Grogger and Bronars (1993); Geronimus and Korenman (1992); Haveman and Wolfe (1994); and Hoffman, Foster, and Furstenberg (1993).
3. 2006 preliminary teen fertility data were released too late for full inclusion in this chapter. Teen fertility increased 3 percent between 2005 and 2006, the first increase reported since 1991. The 2006 teen fertility rate was 41.9 births per 1,000 women age 15 to 19 (Hamilton, Martin, and Ventura 2007).
4. Publicly provided health care includes Medicaid, the State Children’s Health Insurance Program, Civilian Health and Medical Program of the Uniformed Services in the United States, and Medicare (for disabled children).
5. Between 15 and 20 percent of teen births were nonmarital during these years (Ventura and Bachrach 2000).
6. This policy shift was instituted nationally with the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
References
Abma, Joyce C., Gladys M. Martinez, William D. Mosher, and Brittany S. Dawson. 2004. Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002.Vital and Health Statistics 23(24). Hyattsville, MD: National Center for Health Statistics.
Alan Guttmacher Institute, The. 2006. Teenage Pregnancy Statistics: National and State Trends by Race and Ethnicity. New York: The Alan Guttmacher Institute.
Campbell, Arthur A. 1968. “The Role of Family Planning in the Reduction of Poverty.” Journal of Marriage and the Family 30(2): 236–45.
Furstenberg, Frank F., Jr., Jeanne Brooks-Gunn, and S. Philip Morgan. 1987. Adolescent Mothers in Later Life. Cambridge: Cambridge University Press.
Geronimous, Arline T., and Sanders Korenman. 1992. “The Socioeconomic Consequences of Teen Childbearing Reconsidered.” Quarterly Journal of Economics 107(4): 1187–1214.
Grogger, Jeffrey, and Stephen Bronars. 1993. “The Socioeconomic Consequences of Teenage Childbearing: Findings from a Natural Experiment.” Family Planning Perspectives 25(4): 156–61, 174.
Hamilton, Brady E., Joyce A. Martin, and Stephanie J. Ventura. 2006. “Births: Preliminary Data for 2005.” National Vital Statistics Reports 55(11).Hyattsville, MD: National Center for Health Statistics.
———. 2007. “Births: Preliminary Data for 2006.” National Vital Statistics Reports 56(7). Hyattsville, MD: National Center for Health Statistics.
Haveman, Robert, and Barbara Wolfe. 1994. Succeeding Generations: On the Effects of Investments in Children. New York: Russell Sage Foundation.
Hayes, Cheryl D., ed. 1987. Risking the Future. Vol. 1. Washington, DC: National Academy Press.
Hoffman, Saul D., E. Michael Foster, and Frank F. Furstenberg, Jr. 1993. “Reevaluating the Costs of Teenage Childbearing.” Demography 30(1): 1–13.
Martin, Joyce A., Brady E. Hamilton, Paul D. Sutton, Stephanie J. Ventura, Fay Menacker, and Sharon Kirmeyer. 2006. “Births: Final Data for 2004.” National Vital Statistics Reports55(1). Hyattsville, MD: National Center for Health Statistics.
Maynard, Rebecca, Christopher Trenholm, Barbara Devaney, Amy Johnson, Melissa A. Clark, John Homrighausen, and Ece Kalay. 2005. First-Year Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton, NJ: Mathematica Policy Research, Inc.
Santelli, John S., Laura Duberstein Lindberg, Lawrence B. Finer, and Susheela Singh. 2007. “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use.” American Journal of Public Health 97(1): 150–56.
Scarcella, Cynthia A., Roseana Bess, Erica H. Zielewski, and Rob Geen. 2006. The Cost of Protecting Vulnerable Children V. Washington, DC: The Urban Institute.
Singh, Susheela, and Jacqueline E. Darroch. 2000. “Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries.” Family Planning Perspectives 32(1): 14–23.
UNICEF. 2001. “A League Table of Teenage Births in Rich Nations.” Innocent Report Card, Issue 3. New York: UNICEF.
Ventura, Stephanie J., and Christine A. Bachrach. 2000. “Nonmarital Childbearing in the United States, 1940–99.” National Vital Statistics Reports 48(16). Hyattsville, MD: National Center for Health Statistics.
Ventura, Stephanie J., Joyce C. Abma, William D. Mosher, and Stanley K. Henshaw. 2006. “Recent Trends in Teenage Pregnancy in the United States, 1990–2002.” Health E Stats. Hyattsville, MD: National Center for Health Statistics. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/
teenpreg1990-2002/teenpreg1990-2002.htm.
