Another Chance

Although the total teen birth rate in the U.S. has declined dramatically in the last decade, the
news is not as encouraging regarding teen mothers. In 2002, there were nearly 89,000 births to
teens who were already mothers, representing 21 percent of all births to teenagers. In fact, nearly
one-quarter of teen mothers have a second birth before age 20. Given that these young women already
must confront the challenges of caring for their first child?often alone and with little or no help from the
child?s father?it is surprising that so many of them have a second child relatively quickly after the first.
This pattern raises questions about the factors driving this trend and about what it will take to reduce the
rates of second and higher order births to teenagers.
This Science Says research brief offers some answers to these questions. It is based on findings from the
National Campaign publication, Another Chance: Preventing Additional Births to Teen Mothers,
written by Lorraine Klerman, Dr.P.H.1 More specifically, this brief describes what is known about additional
births to teen mothers, including the dimensions of the problem; the factors that seem to increase the
chances of such births occurring to teen mothers; the consequences; and the potential for prevention. Based
on reviews of 19 studies of teen pregnancy prevention programs, it also summarizes research findings
regarding ?what works? to prevent additional pregnancies and births to teen mothers and makes recommendations
for building those components into ongoing prevention efforts.
1 The complete report and an executive summary were published earlier this year by the National Campaign to Prevent Teen Pregnancy and
are available at www.teenpregnancy.org.
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
www.teenpregnancy.org 202.478.8500 web@teenpregnancy.org
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What Factors Contribute
to Subsequent Births
Among Teen Mothers?
In an effort to better understand
why nearly a quarter of teen mothers
have a second birth by age 20,
several studies have compared the
characteristics of teenagers who had
only one birth with those who had
a second one. Although their conclusions
are not identical, they offer
some interesting insights.
Age and Race/Ethnicity: The
National Longitudinal Study of
Youth (NLSY) of 1979 and NELS
differ regarding the importance of
age at first birth and the signifi-
cance of race. Some of the nonnationally
representative studies
suggest that having a child at a
younger age increases the likelihood
of a second birth during the teen
years. Regarding race, there is some
indication that black and Hispanic
teen mothers are more likely to
have a closely spaced birth than are
white teen mothers, although the
association is not very strong when
controlling for other factors.
Marital Status: Teens who are married
at the time of their first birth
or who marry soon thereafter are
more likely to have a closely?spaced
second birth than teen mothers
who remain unmarried. Teen mothers
who are living with a boyfriend,
spouse, or adult other than a parent
also are more likely to have a second
and/or closely-spaced birth
than those who live with a parent
or alone with their child. Even
when they are unmarried, teen
mothers who live in situations
where the child?s father provides
childcare are more likely to have an
additional birth.
Poverty: Neither the NLSY study
nor the NELS study found poverty
to be a major contributing factor
for subsequent teen births. Some of
the smaller, non-representative studies
did find an association between
low socioeconomic status and additional
births.
Education: Teen mothers who stay
in school and who receive high
school degrees or GEDs are more
likely to postpone another birth. A
recent study suggests that low cognitive
ability is associated with having
a second birth before age 20. In
fact, girls with low cognitive ability
are almost three times more likely
than those with high cognitive ability
to have a second birth as a teen.
Lower educational expectations also
are associated with having an additional
birth.
Intendedness: Research indicates
that nearly 80 percent of teen pregnancies
are unintended. According
to the NLSY, a teen mother who
reported that she wanted her first
birth was more likely to have a
second birth as a teenager.
What are the
Consequences of
Additional Births
to Teens?
A closely-spaced birth to a teen
mother appears to be associated
with detrimental consequences for
the mother, for the outcome of
the second pregnancy, and for her
children.
For the mother, an additional birth
is associated with reduced ability to
complete her education or to attain
economic self-sufficiency. There also
may be an increased risk of preterm
delivery, low birthweight, and
infant mortality, although the evidence
in these areas is mixed. It
may be that teen mothers tend to
initiate prenatal care later with subsequent
pregnancies.
The children of these teen mothers
are more likely to have reduced
educational achievement and
behavioral problems?problems
that may be explained, in part, by
the inadequate education of the
mothers themselves or by the poverty
and lifestyle of the family as a
result of school failure and the
inability to secure employment. The
exact period during which having a
second child may worsen child
well-being is uncertain, but it may
well be before the first child reaches
age two.
What Does Evaluation
Research Say About
Programs for Preventing
Additional Births to Teen
Mothers?
The results of the evaluation literature
reviewed in Another Chance are
mixed. More than half of the 19
studies that were included reported
that they had been able to signifi-
cantly postpone additional pregnancies
or births to teen mothers for
some time period. However, only
three of the studies showing
significant positive effects were
based on randomized, controlled
designs?two home visitation
programs and one program in a
medical setting. Moreover, the size
of the effects was often small. With
the exception of the studies of teens
who used a contraceptive implant,
few programs that have been carefully
evaluated have reduced the
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
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3
percentage of additional births in
the two years after the first birth to
less than 20?25 percent. This is
close to what would have been
expected without an intervention.
Even so, the program evaluations
point to several factors that may be
especially important in programs
trying to prevent additional births
to teen mothers:
Service Location and Type.
Another Chance examined evaluations
of different types of programs,
including multi-site, communitybased
programs; programs in medical
settings; school-based programs;
home-visiting programs; contraceptive
implant programs; and a few
miscellaneous others. No single site
or approach seems significantly better
than any other. Rather, the most
important factor in preventing subsequent
pregnancies may be the
strength of the relationship between
the teen mother and the individual
working with her. For instance,
home-visiting programs may
encourage strong relationships
because of the relatively long interactions
and because the home environment
may be less stressful than
medical clinics, schools, or community-
based agencies. Even so, it may
be possible to build close relationships
in these institutional settings
if sufficient time, privacy, and continuity
can be assured.
Program Personnel. The background
of the individual who works
directly with the teenager may also
make a difference. For example,
home-visiting programs that
employ trained nurses appear to be
more successful in reducing additional
births to teen mothers than
those that used workers with primarily
on-the-job training. Perhaps
paraprofessionals, unless they are
exceptionally well trained, lack the
confidence and authority to affect
the behavior of the teen mothers.
Service Initiation and Length. It
may be easier to build close relationships
between teens and program
personnel if contact begins
during pregnancy?a time when
the teenagers may be under less
pressure than after the infant is
born. Longer-term involvement in a
program may also contribute to
postponing additional births among
teen mothers.
Major Emphasis. Many of the evaluated
programs were primarily concerned
with healthy pregnancies
and infants, returning young mothers
to school, and high school graduation,
rather than secondary prevention.
With the possible exception
of the nurse home visitation
programs?which emphasized
maternal and child development?
the major emphasis of the programs
did not seem to make a difference
in their effectiveness in preventing
additional pregnancies or births.
Incentives and Disincentives.
Several programs offered modest
financial incentives for avoiding
pregnancy, while others used financial
penalties for program non-participation.
Neither condition provided
positive results.
Attention to Family Planning. The
amount of time and effort devoted
to family planning varied, and it is
difficult to determine how much of
a difference it made. Programs that
provided contraceptive implants
were successful in reducing additional
births to teen mothers, but
these studies were based on selfselected
populations. With the
exception of the nurse home-visiting
programs (nurses might be
more comfortable discussing contraceptives),
other programs with a
major family planning focus were
not successful.
Fidelity of Implementation. Some
programs may not have shown
positive results because of their
inability to actually carry out the
proposed interventions, rather
than because the interventions
themselves were not effective.
Teen mothers are often difficult to
engage in programs. For instance,
some programs reported that teen
participants did not attend sessions
for which they were enrolled or
skipped scheduled home visits.
Other programs reported that some
staff completed fewer home visits
than expected.
The most important
factor in preventing
subsequent pregnancies
may be the strength of
the relationship between
the teen mother and the
individual working
with her.
Teen mothers are
often difficult to engage
in programs.
Other Measures of Success. Even
the programs without positive
results in preventing subsequent
births should be placed in context.
Many of the programs that did
not claim ?success??as well as
some that did?reported success
elsewhere, including better rates
of returning young mothers to
school and graduating, or improved
mother-child relationships.
What it all Means
Taken as a whole, the evaluation
research offers clues about what a
successful program to delay additional
births among first-time teen
mothers should probably do.
Develop close and sustained relationships
with pregnant teenagers
and young mothers.
Begin when teenagers are pregnant
with their first child and
continue until the first child
is at least two years old and
the mother is 18 years of age
or older.
Employ personnel who have the
training and the authority to
counsel in such sensitive areas as
family planning and domestic
violence?and who are willing to
do so.
Avoid relying on group settings
for education or counseling.
Teenage mothers appear to need
more intense, individualized
attention.
Discuss with teen mothers the
downsides of having more than
one child before age 20 and of
closely spaced births.
Help the teenagers select a contraceptive
method, describe its
good points as well as its possible
side effects, and provide intensive
on-going, specific support to
encourage its proper and consistent
use.
Make teenagers aware that if they
stop using a certain contraceptive
because of side effects or other
reasons, they should seek assistance
with choosing another contraceptive
right away.
Encourage teen mothers to use a
long-lasting, non-coital-dependent
contraceptive, such as Depo-
Provera.
Encourage teen mothers to
return to school after a birth and
to complete the education and
training needed for economic
self-sufficiency.
Provide childcare for kids of teen
mothers who are attending
school or employment programs.
Encourage teen mothers to live
with their parents or other adults
who can provide economic and
social support. Living with a
boyfriend should be discouraged.
Second Chance Homes?maternity
group homes that provide
housing and on-site social support
services for pregnant teenagers
and new mothers who cannot live
at home?are one option.
We Still Have
Much to Learn
Another Chance and this research
brief contribute to our collective
understanding of the factors that
lead teen mothers to have additional
children and the strategies that
can help prevent such occurrences.
Still, there is much that we still do
not know. For instance, the findings
of the NLSY and NELS studies do
not mirror each other regarding the
factors that increase the likelihood
that a teen mother will have additional
births. As for the prevention
programs that were evaluated for
effectiveness, several specific components
were identified that do
seem to make a difference.
However, many of those that
?worked? to prevent subsequent
births did not lower rates much
below what would be expected
among teen mothers not attending
a program. Given the magnitude of
this problem, the detrimental consequences
it can cause, and the
promise that prevention programs
hold for addressing it, additional
research is certainly warranted to
more clearly identify the risk factors
for additional births among teenage
mothers and the key to programs
that are effective in addressing
them.
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
www.teenpregnancy.org 202.478.8500 web@teenpregnancy.org
4
Many of the programs that
did not claim ?success??
as well as some that did?
reported success elsewhere,
including better rates of
returning young mothers to
school and graduating, or
improved maternal-child
relationships.
About the Putting What
Works to Work Project
Putting What Works to Work
(PWWTW) is a project of the
National Campaign to Prevent Teen
Pregnancy and is funded, in part, by
the Centers for Disease Control
and Prevention.Through PWWTW,
the National Campaign is translating
research on teen pregnancy prevention
and related issues into userfriendly
materials for practitioners,
policymakers, and advocates.As part
of this initiative, the Science Says
series summarizes recent research in
short, easy-to-understand briefs.
Author Information
This Science Says brief is based on the
National Campaign to Prevent Teen
Pregnancy publication, Another Chance:
Preventing Additional Births to Teen Mothers
by Lorraine V. Klerman, Dr.P.H. Dr. Klerman
is a Professor of Public Health at The
Heller School for Social Policy and
Management, Brandeis University. She has
studied teen pregnancy and parenting since
the 1960s and is currently a member of a
team examining the parenting practices of
teen mothers under grants from the
National Institute of Child Health and
Human Development and the Robert
Wood Johnson Foundation.
About the National Campaign to
Prevent Teen Pregnancy
The National Campaign to Prevent Teen
Pregnancy is a nonprofit, nonpartisan
organization supported largely by private
donations.The National Campaign?s mission
is to improve the well-being of children,
youth, and families by reducing teen pregnancy.
Our goal is to reduce the rate of
teen pregnancy by one-third between
1996 and 2005.
Funding Information
This research brief was supported by
Grant Number U88/CCU322139-01 from
the Centers for Disease Control and
Prevention (CDC). Its contents are solely
the responsibility of the authors and do
not necessarily represent the official views
of CDC.
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
www.teenpregnancy.org 202.478.8500 web@teenpregnancy.org
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