Adolescent mothers and repeated childbearing: effects of a school-based intervention program
ABSTRACT
This study examined the effectiveness of a public school program for pregnant teenagers in preventing rapid repeated childbearing. Students permitted to attend longer than seven weeks postpartum were much more likely to avoid having another child in the next five years than were students required to return to their regular schools. The results indicate the potential of school-based programs to improve life outcomes for adolescent mothers and their children.
If an adolescent mother bears a second child soon after her first, her chances of becoming educationally and economically self-sufficient are severely limited. Whereas prenatal services to pregnant adolescents are designed to optimize the obstetrical outcomes, research has indicated that adolescent mothers involved in postnatal programs show a substantial decrease in subsequent pregnancy rates, a decrease which may continue for years beyond actual program involvement. In a study at the Polly T. McCabe Center, an alternate public school for pregnant students in New Haven, Connecticut, students who were allowed to remain at least 7 weeks postnatally were almost 3 times less likely to have another baby within the next 2 years than students who were not allowed to remain so long. The 102 adolescent mothers in this study were part of a cohort of residents of New Haven who delivered a live first-born infant on or between March 1, 1979 and February 29, 1980, were less than 19 years old at delivery, were not high school graduates when they became pregnant, were from low-income families, were Black, were regular attendees at the McCabe Center, and either returned to school or graduated after delivery. The duration of the students' assignment to McCabe depended on the timing of their pregnancy. They were referred to McCabe when their pregnancy became apparent or when they notified their current school that they were pregnant. They typically remained at McCabe during the academic quarter in which their baby was delivered and then returned to their home school. However, students delivering during the third quarter were allowed to complete the year at McCabe. These rules had the effect of random assignment to postpartum services. Information on the deliver of a second child was available for 99 mothers. Medical records were collected for the period from the first prenatal checkup until the first baby was 6-years-old. Postnatal time at McCabe was determined to be short if it was or=7 weeks and long if it was 7 weeks. 19 or 52 (36%) of students with a short postnatal period at the school delivered a second child within 2 years compared with 6 of 50 (12%) with a long period (p=.005). At 5 years, 35 of 50 (70%) of the short time group had additional children vs. 22 of 49 (45%) of the long time group (p=.015). After recoding 4 mothers who miscarried and 6 who had involuntary sterilization, it was found that almost half of the presumably fertile mothers who were at McCabe for a long postnatal time avoided subsequent childbearing for 5 years vs. only about 25% of the fertile short-time mothers. The 2 groups were similar in incidence of abortion, in receiving a postpartum check-up and effective means of contraception, in living arrangements, and in child care help received. These findings indicate that the effectiveness of school programs for pregnant adolescents may be greatly enhanced and lead to a longterm improvement in the young mothers' chances for a self-sufficient life if they are extended into the postpartum period, which is an especially optimum time for intervention.