Analysis Sexual Health

Poverty Causes Teen Parenting, Not the Other Way Around

Martha Kempner

Teen mothers are far from a random swath of the teen population who wind up in poverty because of a few particularly fast swimming sperm. Rather, they are likely to be in poverty already.

Like many Rewire readers, I have been closely following New York City’s fear- and shame-based campaign against teen pregnancy. The print ads include pictures of crying babies with captions like “Honestly Mom, chances are he won’t stay with you. What happens to me?” The ads also tell teens that if they have a kid, they will grow up to be poor. But the ads get it all wrong. Teen parenting doesn’t cause poverty; poverty causes teen parenting.

Developed by the New York Human Resources Administration (HRA), the campaign has seen a significant backlash since it was introduced last month. A group of activists in the city created a counter-campaign and demanded the city take the ads down. As Miriam Pérez noted in an article for Rewire, the backlash may have resulted in a few tweaks and improvements, but the ads are still up, and the HRA hasn’t changed the campaign’s underlying tone at all.

I finally saw the ads for myself last week. My subway car was plastered with crying babies telling their potential teen parents not to get pregnant. The ads I saw were focused on money. In one, a curly haired toddler in a bunny rabbit shirt said, “Dad, you’ll be paying to support me for the next 20 years.” Another featured a one-and-a-half-year-old African-American girl with a bow on top of her head and tears streaming down her cheeks, saying, “Got a good job? I cost thousands of dollars a year.”

But the one that got me, the poster that I happened to be standing in front of for my ride on the C train, was one that might almost be seen as encouraging had it not been so completely meaningless. It read, “If you finish high school, get a job, and get married before having children, you have a 98 percent chance of not being in poverty.”

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I don’t know whether this statistic is accurate, though it very well might be. Let’s face it: If you graduate from high school and get a job, you are two steps ahead when it comes to not living in poverty, whether or not you get married and have kids.

But these are big “ifs” that are affected by things way out of teenagers’ control, like where they’re born, the quality of the schools in their area, whether their parents are highly educated, whether their parents are employed, the employment rate in their neighborhood, and what the economy is like when they turn 18. And none of that has to do with whether or not they become parents before they get married.

Pérez points out that supporters of the campaign are missing the point—stigmatizing teen parents won’t prevent future teen parents, because that stigma already exists. I would add that the campaign misses another very important point: Teen parenting does not cause poverty. Poverty causes teen parenting.

Cause and Effect

The ads point out that economic outcomes for teen parents and their children tend to be poor. We know that teen mothers are less likely to graduate from high school, that the children of teen mothers are also less likely to graduate from high school (one ad in the campaign points to this statistics), that teen mothers are less likely to marry, and that they are more likely to live in poverty.  It would be easy to assume that these are natural consequences of teen parenting.

In fact, research has consistently found that teen parenting itself has little impact on a young woman’s economic future. A report commissioned by the New York City Department of Health (DOH) in 2011 (and provided to me by the department) reviewed 11 recent studies and concluded that estimates of causal impact of teen childbearing on socioeconomic status range from mildly adverse to mildly protective.

Economists Melissa Kearney of the University of Maryland and Phillip Levine of Wellesley College have written a number of articles on teen childbearing. In a recent paper, they conclude, “the most rigorous research on the topic has found that teen parenthood has very little if any direct negative economic consequences.”

As I pointed in a piece for Rewire about the roots of teen pregnancy, however, this isn’t good news. Having children at a young age does not affect these young women because these young women are already on a “downward economic trajectory.”

The authors of the DOH review point out that if we want to fairly assess whether teen parenting adversely affects a young mother we have to compare her outcomes at, say, 35, not with the outcomes of other 35-year-olds who didn’t have children as teens but with her own outcomes had she not had a child in her teens. Obviously, this has to be a predication rather than a straight observation. If teen parenthood was randomly distributed throughout the population (equally probable in every young woman) we could make this predication simply by comparing the median incomes of two 35-year-old women—one with a child born before she was 18 and one without. But there is nothing random about teen parenthood.

Teens who get pregnant tend to come from more disadvantaged families than those who do not become pregnant. Moreover, among pregnant teens, those who choose abortion tend to be more advantaged than those who opt to carry the baby to term. “As a result, teen mothers are more likely than women who delay childbearing to come from poor families, to be black or Hispanic, and, before they become pregnant, to be behind in school, and to have lower academic test scores,” write the authors of the DOH report.

Teen mothers are far from a random swath of the teen population who wind up in poverty because of a few particularly fast swimming sperm. Rather, they are likely to be in poverty already.

Why Does Poverty Cause Teen Parenting?

Many researchers have attempted to explain why young women living in poverty are more likely to have children in their teens, and have concluded that growing up with few economic prospects can lead young women to choose teen parenting. Some have referred to this as a “cultural norm” or pointed to the “cycle of poverty.” Kearney and Levine attempt to put it in economic terms by operationalizing the notions of “marginalization” and “hopelessness.” They speculate that “[t]he combination of being poor and living in a more unequal (and less mobile) society contributes to a low perception of possible economic success, and hence leads to choices that favor short-term satisfaction—in this case the decision to have a baby while young and unmarried.”

Essentially, the researchers are suggesting that young women are making logical assessments of their future: “The intuition is that if girls perceive their chances at long-term economic success as being sufficiently low, even if they do ‘play by the rules,’ then early childbearing is more likely to be chosen.”

The economists also examined state-level data on teen pregnancy, abortion, and parenting as well socioeconomic status and found that low-income teens in areas of poverty surrounded by those of wealth are the most likely to become teen a parents. Though their research was done at the state level, New York City is certainly a place where impoverished neighborhoods are within blocks of some of the wealthiest neighborhoods in the country.

Rational Analysis

A look at New York City neighborhoods with high teen pregnancy rates shows that the “ifs” in the teen pregnancy ad (graduating high school and getting a job) are pretty big. (The Department of Health also provided me with a list of some of the neighborhoods with the highest teen pregnancy rates.)

For example, in the Morrisania neighborhood of the Bronx, where teen pregnancy rates are 112.9 pregnancies per 1,000 young women ages 15 to 19 (compared to 72.1 per 1,000 city-wide) students may attend Bronx Regional High School. (In New York, students are not zoned for particular high schools; instead they are can choose to apply to a variety of schools both inside and outside of their neighborhood. I chose to look at neighborhood high schools in these areas to provide a sense of the community.) At Bronx Regional High School, a majority of students (73 percent) qualify for free lunch programs, only between 20 and 30 percent of its students graduate in four years, and only 1.5 percent of students are considered college-ready. The median annual income in Morrisania is $17,770, and almost half of the population is living below the poverty rate. The unemployment rate in 2010 was 17 percent.

Similarly, young women in the Bushwick neighborhood of Brooklyn, where the teen pregnancy rate is 102.7 pregnancies per 1,000 young women ages 15 to 19, may attend Bushwick Community High School. There, 81 percent of students receive free lunch, only 20 percent of its students graduate within six years, and less than 1 percent are considered college-ready. The median annual income in Bushwick is $27,338, and 39 percent of the population is living below the poverty level. The unemployment rate in 2010 was 17 percent.

Young women in these neighborhoods are well aware of their likely economic futures. And if they are doing their own cost-benefit analysis of their future before they choose teen parenting, as Kearney and Levine speculate, posters telling them they’re going to be poor if they have a baby aren’t going to do a lot of good. They are already poor, and they expect to continue to be poor. Moreover, a poster telling them that if they graduate from high school, get a job, and get married before they have kids then they won’t be poor isn’t going to help either if they’re convinced that they likely won’t graduate or get a job.

It should be noted that New York City has done a great deal to bring down rates of teen pregnancy in recent years. The Department of Health, for example, has made efforts to make condoms, contraception, and emergency contraception available to young people. That’s what makes this ad campaign so surprising and disheartening. Instead of wasting money on posters with meaningless, shame-based, and stigmatizing messages, the city should be spending its money on changing the realities of these young women’s futures. Hope is always better than humiliation.

News Law and Policy

Texas Lawmaker’s ‘Coerced Abortion’ Campaign ‘Wildly Divorced From Reality’

Teddy Wilson

Anti-choice groups and lawmakers in Texas are charging that coerced abortion has reached epidemic levels, citing bogus research published by researchers who oppose legal abortion care.

A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”

Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.

White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy. 

“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.

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White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.

Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.

“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”

White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.

During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”

Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.

There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.

‘Extremely common but hidden’

“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”

Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.

“I believe the number is closer to 50 percent, in my opinion,” Parker said. 

There were 54,902 abortions in Texas in 2014, according to recently released statistics from the Texas Department of State Health Services (DSHS). The state does not collect data on the reasons people seek abortion care. 

White and Parker referenced an oft cited study on coerced abortion pushed by the anti-choice movement.

“According to one published study, sixty-four percent of American women who had abortions felt forced or unduly pressured by someone else to have an unwanted abortion,” White said in a statement.

This statistic is found in a 2004 study about abortion and traumatic stress that was co-authored by David Reardon, Vincent Rue, and Priscilla Coleman, all of whom are among the handful of doctors and scientists whose research is often promoted by anti-choice activists.

The study was cited in a report by the Elliot Institute for Social Sciences Research, an anti-choice organization founded by Reardon. 

Other research suggests far fewer pregnant people are coerced into having an abortion.

Less than 2 percent of women surveyed in 1987 and 2004 reported that a partner or parent wanting them to abort was the most important reason they sought the abortion, according to a report by the Guttmacher Institute.

That same report found that 24 percent of women surveyed in 1987 and 14 percent surveyed in 2004 listed “husband or partner wants me to have an abortion” as one of the reasons that “contributed to their decision to have an abortion.” Eight percent in 1987 and 6 percent in 2004 listed “parents want me to have an abortion” as a contributing factor.

‘Flawed research’ and ‘misinformation’  

Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.

“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.  

White sponsored or co-sponsored dozens of bills during the 2015 legislative session, including several anti-choice bills. The bills she sponsored included proposals to increase requirements for abortion clinics, restrict minors’ access to abortion care, and ban health insurance coverage of abortion services.

White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.

The bill was met by skepticism by both Republican lawmakers and anti-choice activists.

State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.

“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”

‘Very small piece of the puzzle of a much larger problem’

White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”

There is research that suggests a connection between coerced abortion and domestic and sexual violence.

Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.

“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”

A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.

Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.

‘Tactic to intimidate and coerce women into not choosing to have an abortion’

TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”

One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”

The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.

The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.

“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”

“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.

Among the other resources that TJF provides is a document produced by Life Dynamics, a prominent anti-choice organization based in Denton, Texas.

Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”

Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.

Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.

“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”

“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.