Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers
Program Components - Alternative school for pregnant public school students
- Same school calendar, schedule, and curriculum as the rest of the public school system
- Comprehensive services, including social and medical services
- Close connection between the school and Yale-New Haven Hospital
- Nurses leading daily classes in childbirth, prenatal development, family planning, and infant care
- Teams of nurses providing individual counseling as well as monitoring appointments and adherence to obstetricians’ instructions
- Counseling to help pregnant or parenting teens plan their immediate and long-term future
- Trained teachers, nurses, and social workers of varied racial and ethnic backgrounds
For Use With - In-school, pregnant and parenting, African American adolescents from low-income families
Evaluation Methodology - Quasi-experimental design with nearly random treatment and comparison conditions determined by the length of time after delivery that students remained at the Center
- Birth cohort of low-income, African American, first-time adolescent mothers in New Haven, delivering a live infant between March 1, 1979 and February 29, 1980
- Data on adolescent mothers who had not graduated from high school at the time of delivery but had attended the McCabe Center (n=106)
- Portion of the young women who either returned to school or graduated after delivery (n=102; 69 percent of entire birth cohort)
- Two-year and five-year follow-up for repeat childbearing
Evaluation Findings - Reduced incidence of repeat childbearing within two years of the first baby’s birth
- Reduced incidence of repeat childbearing within five years of the first baby’s birth
Program Description Polly T. McCabe Center, in New Haven, Connecticut, is an alternative, separate public school for pregnant students. It is fully integrated into the New Haven school system, is operated by the New Haven Board of Education, and follows regular school calendars, schedules, and curricula. In addition, it provides social and medical services. Staff includes teachers, nurses, and social workers of varied racial and ethnic backgrounds. Students receive counseling to help them plan their immediate and long-term future. Counseling also includes grappling with child care issues, completing high school, delaying subsequent childbearing, coping with family conflict, and finding housing, if living with a parent or guardian is not possible.13
The school is closely associated with Yale-New Haven Hospital and nurses from the Yale School of Nursing provide daily classes in childbirth, prenatal development, family planning, and infant care. The nurses also educate pregnant students about the importance of regular prenatal care, monitor their prenatal appointments, and encourage compliance with obstetricians’ instructions. The nurses use a team approach that allows for both individual counseling and group teaching.13
Students are referred to McCabe from their regular school when their pregnancy becomes apparent or when they notify a teacher or counselor of the pregnancy. The students remain at McCabe through the quarter when the infant is delivered, except that students who deliver during the third quarter may remain to complete the fourth quarter as well.13 Evaluation Methodology Approximately two-thirds of all low-income, in-school mothers in New Haven were referred to the McCabe Center. Almost all (87 percent) were low-income and were also referred for WIC or had their birth expenses paid by the federal or state government. This study looked specifically at low-income, African American women who gave birth between March 1979 and February 29, 1980, and who were less than 19 years old when they delivered their first baby and had not yet graduated from high school when they became pregnant. Of 106 African American, low-income teens who regularly attended the McCabe Center, all but four either returned to their regular school or graduated after delivering their infant. Thus, 102 African American, low-income young women were the sample for the study, nearly randomly distributed between those who stayed less than seven weeks at the Center (n=52) and those who had seven weeks or more at the Center (n=50). They represented 69 percent of the entire population of African American, low-income first-time, school-aged mothers in New Haven who delivered during the index period. Of the remaining 31 percent, some had dropped out of school before or during pregnancy; and some attended their regular school during their pregnancy.13
Rules governed when students must leave the McCabe Center and return to their regular school. These rules established a regular relationship between timing of delivery and duration of postnatal attendance at McCabe. For example, students who delivered in January through April could remain for the fourth quarter, receiving more than the median time at McCabe. Students who delivered in May through August received less than the median time before they returned to their regular school in September. In other months, postnatal attendance depended on when the birth occurred relative to the end of the academic marking period. Thus, although random assignment was not used to determine the duration of postnatal attendance, the effects of the attendance rules nevertheless seemed to mimic random assignment in determining the duration of each young mother’s postnatal intervention. In theory, the maximum permissible postnatal time was 22 weeks. In reality, three students were allowed to stay longer, including one who stayed 23 weeks in order to graduate from McCabe and two 14-year-old, developmentally disabled students who were allowed to remain the entire year although each delivered in the fall. Deviations from the rules were rare.13
Researchers contacted the young mothers when their babies were 18 months of age. All the mothers agreed to be interviewed and allowed examination of their school and medical records. Most mothers (n=98) had relocated by the time their child was six years old. One mother, who died, had delivered a second child shortly after her first child. Thus, researchers had information on whether a second child had been delivered to 99 mothers (97 percent of the sample).13
Each mother was interviewed for one-and-a-half to two hours, when her first child was 18 months old and again when the child was six. The young woman’s mother or guardian was also interviewed when the baby was 18 months old. Maternal medical records were reviewed from the first prenatal check-up (or baby’s birth, if there was no prenatal care) until six years postpartum. For all pregnancies, researchers recorded dates of occurrence and outcomes. In addition, researchers elicited information about contraceptive use, accidents, illnesses, and general health and reviewed school records for the period from 18 months prior to delivery until two years postpartum.13
The total number of weeks of postnatal attendance at McCabe varied from zero to 32, with a median of 7.1 weeks. After assessing for selection bias, evaluators determined that the group of those who had less than the median of seven weeks after delivery at McCabe (comparison, n=52) were equivalent to those who had seven weeks or more (treatment, n=50). For example, median age at delivery was 16.8 in both groups; median age at menarche was 12 in both groups; 24 of the treatment group had a previous pregnancy, compared to 19 of comparison mothers. Highest grade point average in the year prior to pregnancy was 2.1 for the treatment group; 1.9 for the comparisons. The primary difference between the groups was the median length of time at McCabe after delivery—13.7 weeks for the treatment group; 2.6 weeks for the comparison mothers (P≤.001).13
Long-Term Outcomes - Reduced incidence of repeat childbearing within two years—Within two years of delivering their first child, mothers who stayed longer at McCabe Center were significantly less likely than comparison mothers to have delivered a second child (12 versus 36 percent; six of 50 versus 19 of 52; P=.005). 13
- Reduced incidence of repeat childbearing within five years—After five years, 45 percent of treatment mothers had delivered at least one more child, compared to 70 percent of comparison mothers (22 of 49 versus 35 of 50; P=.015). Evaluators looked at the medical records of all women who had not had a second child within five years, discovering that four had miscarried and six had become sterile. The sterile women were deleted from the five-year follow-up while the four who had miscarried were recoded as having had a second pregnancy. Re-evaluation at this point found that almost half of mothers in the treatment group (n=21 of 45; 47 percent) successfully avoided subsequent childbearing for five years following the birth of their first child, compared to one-fourth of comparison mothers (P≤.02).13
In addition, among the teens who had not had a second child within two years of the first, 69 percent had remained in school and earned passing grades or graduated, compared with 35 percent of the teens who delivered a second child within two years (P≤.001). At six years postpartum, the educational percentages were 72 versus 46 percent, respectively, who had earned a high school diploma or a GED equivalent (P≤.05). Finally, at six years postpartum, the proportions relying solely on public assistance to support their families were nine and 30 percent, respectively (P≤.05).13
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