Children and Youth Services Review 32 (2010) 1351–1356

Contents lists available at ScienceDirect

Children and Youth Services Review
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c h i l d yo u t h

The risk of teenage pregnancy among transitioning foster youth: Implications for extending state care beyond age 18
Amy Dworsky a,⁎, Mark E. Courtney b
a b

Chapin Hall at the University of Chicago, United States School of Social Service Administration at the University of Chicago, United States

a r t i c l e

i n f o

a b s t r a c t
The purpose of this study is to examine how common teenage pregnancy is among young women in and aging out of foster care and to determine whether the risk of becoming pregnant can be reduced by extending foster care beyond age 18. The study used data from the first two waves of the Midwest Evaluation of the Adult Functioning of Former Foster Youth, a longitudinal study of foster youth making the transition to adulthood in three Midwestern states, as well as the National Longitudinal Study of Adolescent Health. Cox proportional hazard models were estimated to examine the relationship between care status and the risk of teenage pregnancy. Foster youth are more likely to experience teenage pregnancy than their peers in the general population but staying in care seems to mitigate their risk of becoming pregnant even after the effects of other factors are taken into account. Our findings provide additional evidence of the need for a more concerted effort by child welfare agencies to help youth in foster care avoid becoming pregnant and suggest that allowing young people to remain in foster care beyond age 18 may be one way to reduce teenage pregnancy among this population. © 2010 Elsevier Ltd. All rights reserved.

Article history: Received 14 April 2010 Accepted 1 June 2010 Available online 4 June 2010 Keywords: Teenage pregnancy Foster care Aging out

1. Introduction Growing attention has been paid in recent years to the high rate of teenage pregnancy among young people in and aging out of foster care. In fact, the National Campaign to Prevent Teen and Unplanned Pregnancy has identified the reduction of teenage pregnancy among this population as one of the priorities (National Campaign to Prevent Teen and Unplanned Pregnancy, 2009). Although young people in and aging out of foster care are believed to be at high risk of becoming pregnant (National Campaign to Prevent Teen and Unplanned Pregnancy, 2008), the number of adolescents who experience a pregnancy while they are under the care and supervision of the state is far from clear. Gotbaum (2005), who surveyed contract foster care agencies in New York City in early 2005, found that approximately 16% of their 13 to 21 year old female wards were either pregnant (4%) or parenting (12%). Another study with a more geographically diverse sample of foster youth looked not at teenage pregnancy but at early childbearing. Pecora et al. (2003) estimated that at least 17% of the young women who had been served by Casey Family Programs, a private agency with offices in 13 different states, between 1966 and 1998 had given birth to at least one child while in foster care. Although this is more than double the 8.2% of unmarried 15 to 19 year old females in 1998 who
⁎ Corresponding author. Tel.: +1 773 256 5164. E-mail addresses: adworsky@chapinhall.org (A. Dworsky), markec@partnersforourchildren.org (M.E. Courtney). 0190-7409/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2010.06.002

had ever given birth (Bachu & O'Connell, 2001), the Casey Family Programs sample included young women who had been in foster care as many as three decades ago. There is also evidence that foster youth remain at high risk of becoming pregnant even after they become too old to stay in care. Singer (2004) reported that 31% of 18 to 24 year old young women who had “aged out” of Utah's child welfare system between 1999 and 2003 had given birth within 3 years of exiting, and that their birthrate was nearly three times higher than the birthrate for this age group in the state's general population. The present study contributes to our limited knowledge about teenage pregnancy among youth in foster care by addressing three important questions. First, how likely are young women aging out of foster care to experience a teenage pregnancy? Second, how does their likelihood of becoming pregnant compare to that of adolescents in the general population? And third, could we reduce the risk of teenage pregnancy among this population by allowing foster youth to remain in care beyond age 18? This third and final question is particularly relevant in light the Fostering Connections to Success and Increasing Adoptions Act of 2008. Under this legislation, which amended Title IV-E of the Social Security Act, states will be able to claim federal reimbursement for the costs of caring for and supervising eligible foster youth until age 21, rather than 18, beginning in federal fiscal year 2011. This policy change makes sense developmentally given that many young adults continue to rely heavily on their families for support during the transition to adulthood (Settersten, Furstenberg, & Rumbaut, 2005).

1352

A. Dworsky, M.E. Courtney / Children and Youth Services Review 32 (2010) 1351–1356

Using data from the first two waves of the Midwest Evaluation of the Adult Functioning of Former Foster Youth (henceforth the “Midwest Study”), a longitudinal study of foster youth making the transition to adulthood in three Midwestern states, as well as the National Longitudinal Study of Adolescent Health, we find that foster youth are more likely to become pregnant than their peers in the general population but that staying in care seems to mitigate their risk of teenage pregnancy even after the effects of other factors are taken into account. The implications of our results for child welfare policy and practice are discussed. 2. Research design and methods: the Midwest and Add Health Studies The Midwest Study is following a sample of young people from Iowa, Wisconsin and Illinois as they as they “age out” of foster care and transition to adulthood. All of these young people had been placed in out-of-home care before their 16th birthday for reasons other than delinquency and were still in out-of-home care on their 17th birthday. Baseline interviews were conducted with 732 of these young people when they were 17 or 18 years old, and all but 34 were still state wards. Those 34 had been emancipated between selection of the sample and the baseline interview. Eighty two% (N = 603) of the baseline completed a second interview at age 19. Iowa and Wisconsin are like most states in that foster youth typically “age out” when they are 18 years old. Illinois is one of the few states in which young people can (and routinely do) remain “in care” until age 21. Consequently, when the second wave of data was collected, 282 of the young people who were interviewed were still in foster care, and all but two of those young people were from Illinois. In fact, 72% of the Illinois youth were still in care when they were interviewed at age 19. This between-state difference in child welfare policy is what allows us to examine the relationship between care status and the risk of teenage pregnancy. Pregnancy-related data were collected using Audio Computer Aided Self Interviewing (ACASI) from 374 of the 378 young women who completed a baseline interview and 315 of the 326 young women who were re-interviewed at age 19. ACASI involves listening to pre-recorded questions through headphones and entering a response directly into a laptop computer. Data were missing for study participants who chose not to answer the pregnancy-related questions or who did not complete the ACASI portion of the interview. Approximately half of the young women (n= 160) were still in care when the second interview took place. To help put the experiences of these foster youth into perspective, we present data from the National Longitudinal Study of Adolescent Health (henceforth the “Add Health Study”), a federally funded examination of the relationship between adolescent health behaviors and young adult outcomes (Harris et al., 2009). Interviews were conducted with a nationally representative sample of 7th through 12th graders in 1994.1 These same students were re-interviewed first in 1996 and then again in 2001 or 2002. The Add Health data cited in this paper were collected from the 17 and 18 year old females in the core sample who participated in the second wave of data collection and from the 19 year old females in the core sample who participated in the third. Three limitations should be kept in mind when interpreting the results. First, although we have no reason to believe that the experiences of foster youth with teenage pregnancy are significantly different in the Midwest than in other states, the generalizability of our findings is unknown. Second, the Midwest Study was not designed to be a study of teenage pregnancy and hence some potentially relevant predictors are

missing from the data. And third, the Midwest Study cannot address a number of important questions, such as why the risk of teenage pregnancy is so high among youth in foster care. 3. Results One third of the young women in the Midwest Study had been pregnant at least once by age 17 or 18 compared with just 13.5% of their Add Health Study counterparts. That gap had widened by age 19. Half of the nineteen year olds in the Midwest Study but only 20% of their Add Health Study counterparts had been pregnant at least once (Table 1). A potential problem with this comparison is that African-American teens are more likely to become pregnant that teens who are nonHispanic White, and young women were three times more likely to identify themselves as African-American in the Midwest Study than in the Add Health Study. Because this could account for the difference we observed in the percentage of young women who had been pregnant, we re-weighted the Add Health Study sample to reflect the racial composition of the young women in the Midwest Study. The weights were computed by dividing the percentage of Midwest Study females who identified themselves as belonging to a particular racial group by the percentage of Add Health Study females who also identified themselves as belonging to that racial group. For example, 59% of the 17 or 18 year old females in the Midwest Study and 20% of their Add Health Study counterparts identified themselves as African American. Thus, a weight of 2.95 (i.e., .59/.20) was assigned to each 17 or 18 year old African American female in the Add Health Study. Applying the weights reduced the difference by several percentage points, it was quite large. Repeat pregnancies were also more common among the female foster youth. Twenty three percent of the young women in the Midwest Study who had been pregnant by age 17 or 18 had been pregnant more than once compared with 17% of the young women in the Add Health Study. By age 19, those figures had risen to 46% and 34%, respectively. Although teenage pregnancy is generally thought of as something to be avoided, 22% of the young women in the Midwest Study who became pregnant by age 17 or 18 and 35% of those who became pregnant between their baseline interview and their interview at age 19 had “definitely” or “probably wanted” to become pregnant. We took advantage of the between-state difference in the age until which young people can remain in foster care to examine the relationship between care status at age 19 and teenage pregnancy. Although 19 year olds who were still in care were as likely to have been pregnant prior to their baseline interview as 19 year olds who were no longer in care, the former were significantly less likely to

Table 1 Pregnancies and repeat pregnancies: cumulative percentages. Prior to interview at age 17–18 N Midwest Study Ever pregnanta Pregnant more than once (if ever)b Add Health Study Ever pregnant Weighted Re-weighted Pregnant more than once (if ever)
a b

Prior to interview at age 19 N 316 151 # 160 70 % 50.6c 46.4c

# 124 28

% 32.9c 22.6c

374 124

794 795 114

114 146 19

13.5c 18.4c 16.7c

288 290 58

58 79 20

20.1c 27.3c 33.9c

1 Additional information about the Add Health Study can be found at http://www. cpc.unc.edu/projects/addhealth.

Ten of the 19 year olds did not answer the pregnancy questions at waves two. Nine of the young women who had been pregnant at least once by age 19 did not report the number of times they had been pregnant. c Difference between female foster youth and Add Health females is statistically significant at p b .001.

A. Dworsky, M.E. Courtney / Children and Youth Services Review 32 (2010) 1351–1356

1353

have become pregnant since their baseline interview. They were also significantly less likely to have become pregnant more than once if they became pregnant (Table 2). One explanation for why young women who were still in care at age 19 were significantly less likely to have become pregnant since their baseline interview is that becoming pregnant is what caused some young women to leave care. However, a closer look at the data revealed that 79% of the young women who knew the month and year in which their first post-baseline pregnancy began were no longer in care when they became pregnant.2 An alternative interpretation of the relationship we observed is that allowing young people to remain in care beyond age 18 has a protective effect on the risk of teenage pregnancy. It is also possible that this relationship reflects other differences between the young women who were still in care at age 19 and those who were not that would have put the latter at greater risk regardless of their care status. This explanation seems unlikely given that we found no statistically significant difference between them in pre-baseline pregnancies. In fact, the small difference that did exist was in the opposite direction. Nevertheless, we investigated this possibility by estimating a Cox proportional hazard model in which the dependent variable was time until the first post-baseline pregnancy. This model, which takes both the occurrence and the timing of an event into account, can be written, h(t) = q(t)exB, where q(t) represents an unspecified function of time and exB represents a log-linear function of observed covariates. The estimated hazard can be thought of as the risk of becoming pregnant at time t given that a pregnancy had not occurred prior to time t where t = 0 is the date of the baseline interview (Cox, 1972; Yamaguchi, 1991). Observations were treated as right censored at the second interview if the young women did not become pregnant between her baseline interview and her interview at age 19. Each of the 104 19 year olds who reported being pregnant since her baseline interview was asked about the month and year in which her most recent pregnancy began. Although we were modeling the hazard of the first post-baseline pregnancy, this was not a problem in the vast majority of cases because the first post-baseline pregnancy was also the most recent (n = 79). However, some young women had been pregnant more than once since their baseline interview (n = 17), some did not report the number of times they had been pregnant (n = 2), and some had been pregnant only once but did not report the month and year in which their pregnancy began (n = 6). We dealt with the 25 cases for which we were missing data by making some assumptions about the earliest possible and latest possible month and year in which the first post-baseline pregnancy could have begun. Specifically, we assumed the following about the first postbaseline pregnancy: • It could have begun no sooner than the month of the baseline interview. • It could have begun no later than 9 months before the interview at age 19 if the young woman had been pregnant only once and was no longer pregnant. • It could have begun no later than 3 months before the start of the most recent pregnancy (i.e., 2 months until a young woman would have been aware that she had been pregnant and miscarried or arranged for an abortion and another month before she could become pregnant again) if the young woman had been pregnant twice between the two interviews and her first pregnancy had NOT resulted in a live birth. • It could have begun no later than 11 months before the start of the most recent pregnancy (i.e., a gestational period of 9 plus 2 months before she could reasonably become pregnant again) if the young woman had been pregnant twice between the two interviews and her first pregnancy had resulted in a live birth.

Table 2 Relationship between the likelihood of becoming pregnant and care status at age 19. Still in care N Ever pregnant by age 19 Pregnant prior to baseline interviewa Pregnant since baseline interviewb Pregnant more than once since baseline interview (if ever pregnant)d 163 162 160 43 # 77 57 44 3 % 47.2 35.2 27.5 6.8 No longer in care N 163 161 155 59 # 83 48 60 14 % 52.9 29.8 38.7 23.3 p

c c

a Data were missing for one female still in care at age 19 and 2 females no longer in care at age 19. b Data were missing for 3 females still in care at age 19 and 8 females no longer in care at age 19. c p b .05. d Data were missing for one female still in care at age 19 and one female no longer in care at age 19.

These assumptions yielded bounds for the start of all but two of the first post-baseline pregnancies for which data were missing. We estimated our hazard model using the reported pregnancy start date, when that was available, and the midpoint between the two bounds when the reported date was missing. We also tested the sensitivity of our results to the assumptions we had made to impute the missing data by re-estimating our models using, first, the earliest possible start date and, second, the latest possible start date rather than the midpoint between them. In addition to controls for race/ethnicity, all of the models included an array of covariates that we believed might function as risk or protective factors.

3.1. Child maltreatment Numerous studies have found a relationship between childhood maltreatment and teenage pregnancy (Smith, 1996). Much of this research has focused on the link between teenage pregnancy and sexual abuse, but many teenage mothers also report a history of abuse and/or neglect (Boyer & Fine, 1992; Stevens-Simon & McAnarney, 1994). Thus, our model included three dummies that indicated whether a particular type of child maltreatment had occurred prior to placement: one for physical abuse, one for neglect, and one for sexual abuse. Physical abuse and neglect were measured using 16 items taken from the Lifetime Experiences Questionnaire (Gibb et al., 2001). Sexual abuse was measured using 7 items taken from the National Survey of Adolescents (Kilpatrick & Saunders, 1995).

3.2. Placement history Although almost nothing is known about the relationship between teenage pregnancy and experiences in out-of-home care, we hypothesized that those experiences might affect a young woman's risk of becoming pregnant. Thus, our model included three measures of placement instability: a log transformation of the total number of foster homes and group care settings in which the young women had been placed, whether they had ever reentered care after being returned home, and whether they had ever run away from a placement. We used a log transformation of the number of placements because preliminary analyses suggested that the relationship between number of placements and the risk of pregnancy might be nonlinear among youth who had been placed in five or fewer foster homes and group care settings. The model also included the length of time between most recent entry into care and the baseline interview as well as two measures of placement type: current or prior placement with relatives and current or prior placement in group care.

2 Eight of the young women who became pregnant after their baseline interview did not report the month and year in which their pregnancy began.

1354

A. Dworsky, M.E. Courtney / Children and Youth Services Review 32 (2010) 1351–1356

3.3. Education A number of studies have found that teenage pregnancy is negatively related to both expectations for academic achievement and performance in school (Manlove, 1998; Fergusson & Woodward, 2000). Thus, our model included a dummy that indicated having college aspirations and one that indicated having been retained.

3.9. State Finally, our model included a state dummy to distinguish between young women from Iowa and Wisconsin, where remaining in care was not an option, and young women from Illinois, where that option did exist. Estimating a model that included separate dummy variables for Iowa and Wisconsin did not change the substantive results. With the exception of the time-varying covariate and length of stay in care, which required information contained in administrative data from the Illinois Department of Children and Family Services, all but one of the independent variables were measured using the survey data collected at baseline. That one exception was sexual abuse which was not measured until the interview at age 19 due to Institutional Review Board (IRB) concerns. Table 3 shows the parameter estimates from the Cox proportional hazard models after they were converted into hazard ratios. These hazard ratios represent the relationship between each variable and the estimated hazard that a young woman became pregnant after her baseline interview controlling for the effects of the other variables in the model. A ratio significantly greater than one corresponds to an increase in the estimated hazard of becoming pregnant, a ratio significantly lower than one corresponds to a decrease in the in the estimated hazard of becoming pregnant, and a ratio close to one corresponds to no effect on the estimated hazard. If the variable is continuous, the ratio represents the multiplicative change in the estimated hazard of becoming pregnant for each oneunit increase in its value. The percentage increase or decrease in the

3.4. Psychosocial problems Having a psychiatric disorder has been found to increase risk of teenage parenthood (Kessler et al., 1997), and many pregnant teens have a prior history of delinquency and substance use (Huizinga, Loeber, & Thornberry, 1993; Yamaguchi & Kandel, 1987). Thus, our model included a dummy indicating the presence of an affective mental health disorder, a dummy indicating the presence of an alcohol or other drug disorder, and a count of self-reported delinquent behaviors during the past year. Mental health and substance use disorders were assessed using the World Health Organization's (1998) Composite International Diagnostic Interview (CIDI) which is designed for use by non-clinicians and can generate either lifetime or current (i.e., past 12 months) psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

3.5. Closeness to adults A number of studies have found a negative relationship between parent–child closeness and factors such as age at first sexual intercourse and contraceptive use (Miller, Benson, & Galbraith, 2001). Having a close relationship with a caring adult has also been identified as an asset that can help adolescents avoid teenage pregnancy (Kegler, Rodine, Marshall, Oman, & McLeroy, 2003). Thus, our model included a dummy indicating closeness to at least one adult family member (i.e., biological parent, step-parent, or grandparent) and a dummy indicating closeness to a current foster parent or group care staff member. Youth whose placement was a supervised independent living arrangement were coded as not having a close relationship with a current caregiver.

Table 3 Estimated hazard ratios from Cox proportional hazard model predicting first pregnancy between baseline interview and interview at age 19. N Events Censored 303 101 202 Midpoint Placed with kin currently Placed with kin before but not currently Never placed with kin Placed in group care currently Placed in group care before but not currently Never placed in group care Race—White Race—Other Race—African American Ethnicity-Hispanic Neglected prior to placement Physically abused prior to placement Sexually abused prior to placement Log of total number of foster home and group care placements prior to baseline Ever reentered care Length of stay in care since most recent entry Ever ran away from our-of-home care placement Ever retained in school Standardized delinquency score Very close to an adult family member Very close to current out-of-home caregiver Any mental health diagnosis at baseline Any drug or alcohol diagnosis at baseline Received information about contraception or family planning services prior to baseline Pregnant prior to baseline Care status (time-varying) Iowa or Wisconsin Illinois ⁎ p b .05. 1.567 1.095 Earliest date 1.586 1.121 Latest date 1.564 1.092

3.6. Receipt of family planning services Because using contraception should reduce the risk of pregnancy, all other things being equal, our model included a dummy indicating receipt of family planning services or information about birth control prior to baseline.

0.445⁎ 0.625

0.464 0.642

0.462 0.646

0.661 1.090

0.705 1.137

0.652 1.082

3.7. Prior pregnancy Because one third of the young women who were interviewed at age 19 had been pregnant before their baseline interview, our model included a dummy indicating a prior pregnancy.

1.439 0.904 1.433 0.909 1.356 1.138 1.000 1.185 1.334 1.151 1.056 0.893 0.645 1.088 1.698 1.743⁎ 0.528⁎ 1.352

1.355 0.905 1.455 0.878 1.338 1.143 1.000 1.175 1.284 1.136 1.041 0.881 0.667 1.082 1.686 1.763⁎ 0.616 1.210

1.437 0.902 1.448 0.867 1.314 1.128 1.000 1.243 1.330 1.161 1.091 0.904 0.621 1.129 1.655 1.720⁎ 0.434⁎ 1.740

3.8. Care status Because young women who were still in care at age 19 were less likely to have become pregnant since their baseline interview than their counterparts who were no longer in care, our model included care status as a time-varying covariate. Nearly all of these young women were still in care when the baseline data were collected so the initial value of this covariate usually equaled one. The exceptions were 32 young women who exited the care between sample selection and their baseline interview. The value became zero if and when they exited care before their interview at age 19.

A. Dworsky, M.E. Courtney / Children and Youth Services Review 32 (2010) 1351–1356

1355

estimated hazard is calculated by subtracting one from the ratio and multiplying by one hundred. If the variable is categorical, the ratio represents the multiplicative change in the hazard of becoming pregnant associated with belonging to one category rather than the comparison group. If there were more than two categories for an independent variable, the comparison group is italicized in Table 3. Only three of our predicators were associated with a change in the estimated hazard of a post-baseline pregnancy. First, being in care was associated with a 47% reduction in the estimated hazard of becoming pregnant between the baseline interview and the interview at age 19. Second, the estimated hazard of becoming pregnant was 55% lower among young women who were currently in a group care placement at baseline as compared with young women who had never been placed in group care. And third, as expected, having been pregnant prior to the baseline interview increased the estimated hazard by 81%. When we tested the sensitivity of our results to the assumptions we had made to deal with the missing pregnancy start dates, the parameter estimates were much the same. What did change in some cases was whether a particular parameter estimate was statistically significant. Most notably, the hazard ratio for care status was only marginally significant at p b .10 when we used the earlier possible start date but still significant statistically when the latest possible start date was used. 4. Discussion Our data clearly indicate that teenage pregnancy is all too common among young women aging out of foster care and transitioning to adulthood. Not only are female foster youth more likely to become pregnant than their non-foster peers, but many of those who become pregnant experience a repeat pregnancy. Thus, our findings confirm the need for current efforts being made by the National Campaign to Prevent Teen and Unplanned Pregnancy to reduce teen pregnancy among youth in foster care (National Campaign to Prevent Teen and Unplanned Pregnancy, 2009). Another major finding to emerge from our research concerns what appears to be a protective effect of remaining in care on the risk of teenage pregnancy. What might explain the reduction we observed in the estimated hazard of becoming pregnant? One possibility is that young women who are still in care simply have fewer “opportunities” to become pregnant due to the supervision that their foster parents or other caregivers provide. Another is that young women who are still in care may be given more advice about risky behaviors to avoid or more encouragement to engage in positive activities. Understanding this relationship will require more research. However, it is particularly relevant now that states are weighing whether or not to respond to the Fostering Connections to Success and Increasing Adoptions Act of 2008 by extending foster care to age 21. Our findings suggest that allowing young people to remain under the care and supervision of the state until their 21st birthday may be one way to reduce teenage pregnancy among this population. Care status was not the only factor that we found to be associated with the risk of teenage pregnancy. Not surprisingly, the estimated hazard of becoming pregnant was significantly higher for young women who had had a prior pregnancy. This underscores the need for interventions aimed at preventing repeat pregnancies. There was also evidence of a relationship between the risk of teenage pregnancy and placement history. Current placement in group care was associated with a significant reduction in the estimated hazard of a post-baseline pregnancy. Perhaps young women in group care were at lower risk of becoming pregnant than those who had never been in a group care placement because group care allows for greater supervision and more restrictions on behavior. In addition, the hazard of becoming pregnant was positively related to the total number of foster homes and group care settings in which a young woman had been placed. One explanation for this finding is that

placement instability makes it difficult for young women to develop the kind of relationships with adults that have been shown to be critical to helping adolescents avoid teenage pregnancy as well as other risky behaviors (Blum & Rinehard, 1998; Miller, 1998; Resnick et al., 1997). If nothing else, it provides one more reason to minimize the number of placement changes that foster youth experience. The positive relationship we observed between the estimated hazard of becoming pregnant and the receipt of family planning services or contraceptive information is more difficult to explain. One possibility is that the young women who received family planning services or information about birth control were more likely to be sexually active. Our findings raise a couple of important questions. First, why is this population at such high risk of teenage pregnancy? At least some evidence suggests that although foster youth may have access to contraceptive services, whatever sex education they receive in school is both too little and too late. Many still have misconceptions about methods of birth control and how to use them effectively (Love, McIntosh, Rosst, & Tertzakian, 2005). An even bigger problem may be a perception among some youth in foster care that the benefits of teen pregnancy far outweigh the costs. For some foster youth, having a child is a way to create the family they don't have or fill an emotional void (Love, McIntosh, Rosst, & Tertzakian, 2005). Foster youth may also feel a need to prove they can be good parents and may not understand why it would be better to delay parenthood. Either might explain why more than one third of the young women in the Midwest Study who experienced a pregnancy between their first two interviews described themselves as “definitely or probably wanting to get pregnant.” The second important question raised by these results is what can child welfare agencies do to help youth in foster care avoid becoming pregnant before they are physically, emotionally and financially ready to be parents? An important first step that agencies could take would be to implement a comprehensive pregnancy prevention strategy. Unfortunately, at least one recent study of child welfare services providers indicates that this may not be happening, even among agencies whose programs specifically target pregnant and parenting foster youth (Love, McIntosh, Rosst, & Tertzakian, 2005). Such a strategy would need to include a number of components. One is training for caseworkers. Many child welfare workers feel unprepared to talk with foster youth about sex and contraception. For example, 58% of the child welfare service providers that Love et al. surveyed, including 43% of those whose programs are aimed at pregnant and parenting foster youth, reported that they had not received adequate training when it comes to pregnancy prevention. A similar argument could be made about training foster parents, including relative caregivers (Love et al., 2005). Foster parents must be able to have initiative conversations with their foster youth about sex and pregnancy prevention so that foster youth feel comfortable approaching them with questions and concerns. Although child welfare agencies must ensure that foster youth have access to contraception as well as to reproductive health care services more generally, the fact remains that more than one third of the young women in the Midwest Study who experienced a post-baseline pregnancy described themselves as “definitely or probably” wanting to get pregnant. This suggests that providing foster youth with information about and access to birth control will not be enough to prevent teenage pregnancy among this population. Equally important will be addressing this motivation. In particular, some foster youth perceive having a child as a way to create the family they don't have or fill an emotional void and don't understand why it would be better to delay parenthood (Love et al., 2005). Yet another component that an effective pregnancy prevention program for this population should include is a focus on helping foster youth develop permanent connections with caring adults. Researchers have found that strong relationships between adolescents and their parents or other caring adults are critical to helping youth avoid teenage pregnancy as well as other risky behaviors (Blum & Rinehard,

1356

A. Dworsky, M.E. Courtney / Children and Youth Services Review 32 (2010) 1351–1356 Kilpatrick, D., & Saunders, B. (1995). National survey of adolescents in the United States. ICPSR 2833. Ann Arbor, MI: Inter-University Consortium For Political and Social. Kirby, D. (2007). Emerging answers: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy. Love, L., McIntosh, J., Rosst, M., & Tertzakian, K. (2005). Fostering hope: Preventing teen pregnancy among youth in foster care. Washington, DC: National Campaign to Prevent Teen Pregnancy. Manlove, J. (1998). The influence of high school dropout and school disengagement on the risk of school-age pregnancy. Journal of Research on Adolescence, 8(2), 187−220. Miller, B. (1998). Families matter: A research synthesis of family influences on adolescent pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy. Miller, B., Benson, B., & Galbraith, K. (2001). Family relationships and adolescent pregnancy risk: A research synthesis. Developmental Review, 21, 1−38. National Campaign to Prevent Teen and Unplanned Pregnancy (2008). Policy brief: Preventing pregnancy among youth in foster care. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy http://www.thenationalcampaign.org/ policymakers/PDF/Briefly_PolicyBrief_Youth%20in%20Foster%20Care.pdf National campaign to prevent teen and unplanned pregnancy (2009). Teen Pregnancy Prevention Among Youth in Foster Care Multi-State Project http://www.thenationalcampaign.org/fostercare/casey_project.aspx Pecora, P., Williams, J., Kessler, R., Downs, A., O'Brien, K., Hiripi, E., et al. (2003). Assessing the effects of foster care: Early results from the Casey National Alumni Study. Seattle, WA: Casey Family Programs. Resnick, M., Bearman, P., Blum, R., Bauman, K., Harris, K., Jones, J., et al. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Assocation, 278(10), 823−832. Settersten, R., Furstenberg, F., & Rumbaut, R. (Eds.). (2005). On the frontier of adulthood: Theory, research, and public policy. Chicago: University of Chicago Press. Singer, A. (2004). Assessing outcomes of youth transitioning from foster care. Salt Lake City, UT: Utah Department of Human Services. Smith, C. (1996). The link between childhood maltreatment and teenage pregnancy. Social Work Research, 20(3), 131−142. Stevens-Simon, C., & McAnarney, E. (1994). Childhood victimization: Relationship to adolescent pregnancy outcomes. Child Abuse & Neglect, 18, 569−575. World Health Organization (1998). The composite international diagnostic interview (CIDI). Switzerland: Geneva. Yamaguchi, K. (1991). Event history analysis. Newbury Park, California: Sage. Yamaguchi, K., & Kandel, D. (1987). Drug use and other determinants of premarital pregnancy and its outcome: A dynamic analysis of competing life events. Journal of Marriage and the Family, 49, 257−270.

1998; Miller, 1998; Resnick et al., 1997). These are precisely the kinds of relationships that too many foster youth don't have. A number of programs have been shown to delay early sex, increase contraceptive use, and reduce teen pregnancy (Kirby, 2007), but they were not designed with the unique needs of foster youth in mind. Although foster youth are similar to their non-foster peers in many respects, there are important differences that must be taken into account. This suggests a need to develop and then rigorously evaluate interventions that specifically target youth in foster care. References
Bachu, A., & O'Connell, M. (2001). Fertility of American women: June 2000 (current population rep. no. P20–543RV). Washington, DC: U.S. Census Bureau. Blum, R., & Rinehard, P. (1998). Reducing the risk: Connections that make a difference in the lives of youth. Minneapolis, MN: Center for Adolescent Health and Development, University of Minnesota. Boyer, D., & Fine, D. (1992). Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Family Planning Perspectives, 24, 4−11. Cox, D. (1972). Regression models and life tables. Journal of the Royal Statistical Society Series B, 34(2), 187−220. Fergusson, D. M., & Woodward, L. J. (2000). Teenage pregnancy and female educational under-achievement: A prospective study of a New Zealand birth cohort. Journal of Marriage and the Family, 62, 147−161. Gibb, B., Alloy, L., Abramson, L., Rose, D., Whitehouse, W., & Donovan, P. (2001). History of childhood maltreatment, negative cognitive styles, and episodes of depression in adulthood. Cognitive Therapy and Research, 25, 425−446. Gotbaum, B. (2005). Children raising children: City fails to adequately assist pregnant and parenting youth in foster care. New York, NY: Public Advocate for the City of New York. Harris, K., Halper, C., Whitsel, E., Hussey, J., Tabor, J., Entzel, P., et al. (2009). The National Longitudinal Study of adolescent health: research design. Available at: http://www. cpc.unc.edu/projects/addhealth/design. accessed November 19, 2009. Huizinga, D., Loeber, R., & Thornberry, T. (1993). Longitudinal study of delinquency, drug use, sexual activity, and pregnancy among children and youth in three cities. Public Health Reports, 108, 90−96. Kegler, M., Rodine, S., Marshall, S., Oman, R., & McLeroy, K. (2003). An asset-based youth development model for preventing teen pregnancy: Illustrations from the HEART of OKC project. Health Education, 103(3), 131−144. Kessler, R., Berglund, P., Foster, C., Saunders, W., Stang, P., & Walters, E. (1997). Social consequences of psychiatric disorders, II: Teenage parenthood. The American Journal of Psychiatry, 154, 1405−1411.

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.