Is There a Link
Between Welfare Reform and Teen Pregnancy?
Richard P. Nathan, Paola Gentry, and
1996 federal welfare reform law exhorts states to reduce teen and out-of-wedlock births,
preliminary field research has found few links between welfare reform and pregnancy
prevention, and the ones that do exist are often tenuous, hard to describe, and difficult
to assess. States have established new and stronger connections between welfare and
employment services under welfare reform, but creating welfare programs that explicitly
stress pregnancy prevention has been inhibited by several factors. There is little
consensus on how to prevent teen and out-of-wedlock births, not just as a practical matter
but also as an ethical and political issue. This divisiveness has led most states to
devolve critical questions about the design of such programs down to local and community
levels. Also, the health agencies that have traditionally administered pregnancy
prevention programs have usually not worked closely with welfare agencies in the
past. And the federal reforms provide few incentives for states to create strong
linkages. Nonetheless, there is an opportunity here for leaders and groups committed
to teen pregnancy prevention, regardless of the approach they favor, to forge creative
linkages to welfare/ employment bureaucracies.
The main lesson so far from our implementation research on the
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 is straightforward
on the question of linkages between welfare reform and teen pregnancy prevention:
- There are no links in most places, or at least only
very limited ones. Even where a link does exist, it is often tenuous and extremely hard to
describe, much less to assess its impact.
The Rockefeller Institute 20-state
study of the implementation of the 1996 Act provides four subsidiary management lessons
that apply to this topic.
- First, we find a definite, strong move to devolution for
domestic policy, one that applies broadly to welfare, employment programs, and services
related to employment, such as child care and transportation.
- Second, we find extensive second-order and tertiary
devolution, that is, the assignment of increased responsibilities for devising
strategies and setting up systems to combat family dependency to local governments, local
offices of state agencies, and private groups (often nonprofit organizations).
- Third, in the highly sensitive area of teen pregnancy
prevention, this push to localize and decentralize is very powerful. This political
hot potato is regularly tossed to local leaders and groups because the values and
attitudes involved are so diverse in this country. In liberal communities, providing
contraceptives and even abortions is accepted. In others, they are a source of great
- Fourth, the institutions and agencies responsible for
preventing teen pregnancy and out-of-wedlock births do not connect well or easily with
welfare and employment bureaucracies even in communities where liberal attitudes prevail
on pregnancy prevention. Welfare and employment bureaucracies are increasingly linked all
over the country (though their relations are often tense, usually because their activities
are increasingly intertwined). As a generalization that stands out from our field
data, neither of these two major types of agencies welfare or employment agencies
have close ties with health agencies or local public health clinics, particularly
family planning clinics.
This problem the lack
of connections between welfare and employment and health agencies and organizations
provides an opportunity. The opportunity is for leaders and groups committed to
teen pregnancy prevention, regardless of the approach they favor, to forge linkages to
welfare/employment bureaucracies. So far, we find little inclination to do this from our
The U.S. General Accounting Office reported similar findings, saying the Personal
Responsibility Act has had a limited effect on teenage pregnancy prevention.2
Of course, saying bureaucratic
linkages are key next steps is a lot easier than taking them. However, if one stipulates
that a purpose of the new welfare is to reduce teen pregnancy and out-of-wedlock births
as the law so strongly states the clear and present need is to do precisely
this: make connections. Public agencies and foundations that care about this policy
objective however they wish to achieve it would benefit by building
relationships at the ground level between health agencies and welfare/job systems.
The new five-syllable word we use in
our research on the new welfare is connectivity. Controversies have arisen about
connectivity among social programs as TANF cash-assistance becomes ever more focused on
jobs. The biggest controversies have been the possible effects of the large reductions in
welfare rolls on participation in food stamps and Medicaid, programs which have also shown
recent declines in enrollment. This connectivity idea, however, is even broader. It
involves not only income support and job programs for families but also child care,
transportation, and a range of social, family, and childrens services intended to
enhance family self-sufficiency. The lack of connectivity in the case of teen pregnancy
prevention is the most striking among all the areas that could be keys to helping
poor families become and remain stable, healthy, and independent.
For the past year, the Rockefeller
Institute of Government and the U.S. General Accounting Office have conducted a Working
Seminar on Social Program Information Systems, a permanent group that meets
quarterly on the nuts and bolts of social program connectivity. The overarching agenda of
the Working Seminar is service integration. For years, people have talked about
holistic strategies to overcome the bureaucratic separation of social program fiefdoms.
Technology provides the power to make these connections at the front lines. Some states
are well down this road. Teen pregnancy prevention, however, is not on this screen
either figuratively or literally.
Work Is the Focus of the New Welfare.
The Personal Responsibility Act was
intended to discourage welfare receipt and promote job preparation, work, and marriage as
well as prevent and reduce out-of-wedlock births and teen pregnancies. As our first report
on state and local implementation of the Act shows, governors and state legislators have
adopted welfare reforms that strongly signal the importance of one of these two
objectives: work. This is often done with enthusiastic and bipartisan political
coalitions. In contrast, we have not found similar widespread enthusiasm for the
Acts antireproduction goals. Legislative proposals and often tentative
administrative policy initiatives to change sexual behavior have been advanced in some
states, but often they are dropped, watered down, or de-emphasized before legislation has
been passed or broad executive orders promulgated. Of course, this issue elicits some very
controversial attitudes and proposals that probably cannot generate broad support in any
state. In Mississippi, for example, the states original welfare reform bill in 1992
included provisions calling for Norplant implants for AFDC recipients with four or more
children and a thousand dollar reward to women who married and left the rolls,
but these components were eventually dropped from the bill before it was enacted into law
(Mississippi Field Research Report, 1998).
Overall, the political problems in
this field are the obvious ones. While there may be consensus on the wisdom and
desirability of preventing pregnancies among teens and out-of-wedlock births generally
among the TANF-eligible population, there is no consensus on how to do it. The
essential issue involves moral values, disagreements about how to prevent teen
pregnancy and out-of-wedlock births. The basic divide is between abstinence and the
distribution of contraceptives. In Utah, front-line workers are not allowed to discuss
birth control options with welfare clients. In Washington State, on the other hand, field
reports indicate that front-line workers do not feel it is appropriate to discuss such
personal issues with clients, even though state policy is permissive in this respect. One
New York City official commented to our field researcher, Ninety percent of our
workers are themselves single parents and identify on that point with their clients
(New York State Field Research Report, 1998). In the world of welfare, this subject tends
to be off limits.
Although the basic fissures
are cultural, the disagreements are compounded by a lack of scientific knowledge. Teen
pregnancies have gone down since 1991 after climbing steeply in the late 1980s, and the
drop has been especially pronounced for second births to teens.3Although these trends seem to be related to
changes in teen sexual activity and the use of contraceptives, not much is known about why
sexual behavior and contraceptive use have changed, making it very difficult to know what
kind of program would maintain or accelerate the declines in the rates of teen pregnancy
and teen out-of-wedlock births. Nor is it well understood why both rates are still
strikingly high in the United States.4
Given this uncertainty and deep
clashes over values, most states favored indirect approaches to reducing teen and
out-of-wedlock pregnancies. Changes in reproductive behavior were often treated as
expected side-effects of policies that could be justified for other reasons. Our research
team in Wisconsin put it this way:
Certainly the architects of W-2 expect the program over
time to reduce non-marital births, mostly because mothers can no longer receive cash
assistance without working and because teen parents must live in an adult-supervised
setting to receive W-2 services or support. . . . But reduction in out-of-wedlock
pregnancies is a hoped-for by-product of W-2. . . . The program has no components aimed
exclusively at the issue, and W-2 agencies have no formal role in preventing
out-of-wedlock pregnancies. (Wisconsin Field Research Report, 1998; emphasis added.)
Nine states in our sample created task
forces on teen pregnancy prevention to deal with this subject, a familiar tactic to put
off action in sensitive, controversial policy areas. While many aspects of this policy
area are controversial, some provisions of the 1996 welfare reform legislation were rather
quietly enacted; for example, the requirements that teen mothers live at home or in an
adult supervised setting and that they stay in school.
Some states are trying to find
a middle ground that is not ideologically charged, an approach that offends neither
liberals nor conservatives. In West Virginia, for example, there is a marriage incentive,
a ten percent increase in the monthly cash grant for two-parent families.5 The relative popularity of
family caps twenty states now have them reflects the same purpose, i.e., to
discourage the birth of additional children without specifying how those births are to be
prevented. However, the politically attractive ambiguity of this approach may not last.
Recent studies of the effects of family caps in New Jersey conducted by researchers at
Rutgers University suggest they may increase the incidence of abortions, thus casting
doubts on their political acceptability.6
The Devolution Is in the Details
The Personal Responsibility Act complicates this
value-reconciliation challenge. It makes $250 million available over five years for
abstinence-only education programs to be administered by the states. There is a detailed
set of regulations that must be followed to obtain this money. To be funded, a program
- Have as its exclusive purpose, teaching the social, psychological,
and health gains to be realized by abstaining from sexual activity;
- Teach that abstinence from sexual activity outside marriage is the
expected standard for all school-age children;
- Teach that abstinence from sexual activity is the only certain way
to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated
- Teach that a mutually faithful monogamous relationship in the
context of marriage is the expected standard of human sexual activity;
- Teach that bearing children out of wedlock is likely to have
harmful consequences for the child, the childs parents, and society;
- Teach young people how to reject sexual advances and how alcohol
and drug use increases vulnerability to sexual advances; and
- Teach the importance of attaining self-sufficiency before engaging
in sexual activity.7
Most states have applied for
and received their allotments under this grant, but it is not clear that they will
actually use the money. Many state officials see the abstinence-only program requirements
as restrictive. In the opinion of one state official, few projects will be able to
implement faithfully all components of the definition in the law.8The provision, which requires
abstinence programs to teach that a mutually faithful monogamous relationship in the
context of marriage is the expected standard of human sexual activity, has come
under the most scrutiny. In addition, some state officials have told our field researchers
they are wary about setting aside money for abstinence education because there are few
studies that have linked abstinence programs with the reduction in out-of-wedlock births,
although the U.S. Department of Health and Human Services is currently supporting
evaluations of abstinence programs.9 Finally, to use abstinence-only funds, the state needs to match every four
federal dollars with three state dollars. This matching requirement has proven difficult
in some states, in part because of the fear that the money used for abstinence education
competes or conflicts with funding for other efforts to prevent teen pregnancies and
Imposing requirements on the
states to take steps to prevent teen pregnancy is not new, though the emphasis on
abstinence is. In 1967, a law was enacted that required states to offer family planning
services in appropriate cases to recipients of Aid to Families with Dependent
Children (AFDC), for the purpose of preventing or reducing the incidence of births
out of wedlock. The 1972 amendments explicitly included sexually active minors in
the definition of appropriate cases, and required that family planning
services be provided promptly to all who requested them.10The 1972 amendments also
established a penalty if states failed to comply with these requirements and provide
family planning services under Medicaid.11 The requirement that AFDC clients be given information on family planning
remained on the books until it was repealed by the 1996 welfare law.
In addition to the abstinence-only
emphasis in the 1996 Act, there are financial incentives to states tied to pregnancy
prevention. Two bonuses provided in the Act are to be given to the states with the best
performance. The first is the Bonus to Reward High Performance States.
Beginning in 1999, the federal government will reward states that best achieve the
purposes set forth by the Personal Responsibility Act (all of the goals, not just those
related to reproduction-reduction). Standards for this bonus were established by the
Secretary of the U.S. Department of Health and Human Services in consultation with the
National Governors Association and the American Public Welfare Association, now the
American Public Human Services Association. One of the four goals on which
performance bonuses are based is the reduction of out-of-wedlock births. One hundred
million dollars per year will be available for fiscal years 1999 and 2000. In
addition, a specific Bonus to Reward a Decrease in Illegitimacy makes $100
million available, to be shared by the five states that demonstrate the greatest
reductions in out-of-wedlock births. To qualify for the bonus, states must
demonstrate that the abortion rate is less than the FY 1995 level. It is important
to note that both of these bonuses are directed at the states entire
population, not only teens or welfare recipients. These financial incentives,
however, do not appear to be promoting active policy initiatives and administrative
linkages between welfare and pregnancy prevention, although states are happy to receive
the money if they happen to win.
A significant institutional barrier
to linking pregnancy prevention and welfare/job programs is the fact that pregnancy
prevention programs are administered by health agencies, local health clinics, family
planning clinics, and education departments not welfare agencies. These agencies
typically concentrate their efforts in low-income communities, but the missions and
mechanisms involved do not directly tie into the welfare/job system. Historically,
pregnancy prevention has been funded by the federal government under the Title X Family
Planning Program and public health and education laws to achieve reductions in infant
mortality or high school drop-out rates for pregnant and parenting teens.
disagreements over how to prevent teen pregnancy and thus how to make
connections between programs and program bureaucracies are often less strong within
communities than within states, most states have devolved pregnancy prevention functions
downwards in connection with the 1996 welfare reform act. Teen pregnancy prevention shows
the highest degree of second-order devolution of the four basic welfare-related service
functions we examined. As Table 1 demonstrates, state agencies perform a relatively weak
role in managing pregnancy prevention activities when compared to their roles in the
administration of cash assistance or employment and training services. In our research
sample, fewer than half of the state governments play an important role in delivering
pregnancy prevention services, and only two out of three state governments exercise
significant control over the administrative design of such programs. One out of four
states have no important policy-making function in this area. Even among the states that
retain significant control over policy, they often share that power with a wide variety of
local institutions, including local public health agencies, public schools, and private
1. Devolution Of Pregnancy Prevention Program Functions to Local Governments, Public
Institutions, and Private Agencies
of states indicating that various institutions perform a significant role in
policy-making, administrative design, and service delivery for pregnancy prevention,
employment and training, and cash assistance programs.
|Other public institutions
|Other public institutions
|Other public institutions
Research Reports, State Capacity Study, 1998.
Note: Data from nineteen states are included in the table.
State government includes local as well as central offices of state agencies.
Other public institutions includes school districts, community colleges,
public hospitals, and so on.
This downward shift in program
responsibility may reduce some obstacles, but it creates others. Devolution down to
localities may allow for greater flexibility and community involvement, but it can also
decimate the budget for such programs. For example, Ohio tried to create a teen-pregnancy
prevention bonus modeled after the federal one and was unsuccessful. Despite the fact that
there is a state-provided incentive payment for the top performing counties in reducing
out-of-wedlock births, we were told that Hamilton County (Cincinnati) downplayed the
minimal amount of incentive money . . . people interviewed were doubtful that the county
could do much to affect out-of-wedlock pregnancy and stressed that the financial rewards
are too small for the county to expend much energy developing a program (Ohio Field
Research Report, 1998).
Although site-specific actions in
this policy area were not found to be widespread, several field researchers did identify
cases of connectivity of welfare/job and teen pregnancy prevention efforts.
- In Washington State, welfare offices have family planning nurses
on staff. Eight of fifty welfare offices are co-located with a family planning clinic.
While funding has increased for family planning under TANF, these connections are not new.
- Florida has mapped out a long-term strategy that includes the
implementation of a statewide protocol for the referral of clients to family planning
services. Eventually, steps are to be taken so that family planning services are
integrated with work activities. Currently, some WAGES (Work and Gain Economic Self
Sufficiency) coalitions have designated a staff member to coordinate pregnancy
prevention programs within their region.
- In Georgia, as part of the eligibility process, family members
identified as needing information regarding family planning are to be referred to
services. The state plan includes a list of personal responsibility requirements that may,
for example, include requiring family planning counseling as well as participation in
parenting classes for all teens whether or not they are parents. Recent controversy
appears to have dampened the early enthusiasm for implementing this requirement.
Nevertheless, in Bibb County, Georgia, we found that a family planning clinic is located
just outside the welfare office and workers make frequent referrals. In Fulton County,
Atlanta, one welfare office has on-site family planning services.
These examples are more the exception than the rule. We
are continuing these local field observations and also considering launching a special
review of implementation activities in this policy area for the second round of our
20-state field research.
The Conclusion A Policy Quandary
At a conference last year at the
American Enterprise Institute on teen pregnancy prevention, Douglas Besherov, the
convenor, summarized the overall situation by citing deep ambivalence in this
policy area. Jason Turner, Commissioner of the New York City Human Resources
Administration, who also spoke at this conference, agreed to the lack of a
consensus not about whether to reduce teen pregnancy but how. On television,
there are constant reminders that the popular culture signals one way and the political
culture gives decidedly different signals.
Government can do many things, but
it cannot do things that are out of sync with public values, or when public values are
highly conflicted. For social policy in America, signals have changed. This is clearly the
case in one of the two main policy areas emphasized in the 1996 law the work area.
In this area, the national consensus has been consistently loud and clear in favor of work
instead of welfare. But in the other area where the signaling of the 1996 Act is even
stronger, this is not the case namely, for the virtually hortatory purposes of the
1996 law to promote marriage and reduce teenage pregnancy and out-of-wedlock births.
Herein lies the quandary (a state of perplexity and doubt) of welfare reform:
Deep political divisions exist about the appropriateness, not of the goal, but of the
different means for achieving it. These disagreements reach inside welfare agencies.
Despite this finding that the
pregnancy prevention objectives of the Personal Responsibility Act have so far had little
effect on the bureaucratic behavior of welfare/job bureaucracies, there are grounds for
expecting personal behavior in this area to change as a result of the Act, and
indeed it may already be changing. TANF-aided family heads (most of them female, and many
of them unmarried) face the new reality of time-limited cash assistance and serious
requirements for work and participation in work-search and related activities. They have
to participate in work-related activities for fixed amounts of time under negotiated
Personal Responsibility Agreements, that states require be signed and agreed
to before a TANF cash-assistance case is opened. If there is a noncustodial parent,
usually a male, there is now a new social dynamic: If he isnt required to
do anything, why should I be; why shouldnt he be responsible too?
Some state officials we have interviewed predict that this kind of attitude change and the
resentment evoked by time-limited cash assistance ultimately will affect child-bearing
behavior. Perhaps it already is, but it would seem that larger forces are also at work
here economic and technological. Determining causality in such a puzzling and
off-limits policy area is a daunting task.
For public administration, the
lesson is obvious. Changes in bureaucratic behavior are more likely to happen when there
is a clear policy signal that is big enough to be widely noticed both within the pertinent
political sub-system and in public opinion generally. But this may not be enough: Change,
when it occurs, does so more easily and widely when it is in line with the dominant social
values. In the case of the 1996 Personal Responsibility Act, which is a big, and clear
signal, bureaucratic behavior is changing in one area and not another in a way that
reflects the political correctness of one signal (the work signal) and not the other
signal about pregnancy prevention.
1. Nathan, Richard P., and Thomas L.
Gais. Implementing the Personal Responsibility Act of 1996: A First Look (Albany:
The Nelson A. Rockefeller Institute of Government, 1999.
2. U.S. Senate. Chairman of the
Committee on Labor and Human Resources. Teen Pregnancy: State and Federal Efforts
to Implement Prevention Programs and Measure Their Effectiveness. Report
prepared by the General Accounting Office. GAO/HEHS-99-4, 1998.
3. Center for Disease Control. Decline
in Teenage Birth Rates, 1991-1997: National and State Patterns. Vol. 47, No. 12
of National Vital Statistics Report (Washington, D.C.: Center for Disease
4. Ventura, Stephanie J. et all. The
Demography of Out-of-Wedlock Childbearing. Department of Health and Human
Services Report to Congress on Out-of-Wedlock Childbearing, 1995.
5. Levin Epstein, Jodie. State
TANF Plans: Out-of-Wedlock and Statutory Rape Provisions (Washington, DC: Center
for Law and Social Policy, 1997.
6. Preston, Jennifer.
With New Jersey Family Cap, Births Fall and Abortion Rise. The New
York Times, November 3, 1998.
7. Haskins, Ron and Carol
Statuto Bevan. Abstinence Education Under Welfare Reform. In
Abstinence Education Grants and Welfare Reform Seminar web page. College Park, MD:
University of Maryland Welfare Reform Academy, MD, 1997 (cited March 18, 1999).
Available from http://welfareacademy.org/pubs.htm
8. Ibid, 6
9. Ibid, 6
10. Social Security Act, U.S. Code
Annotated, Vol. 42 Secs. 602(a)(15)(A)(7) (1991).
11. Congressional and Administrative
News, Legislative History, 1972, P.L. 92-603.
About the Authors
Richard P. Nathan is director of the Nelson A.
Rockefeller Institute of Government, the public policy research arm of the State
University of New York, and is principal investigator of the Institutes twenty-state
field network field evaluation of the implementation of the Personal Responsibility and
Work Opportunity Act of 1996. This Rockefeller Report is based on a talk he gave on March
7, 1999, at the annual conference of the American Public Human Services Association
at a session arranged by Nancy Thorne of the Population Research Center. Catherine
Lawrence is a research associate at the Rockefeller Institute and doctoral candidate at
the Rockefeller College School of Social Welfare. Paola Gentry is a research assistant at
The authors would like to thank Thomas Gais, director of
the Institutes Federalism Research Group and project director of the implementation
study, for his suggestions and assistance in the preparation of this paper.
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