Preventing Subsequent Births for Low-Income Adolescent Mothers: An Exploratory Investigation of Mediating Factors In Intensive Case Management

Purpose.  Adolescent parenting put both mother and child at risk of poor health and socioeconomic outcomes and result in significant costs to our nation. Adolescents who have subsequent births are at even greater risk of experiencing long-term poverty and problematic behaviors such as school difficulties, drug use, and delinquency. Although previous research suggests the benefits of support services, such as case management for adolescent parents in reducing subsequent births, the mechanisms for these interventions have not been explored.  The following project developed and tested a conceptual model for the potential mechanisms for an intensive case management (ICM) program that focused on the long-term relationship between case manager, adolescent mother and birth control counseling. Specifically this study: 1) examined the impact of an ICM program that utilized a resiliency-based developmental assets approach to prevent subsequent births for low-income adolescent mothers, and 2) tested whether perceived social support and birth control were mediators in the relationship between case management and subsequent births.

Methods. Using a quasi-experimental design, comparisons were made for low-income adolescent mothers receiving ICM (n=55) for at least six months (m=2.25 yrs, sd=0.97) versus a similar group of low-income adolescent mothers not in case management (n=32). Using SPSS and MPLUS, chi-square and path analyses were used to test two hypotheses, respectively:  1) ICM will reduce the likelihood of subsequent births to adolescent mothers, and 2) birth control and perceived social support, when controlling for age and head of household, will mediate the relationship between the intervention and subsequent births.

Results. Adolescents in the ICM group (16%) were significantly less likely to have a subsequent birth within three years of the previous birth than the comparison group (32%), but birth control and perceived social support did not appear to be mediators for the intervention. The only significant finding in the path analysis was between birth control and subsequent births. A post hoc analysis found a significant difference in reported birth control between adolescents who had a subsequent birth and adolescents who did not have a subsequent birth (χ2= 4.138, df= 1, p=0.048). Specifically, adolescents who experienced a subsequent birth were less likely to report using birth control.

Implications.  This study suggests that ICM may be effective in preventing subsequent births for low-income adolescents. These findings also suggest that enhanced provision of birth control, perhaps in coordination with health care providers, could result in significant reductions in subsequent births to adolescent mothers. However, specific mechanisms of action for decreasing the likelihood of subsequent births within ICM programs require further investigation. Anecdotally, qualitative interviews with adolescents in this project suggested that intentionality of family formation, or the mother’s desire to have another child, may also be a salient factor in the occurrence of subsequent births. Future research should address relationships between intentions, behaviors, and subsequent births for adolescent mothers in order to delineate and inform social support programs.