Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Geronimus, Arline T., and Sanders Korenman. "Maternal Youth or Family Background? Preliminary Findings on the Health Disadvantages of Infants with Teenage Mothers." PSC Research Report No. 91-204. March 1991.
The health disadvantages of infants with teen mothers are well documented, but the causal mechanisms that mediate these associations have not been clearly demonstrated. In work on this subject, an important consideration is often overlooked: teenage mothers come disproportionately from disadvantaged and minority populations. Observed differences in infant health between teen mothers and women who postpone childbearing may reflect unmeasured socioeconomic background factors, factors that precede the first pregnancy, rather than the effects of maternal age. We analyze data from the NLSY and present new estimates of the relationship between maternal age and low birth weight, preterm birth, indicators of prenatal care utilization, smoking and alcohol use during pregnancy, breastfeeding, and well-child visits. We control for pre-pregnancy family background differences between teen and older mothers by comparing sisters who experienced their first births at different ages. Our findings suggest that family background characteristics of mothers, factors that precede their childbearing years, can account for many of the health disadvantages of infants with teenage mothers. When we controlled for family background, the effects of teen childbearing were mixed and modest. Differences in health-related indicators across socioeconomic stratum among women with similar fertility timing were large by comparison. For both blacks and whites, sisters comparisons suggested a less adverse effect of teen childbearing than suggested by cross-sectional comparisons. A common pattern was narrowing of differentials for whites and elimination or reversal of differentials for blacks. Compared to their sisters who had first births at older ages, black teen mothers were less likely to smoke during pregnancy or to have low birth weight infants, and more likely to breastfeed and bring their infants in for well child visits, but the reverse was true for whites. For all families and maternal age groups, absolute levels of poor birth outcomes and inadequate well child visits were higher for blacks; those for unhealthy behaviors and breastfeeding were markedly lower for blacks. These findings suggest that the processes leading to poor birth outcomes for teen mothers are complex. Theoretical, clinical, programmatic and policy implications are discussed.