The Story of a Standard: Pregnancy and Parenting in Foster Care
While overall teen pregnancy rates in the United States have declined since their peak in the early 1990s, early pregnancy remains prevalent among youth in the child welfare system. Compared to their peers in the general population, youth living in foster care are more than twice as likely to become pregnant before 19 and more likely to have given birth and to have experienced subsequent pregnancies before age 21. They are also more likely to be investigated for maltreatment and at higher risk of having their children removed involuntarily from their care than other pregnant or parenting youth.
To address these trends and ensure agencies are prepared to meet the needs of this vulnerable population, COA introduced standards addressing service delivery to pregnant and parenting youth in foster care to its public agency accreditation program in 2016 and to the private organization accreditation program in 2018.
Understanding the Epidemic
Placement and family instability in the foster care system is a major factor contributing to the significantly higher rates of pregnancy among youth in foster care. These instabilities can create gaps in their sexual and reproductive health education, inhibit the formation of trusting relationships with caring adults, and may even be a motivation for early motherhood.
While disruptions in schools is associated with a number of issues related to the health and well-being of youth in foster care, it is particularly concerning as it relates to sexual and reproductive health education. Delivery of comprehensive sex education in schools is already inconsistent across the United States because local school districts make their own determination about if and when sex education is taught, and what the curriculum includes. Placement instability in foster care adds to this inconsistency by disrupting school attendance, forcing youth to change schools and potentially miss out on sex education either in part or in entirety.
The inadequacy in education on sex and relationships is even more alarming if you consider how the traumatic experiences of abuse, neglect, and family instability contribute to risky or maladaptive behavior, as well as exploitation. Research demonstrates that risky sexual behavior, sexual initiation at an early age, and sexual assault victimization are all disproportionately higher among foster youth. Although caseworkers and foster parents should be in an optimal position to fill in the gap in sex education by providing supplemental counseling and support, too often they are apprehensive or reluctant to take on this important role, whether due to personal beliefs or lack of guidance or training. High caseworker turnover and placement instability are also compounding risk factors, in that they prevent youth from forming strong relationships with the adults in their lives -- relationships which research indicates are a protective factor against teen pregnancy.
Some evidence also suggests that girls in foster care may generally be more inclined towards early motherhood due to the loss or breakdown of their own family relationships. Surveys of girls in foster care reveal that many yearn for both permanent family connections and independence, and often view motherhood as an opportunity to “create a family of their own”, to gain entry into adulthood, or to maintain a relationship with a partner.
The Standards Development Process
COA's standards development projects can be triggered by a number of different forces, including feedback from our stakeholders, new regulations, and shifting trends in the field. In this case, however, the story of the standard has a less conventional start: suicide prevention.
The suicide prevention project was an initiative geared towards infusing the standards with information on suicide risk and guidance on prevention strategies. Among other things, this included adding an emphasis on identifying and treating postpartum depression in pregnant and parenting service recipients. The content was easily incorporated into existing sections of the Group Living Services (GLS) and Residential Treatment (RTX) standards, but the work highlighted a gap in the Foster Care (FKC) standards.
Historically, pregnant youth in the child welfare system were more commonly placed in group settings, such as specialized maternity homes, for reasons ranging from their increased healthcare needs to the stigma of teen pregnancy. As the child welfare field has shifted away from congregate care in favor of family settings, however, the need to address this population within foster care has emerged. While some pregnant and parenting youth do require a higher level of care, most can and should be placed in the least restrictive, most family-like setting with the goal of achieving permanency and lifelong connections – provided organizations are prepared to meet their unique needs.
Ensuring the availability of foster home placements and appropriate services for pregnant and parenting youth is one of the central arguments for establishing these new standards for foster care, the goals of which are to:
promote the health of pregnant youth and their children by ensuring timely delivery of prenatal and postnatal healthcare; and
prevent the separation of parenting youth from their children by protecting youths' rights as parents and supporting them to acquire the skills and resources to care for their children.
Stigmatization of teen pregnancy remains an obstacle to effective service delivery and positive outcomes for affected youth and their children in foster care. Youth who become pregnant in foster care are in an especially vulnerable position because of their dependence upon their foster parents and the organization and, fearing rejection and other negative consequences, often conceal their pregnancies, with runaway incidents upon discovery of the pregnancy being a common occurrence. This delays notification of the custodial agency, which in turn delays access to needed health services. The majority of pregnant youth in foster care fail to receive prenatal care within their first trimester and youth seeking to terminate a pregnancy can easily find themselves outside the legally allowable time frames. These trends are concerning because delayed prenatal care is associated with poor childbirth outcomes, including premature delivery, low birthweight, infant mortality, and other developmental and health issues. Training caseworkers and caregivers to be open and nonjudgmental may encourage youth to disclose pregnancy at an earlier stage and receive timely and appropriate health services.
Pervasive negative attitudes about pregnant and parenting youth have led to resource families rejecting pregnant youth in their care, and can influence agencies to adopt policies that separate youth from their children unnecessarily. Although both best practice and client rights perspectives argue that parenting youth and their children should always be placed together in a family-setting, unless specific safety risks are identified, testimony from the field and subject matter experts who participated in our standards advisory panels confirm this is often not the case. Compared to mothers of a similar age, youth in foster care are significantly more likely to have their children removed from their custody, with neglect and inadequate supervision being the most commonly cited justifications. While these higher rates of removal can often be attributed to the increased scrutiny and surveillance that comes from already being known to the child welfare authority, removal proceedings are sometimes triggered by inappropriate motivations such as meeting eligibility requirements for financial assistance, or as disciplinary actions against youth. We have also heard reports from stakeholders providing foster care in jurisdictions where removal proceedings are automatically initiated soon after childbirth. These kinds of unjustified removals not only add to the trauma of youth in foster care, who have already been separated from their own families, but perpetuate a cycle of child welfare involvement from one generation to the next.
Let’s finish on a more positive note. It’s important to remember that the goal of child welfare is to promote strong and stable family connections and, when successful, those connections do serve as a protective factor against early pregnancy as well as for youth who are already parenting. And in spite of the challenges of being young parents, many former foster youth report that parenthood is an empowering experience that motivated them to achieve their goals and seek better opportunities for their children -- with the help and support of caring adults.
So what can agencies do to better address teen pregnancy in foster care and to support pregnant and parenting youth?
Empower caseworkers and resource families to talk to youth about their reproductive health. Adopt an organization-wide policy or guidelines to promote a shared understanding about what the case worker’s and resource parents’ roles are in ensuring that youth understand consent, pregnancy and STD risk, and healthy relationships. Many pregnancy prevention advocates promote the use of long-acting reversible contraceptives (LARCs) among youth, especially in foster care, which may be more effective for this age group than other contraceptive methods that depend on perfect and consistent use.
Fight for the rights of pregnant and parenting youth to be placed together with their children, and in a family setting. Rather than removing pregnant youth from a stable placement into congregate care, perform an assessment to determine if their needs can continue to be met in their current setting. Ensure that pregnant and parenting youth are informed of their rights, connect them to legal assistance, and demand documentation of a substantiated health or safety concern from protective services agencies seeking to remove a child from a youth parent.
Recruit foster parents who are willing and able to provide “whole family placements” for parenting youth to live together with their child. One major challenge to keeping youth and their children together in a family setting is a shortage of appropriate placements, as many resource families are reluctant to become caregivers for a teen parent and her child. Such foster parents may need specialized training to prepare them to model positive parenting for the youth, and to understand and manage the dual developmental needs of the youth and their child. Workers should help resource parents in these situations to meet any additional licensing requirements, and to develop a mutually agreed upon parenting plan with the parenting youth that outlines each family member’s role, responsibilities, and rights.
Promote extending foster care to age 21+, which has been associated with better outcomes for pregnant and parenting youth in foster care. Extended foster care provides a valuable opportunity to support foster youth in their transition to adulthood, and to meet their educational and vocational goals. This support is crucial for parenting youth, who are in the process of developing parenting skills in addition to fundamental independent living skills, and can help prevent negative outcomes further down the road, including homelessness, repeat pregnancy, and custody loss.
Want to Learn Even More? Check Out:
Supporting the Sexual and Reproductive Health of Youth in Out-of-Home Care: A guide for caseworkers
- Center for the Study of Social Policy
Teen Pregnancy Among Young Women in Foster Care: A Primer - Guttmacher Institute
Cause for Concern: Unwanted pregnancy and childbirth among adolescents in foster care
- National Center for Youth Law
Twice the Opportunity: Policy recommendations to support expectant and parenting youth in foster care and their children - Center for the Study of Social Policy
Expectant and Parenting Youth in Foster Care: Addressing their developmental needs to promote healthy parent and child outcomes - Center for the Study of Social Policy
Webinar: Evidence-Based Programs for Young Parents in Foster Care - Annie E. Casey Foundation