Pregnancy Prevention, Family Planning Can Help Curb Maltreatment Mortality

In my previous column, I quoted Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy, who said that groups focusing on child and family well-being rarely propose interventions that begin before conception.

Nowhere is this more true than in the field of child welfare. So it is not surprising that the draft recommendations of the Committee to Eliminate Child Abuse and Neglect Fatalities (CECANF) do not include family planning.

But anyone who has worked with children in foster care knows that more of these youth come from larger, closely spaced sibling groups than one would expect in the general population. Indeed, research shows a strong relationship between larger families and child maltreatment.

Using earlier data from California, Barbara Needell and Richard Barth found that 59 percent of infants entering foster care between 1989 and 1994 were the third or later child born to their mother, compared to only 29 percent of the general population of infants.

Federal data from the Fourth National Incidence Study of Child Abuse and Neglect shows that one in 48 children in households with four or more children were likely to suffer abuse or neglect. This is double the rate of children in households with two children, which had the lowest rate.

Unfortunately, we don’t know what proportion of child fatalities come from large families. But at least one expert has noticed a pattern. Angela Diaz, who directs New York’s Mount Sinai Adolescent Health Center, testified that during her tenure on a panel that reviewed child fatalities in New York City, the mother of the dead child often had had a child in adolescence, followed by more children in short order.

The correlation between larger families and child maltreatment is not surprising. Parents of larger families undergo more stress due to both the difficulty of supervising more children and the financial burden.

Financial strain can also lead to neglect in the form of lack of supervision when the parent must work, inadequate housing, etc. Moreover, both child maltreatment and larger families may be related to underlying social factors such as poverty and low education levels.

Of course, many people raise large families with no difficulties, and many adults from large families treasure their upbringing and their strong support system. In the past, larger families were more practical for all income levels.

Today, I’d submit that a very large family is financially risky to most adults without a serious cash reserve or income in the top percentile. For parents already involved with child welfare, especially those struggling to make ends meet, it is hard to dispute the benefits of postponing further children.

In the last few years, advances in contraception have led to the availability of Long Acting Reversible Contraceptives (LARCs). But the availability of LARCs and knowledge of their safety and efficacy have not yet caught up.

As I recommended in an earlier column, system-involved mothers could be offered the opportunity to get a LARC immediately. Judges, attorneys and social workers could provide information about LARCs and explain the importance of avoiding further births as a mother tries to regain her children and get the agency out of her life.

CECANF should add to its recommendations that future data collection about child deaths include family size. But the correlation between family size and child maltreatment is compelling enough for immediate action. CECANF should suggest that states explore the possibility of integrating pregnancy prevention with child welfare services.

On a policy level, it is time to discuss ways to limit childbearing by women who lack the financial means to handle more kids. A grant program might even be created in order to encourage states to experiment with different approaches.

Such proposals are difficult to bring up in America, thanks in part to our country’s shameful history of attempting to restrict childbearing by women of color through means including forced sterilization and the promotion of birth control methods like Norplant. But the welfare of children should take precedence over the reluctance to offend adults.

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