British Medical Bulletin 69:155-166 (2004)
British Medical Bulletin, Vol. 69 © The British Council 2004; all rights reserved
Teenage childbearing as cultural prism
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
Correspondence to: Arline T Geronimus, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. E-mail: arline{at}umich.edu
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Abstract |
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 Top Abstract IntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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Postponing childbearing beyond the teenage years is now adaptive practice for European Americans. European American adults put this cultural priority into action and employ substantial social resources to disseminate the social control message meant for their youth that teenage childbearing has disastrous consequences. Yet, patterns of fertility-timing are culturally and historically variable. Early fertility-timing patterns may constitute adaptive practice for African American residents of high-poverty urban areas, in no small measure because they contend with structural constraints that shorten healthy life expectancy. The entrenched cultural interdependence of and social inequality between European and African Americans lead African Americans to be highly visible and vulnerable targets of moral condemnation for their fertility behaviour. This, in turn, sets up African Americans to pay a particularly high price politically, psychosocially, and in terms of their health.
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Introduction |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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The public perception that teenage childbearing is a social problem is relatively new, dating in the United States roughly to the 1970s1. Although studies in the 1970s and 1980s documented an association between teenage childbearing and poor outcomes for teenage mothers, their offspring, and society at large, from a methodological standpoint the conclusion that teenage childbearing caused these poor outcomes was premature2,3. In the United States, those who become teen mothers differ from the larger population in countless and consequential ways—all of which would increase the chance of poor outcomes for women of any age4. Given these systematic differences, the question social scientists need to answer is: Would social, clinical, or public health problems be alleviated if the same women who become teenage mothers postponed childbearing to older ages?
The past 15 years have witnessed the publication of a raft of studies designed to approximate this counterfactual condition. Unlike the simple comparisons made between teenage and older mothers in early studies that had few or no control variables, more recent researchers have tried to approximate an experimental approach by comparing teen mothers to older mothers who match them more closely in other respects. For example, investigators have compared outcomes among national samples of sisters3,5,6 or between teenage mothers and teenagers who became pregnant but miscarried7.
When the assessment of the consequences for teen mothers is based on these studies, a different picture emerges from the entrenched wisdom. For example, Hotz et al review studies that use various approaches to account for unobserved background factors that may confound the relationship between teenage childbearing and long-term educational and economic outcomes of teen mothers7. They conclude that selection bias "vastly" overstates the negative consequences of teenage childbearing estimated in cross-sectional studies. They further conclude that the range of scientific uncertainty is over whether the effects of teenage childbearing on educational and economic outcomes are "slightly negative," "negligible," or "positive."
Studies of child development indicators also arrive at conflicting estimates of the magnitude or direction of any effects of teenage childbearing depending on the outcome, the maternal age groups compared, or whether the focus is on black or nonblack children8,9. Colleagues and I have previously studied the performance of preschool and elementary school age children of a national sample of sisters who experienced their first births at different ages6. We found little difference between children with teenage versus older mothers on several standard tests of achievement and cognitive development. Those tests where statistically significant differences were estimated usually favoured the children of teenage mothers. Similarly, Moore et al found that among black children in their national sample of 4- to 14-year-olds, those whose mothers were 18 or 19 at their birth performed better in reading and mathematics than those whose mothers had been in their early 20s8.
The few studies that consider the effect of teen motherhood on the behaviour of their adolescent or young adult children in a multivariate context find at most small effects. They leave open the question of whether any negative effects of teen childbearing on adolescent and young adult children of teen mothers would remain in the presence of more comprehensive controls. Levine et al mention, but do not report, estimates based on within-family comparisons, noting that they are suggestive, if not conclusive, that employing such comparisons could eliminate the effects they observed of teenage childbearing on behavioural outcomes for adolescent and young adult children9. Similarly, based on her empirical work on child abuse or neglect, Massat concluded that the prevailing wisdom, "that adolescent parents are more likely to maltreat their children than are older parents appears to be a myth entrenched in the popular culture"10.
On the relationship of teenage childbearing to infant health, there is strong evidence to refute the idea that the association between teenage childbearing and poor infant outcome is the result of maternal age, per se2,5,11,12. Indeed, among African Americans, low birth weight and infant mortality rates are lowest for babies whose mothers are in their mid to late teens. This finding is pronounced in high poverty urban communities13–16. For example, in Harlem, infant mortality rates for teens are half those for older mothers14.
Of particular interest, given the widely held belief that teen mothers are very expensive to society, are the empirical findings of Hotz et al who compared teenage mothers to those who would have become teenage mothers, but for the accident of miscarriage7. This approach approximates random assignment to teen motherhood and, thus, yields estimates that can be considered to be close to true effects17. Hotz et al estimated that the lifetime earnings of teenage mothers would decrease if they delayed childbearing7. Moreover, Hotz et al calculated that if all current teenage mothers delayed childbearing "the net annual outlays by government for cash-assistance and in-kind transfers to these women would actually increase by 35%, or $4.0 billion"7.
Few people are aware of findings such as these. Well-publicized conventional wisdom continues to hold teen childbearing to be, in all cases and in every aspect, an antisocial act, and an important public health problem, especially when practiced by urban African Americans. Meanwhile, a significant body of reputable scientific evidence has existed for more than a decade that casts doubt on the conventional wisdom but does not get the same public "air time"1,4,18.
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Culture, social control and social support |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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A useful conceptualization of culture and its dynamic relationship to structure and identity can be formulated to address the question of why the conventional wisdom on the consequences of teen childbearing continue to be, at once, overstated and never in doubt. The primary premise of this conceptualization is that cultures share basic universal imperatives which include promoting economic security and ensuring healthy reproduction19.
LeVine and colleagues focus on the critical role parents play in employing and adapting cultural traditions to promote children’s economic and reproductive success and cultural competence19,20. I extend this parental role more broadly to include other adults or elders. Such parenting goals, "constitute a framework for adaptation, since local conditions threatening their fulfilment motivate parents to develop strategies for minimizing perceived risks to children and for maximizing their welfare"20. Once specific adaptive practices become cultural traditions, LeVine states they are, "carried out by parents as tested commonsense formulas that embody a folk wisdom greater than the parents themselves can conceive or explain but which reduces or prevents their anxiety"20.
In actively implementing "commonsense formulas," parents/elders are likely to be aware of their high motivation to secure the best for their children, as they see it. They are less likely to be aware of the ways in which their particular strategies or cultural traditions are suited to their distinct mix of social and economic opportunities and constraints and might not be suitable in others. Inasmuch as European Americans and African Americans draw on different cultural traditions and historical experiences, and face different environments, resources and constraints, cultural variation in family ideals and the ensuing patterning of family-related behaviour is expected—even inevitable.
The cultural imperatives toward economic and reproductive success suggest that, for any group, culturally regulated fertility and family behaviour will be exquisitely attuned to ensuring economic and reproductive success, and not adversarial to it. Furthermore, this suggests that groups subjected to chronic threats to their very survival, such as African American residents of high-poverty urban areas, might mobilize a great deal of their cultural resources to protect and support the reproductive and economic success of group members. In this light, it is curious that the dominant culture currently argues the opposite when discussing high rates of teen childbearing in high-poverty, urban African American communities.
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Fertility-timing norms |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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The guidelines a cultural system sets for childbearing and family behaviour are deeply salient to individual group members. Cultural ideals are well recognized within the group. Parents/adults work actively to enable children to recognize and follow local ideals. Cultural ideals are central to the development of personal identity and, thus, to personal susceptibility to specific social control messages, and personal receptivity to specific forms of social support. Conversely, cultural ideals are central to the intensity and rigidity with which parents/adults express specific social control messages and to their willingness to provide social support, and to whom. For example, a new mother’s parents (or the state) may gladly provide resources to her and her child if she is married, but withhold the same resources if she is not. Social support becomes a vehicle for social control that is offered or withheld to realize beliefs about appropriate ages and circumstances for childbearing in a self-fulfilling way. In this way, individual fertility-related behaviour, while not culturally determined, is culturally mediated and responsive to social control and social support.
Recognition of a group’s norms, sensitivity to its social control messages, and the need for social support from the group limit the range of behaviour among individual group members. In practice, individuals will not always fulfil their cultural ideals, but group recognition of these ideals generates social expectations, sanctions and norms that regulate individual behaviour. These cultural influences affect the range of feelings among individuals who deviate from cultural scripts, e.g. how conflicted, guilty, or ashamed they feel about specific deviations, and the lengths to which they feel compelled to go to avoid or conceal them. Cultural frameworks also shape the social, material, or psychological means available to resolve contradictions between cultural norms and behaviours. For example, ‘shot-gun weddings’, adoption, and abortion are available or acceptable in some cultural groups, but not in others. They are all means by which those individuals who violate the prevalent cultural ideals of marital sex and childbearing through bearing an extramarital pregnancy may attempt to reduce their public humiliation, internal conflict, or the pain their actions may cause significant others.
Fertility-timing norms are critical mechanisms through which the basic cultural imperatives toward economic and reproductive success are pursued; at their best, fertility-timing norms are well calibrated to support and draw support from local family economies and caretaking systems. For example, the nuclear family ideal aspired to by European Americans calls for biological parents to be self-sufficient in the care of their children—that is, not to expect support from others whom they cannot afford to pay. Early childbearing in this population constrains the use of their extensive educational and career opportunities. Given these opportunities and ideals, youth in this group have every reason to believe they will be better providers for their children if they delay parenthood. These circumstances motivate European American elders as good parents to employ their substantial and far-reaching resources to disseminate the social control message that teenage childbearing has disastrous consequences (including expending energy to discredit or, in effect, censor alternative perspectives)1,4,18. Their culturally-mediated perceptions also limit their ability to develop a more nuanced understanding of early childbearing.
In contrast, in communities such as high-poverty, urban areas, where income is low and precarious, and healthy life expectancy is uncertain21, the vitality of the community may be enhanced by early childbearing norms coupled with a normative family structure that is multigenerational and extends the responsibility for children’s well-being beyond the biological parents2–4,22–24. In the context of collective health uncertainty, African American parents in poverty may experience legitimate worries of leaving their children orphaned or of becoming compromised in their capacity to provide for them25. Parents who value providing consistent emotional and material support for their children may develop, invest in, and rely on extended family or networks of kin to ensure their children have caring adults who are willing and able to supplement or even substitute for parental support. Children may fare best if their birth and preschool years coincide with their mother’s peak health and access to social and practical support provided by relatively healthy kin.
Generally, childbearing in the youngest teenage years is not approved and is a rare event, even in populations where later teenage childbearing is acceptable26; having an early childbearing group norm does not imply that all members become or are encouraged to become young mothers. Individual youths may have personal agendas that do not include early childbearing. Moreover, as low-income African American families configure themselves, youths who show promise as economic providers or have other talents that give them the opportunity to overcome structural barriers to social mobility may be discouraged from early childbearing, despite a broader norm22,23,27. Peers and elders who, themselves, have little chance of social mobility may rally round and invest in supporting these exceptional youth, becoming important parts of their eventual social or economic success.
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White elders, black teens: in loco parentis or la vida loca? |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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According to this cultural model, it is highly adaptive for European American parents to use their influence to discourage early childbearing and to emphasize to their children—early and often—its potentially disastrous consequences. But what motivates dominant group elders to condemn or try to change the fertility-timing norms of African American residents of high-poverty urban areas? Clearly, the notion that the ages seen as appropriate for childbearing can vary across generations and cultural groups is not beyond our grasp. Many of our grandmothers became mothers as teenagers. Why is the broader public so disapproving of current African American teen mothers?
As noted, the most common justifications related to children’s well-being or social costs are open to question. Instead, according to our conceptual model, promoting the view that teenage childbearing is an antisocial act can be viewed as adults in the dominant culture putting their cultural priorities into action. Key is the fact that, as representatives of the dominant group, they have use of the public stage—through control of the media, advocacy organizations, political campaigns, the legislative process, public school curricula, scientific research funding, and publishing—to broadcast the social control message intended for their children that cultural competence requires the postponement of childbearing. This message gains maximum force when it is seen as absolute.
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Social inequality, social control and social identity: the costs to African Americans |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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A key reason, then, that dominant group elders are unable to view early fertility-timing norms in high poverty African American communities with equanimity may be the following. Cultural variation in family ideals is a relatively straightforward and tolerable concept when the varying cultures are politically, economically and socially distinct from one another. Accepting cultural relativity in deeply cherished, fundamental family ideals becomes more difficult, complicated and threatening, however, in a society that is multicultural and stratified. In such a society, although the dominant culture may be identified as the ‘mainstream’ and others as minority groups, the cultures are not distinct. To the extent that they coexist in the same political and economic space, they will share some ideals, have some common access to the broad popular culture, and have some mutual effects on one another, including that their contours and adaptive practices will, in part, reflect their exposure and relationship to one another. If one group depends on the subordination of another to fulfil its cultural imperatives or to maintain its identity, these effects may be profound. This is the historical relationship between European Americans and African Americans.
The effects of this historical relationship can be seen in the public racial coding of behaviours that are deemed irresponsible or even threatening by European Americans, such as teenage childbearing. This includes paying disproportionate attention to early fertility timing of African Americans, not only compared to white Americans (who are the bulk of teenage mothers), but also compared to other ethnic groups. For example, European Americans express less public concern, and expend fewer resources to understand the root causes of or stigmatise teenage childbearing among Latinas than among African Americans, although the black teenage birth rate is only marginally higher than the Latina teenage birth rate, and both are substantially higher than the rate for whites28.
To the extent that cultural participants benefit in tangible or other meaningful ways from conventional wisdom, they have little incentive to question it. At the point where the costs of maintaining a cultural system outweigh the benefits, individuals or groups may resist it or press for change. However, those who are burdened by a cultural system, but who remain sensitive to its social control messages or are unable to change the system, enjoy relatively few of the benefits of participation while absorbing a disproportionate share of the costs. In the case of fertility timing, this describes the circumstance for many African Americans. That is, the entrenched cultural interdependence of European and African Americans not only selects African Americans to be the primary targets of moral condemnation, but also sets up African Americans to pay a particularly high psychosocial price in response to racial inequality: they face heightened vulnerability to stigma29, lifestyle or status incongruity30, and the adverse effects of these on mental and physical health. They suffer in comparison to other ethnic or economically disadvantaged groups whose identities are not yet "American" (e.g. new immigrants) or have not been forged in the same crucible of long-term subordination to whites as has the African American identity31. As multigenerational Americans, African Americans are responsive to the family ideals of European Americans. The fact that they cannot always follow them poses a painful, poignant, and potentially humiliating personal contradiction. As Erving Goffman29 outlines:
The stigmatized individual tends to hold the same belief about identity as we do ... Further, the standards he has incorporated from the wider society equip him to be intimately alive to what others see as his failing, inevitably causing him, if only for moments, to agree that he does fall short of what he really ought to be (p. 7).
Or, as WEB DuBois32 wrote more generally:
It is a peculiar sensation, this double-consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels his two-ness,—an American, a Negro ... (p. 17).
Meanwhile, the ever-present viewpoint that African American fertility and family behaviour contradict dominant cultural norms for family structure and childbearing can wear away the ability of African Americans to protest this caricature of themselves as morally marred. Instead, the interpretation that African Americans experience self-inflicted wounds perpetuates entitlement and privilege for European Americans. It provides a compelling object lessen for dominant group youth, namely that deviations in personal behaviour from cultural ideals may be calamitous—perhaps leading to loss of social support, ostracism, or even class suicide. Socially liberal or progressive, as well as socially conservative, dominant group parents may share a common desire for their children to learn this lesson, even if they endorse different ways to act on it.
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Conclusion |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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The well-being of children and families and, by extension, the vitality of communities and their economic and reproductive success, are likely to be enhanced when the adults charged with the primary care of children have reliable social resources outside of themselves. The illusion that US parents in socio-economically advantaged nuclear families raise their children independently is an artefact of the availability of, and their access to, a range of social resources that supplant the need to depend on relatives, neighbours, or friends for the day-to-day care and socialization of their children. In addition to these child-rearing resources, socio-economically advantaged parents take for granted the ways their social and economic resources help ensure their health and vigour and that of their children33.
More hidden is the help these parents derive from the dominant culture in reinforcing the social control messages and values they want their children to internalize. Even the age-grading of academic and work institutions fits the cadence of dominant life-course demands and norms of care and responsibility across and within generations; it thus reinforces dominant cultural perspectives on the proper timing and sequencing of life course events, including fertility timing.
African American residents of high-poverty urban areas experience only partial success in their efforts to amass resources comparable to those European Americans often take for granted. They face structural barriers to the achievement of some of these goals. For example, residential segregation imposes limits on their neighbourhood or housing options34, often confining low-income African American parents to raising children amid poverty, crime and urban decay35,36. Thus, helping African American children in high-poverty areas to achieve cultural competence or accrue cultural capital (by either local or dominant standards) is complicated by structural barriers, material hardship and their negative impacts on health and well-being37–40.
In addition, the work of kin networks is made more difficult and costly by dominant ideological forces that directly conflict with the ideologies, values and life-course timetables needed to sustain it. More broadly, the success of the dominant culture in ghettoizing African Americans has disrupted and undermined urban African American kin networks, leaving them with fewer resources to spread across greater needs36,38. Networks now have a hard time absorbing "down and out" members. Some may even, as Stack and Burton23 note, "reluctantly ‘let go’ of family members who cannot pull their weight." This amounts to a structurally induced breakdown of supportive family and community systems. This breakdown has profound effects on the health of high-poverty urban populations, but it emanates from the dominant culture.
In sum, a danger of social inequality is that dominant groups will be motivated to promote their own cultural goals, at least in part, by holding aspects of the behaviour of specific marginal groups in public contempt. This is especially true when this behaviour is viewed as antithetical or threatening to social control messages aimed at the youth in the dominant group. An acknowledgment that teenage childbearing might have benefits for some groups undermines social control messages intended to convince dominant group youth to postpone childbearing by extolling the absolute hazards of early fertility. Moreover, to acknowledge cultural variability in the costs and consequences of early childbearing requires public admission of structural inequality and the benefits members of dominant groups derive from socially excluding others. One cannot explain why the benefits of early childbearing may outweigh the costs for many African Americans without noting that African American youth do not enjoy the same access to advanced education or career security enjoyed by most Americans; that their parents are compelled to be more focused on imperatives of survival and subsistence than on encouraging any but their most talented children to engage in extended and expensive preparation for the competitive labour market; indeed, that African Americans cannot even take their health or longevity for granted through middle age21. And one cannot explain why these social and health inequalities exist without recognizing that structural barriers to full participation in American society impede the success of marginalized groups30,38,39. To acknowledge these circumstances would be to contradict the broader societal ethic that denies the existence of social inequality and is conflicted about cultural diversity. And it would undermine the ability the dominant group currently enjoys to interpret their privilege as earned, the just reward for their exercise of personal responsibility.
Public health professionals concerned with eliminating social inequalities in health cannot sidestep these issues. The failure to recognize that early-fertility distributions are adaptive in some populations, while, even worse, holding such practice in contempt or working actively to prevent it, is likely to maintain or exacerbate social inequalities in health. Among other reasons, this stance affects perturbations in the protective systems worked out by kin networks; it aggravates stress, stigma, hardship and the poor health experienced by African Americans; and it directs our resources and attention away from more compelling sources of health inequalities. By using our considerable resources to put our cultural priorities into action, we (however unwittingly) add to the hardships faced by many African Americans and, in the process, help to maintain their marginal status. This can occur even when the conscious and heartfelt goal of dominant culture members is to expand opportunities available to disadvantaged groups.
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Acknowledgements |
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TopAbstractIntroductionCulture, social control and...Fertility-timing normsWhite elders, black teens:...Social inequality, social...ConclusionAcknowledgementsReferences |
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I am indebted to Sherman James, Jay Pearson and John Bound for helpful comments. I also gratefully acknowledge financial support for this work from the Robert Wood Johnson Foundation through an Investigator in Health Policy Research Award. The views expressed are my own.
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