State welfare family-cap policies and poor women's reproductive health and rights

Background: In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (or “welfare reform”) was passed. Among other things, this legislation sought to discourage poor women from having children by stipulating requirements related to reproductive health behaviors as conditions for cash assistance. Approximately half of all states have implemented some form of family-cap policy, which prohibits an increase of cash assistance to poor families when an additional child is born. We asked the following three research questions: How have states varied in implementation of the policy? What do state welfare officials think about the effectiveness, benefits, and disadvantages of the family cap, and how do their attitudes towards the policy affect poor and low-income women's access to family planning services? Methods: Through a comprehensive analysis of publicly available data, as well as key informant interviews with state welfare agency officials, we collected and analyzed both quantitative and qualitative data on the development, implementation, status, and evaluation of the family-cap policy in all 24 states. Results: Very few states have conducted formal evaluations of the policy; thus, most lack empirical evidence of the policy's effectiveness. Nonetheless, state welfare representatives often held definitive opinions about the effectiveness, benefits, and disadvantages of the policy. Most stated that the policy's administrative and economic drawbacks may outweigh potential benefits. Discussion: Our research points to the lack of rigorous evaluation of state policies intended to influence poor women's fertility. In addition, the notion of reproductive rights was absent from welfare officials' deliberations about the policy.