176662 State welfare family-cap policies and poor women's reproductive health and rights

Monday, October 27, 2008: 11:30 AM

Diana Romero, PhD, MA , Urban Health Program, Hunter College, City University of New York, New York, NY
Madina Agenor, MPH , Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA
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.

Learning Objectives:
1) Discuss state variation in the development, implementation, status, and evaluation of the family-cap policy; 2) List policy implications for state welfare officials, case managers, and caseworkers; and 3) Identify how the family cap undermines the reproductive health and rights of poor and low-income women, and women of color.

Keywords: Welfare Reform, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the study's Principal Investigator and oversaw the research project's planning; data collection and analysis; and manuscript/presentation preparation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.