US Fertility Prevention as Poverty Policy: A Public Health Analysis

Background: The welfare reform legislation passed 15 years ago sought to discourage poor women from having children. Approximately half of the states implemented a “family-cap” policy prohibiting an increase in cash assistance to families with a newborn. We explore the impact of the family cap on poor women's childbearing by addressing whether it has been effective and ethical. Methods: For the first question, we reviewed national- and state-level quantitative and qualitative research conducted to determine if the family cap has had an impact. Through a comprehensive analysis of publicly available data, as well as key informant interviews with state welfare agency officials, we collected and analyzed data on the development, implementation, status, and evaluation of the family-cap policy in all 24 states. For the second question, we reviewed international human and reproductive rights documents. Results: Few states have conducted formal evaluations of the policy; thus, most lack empirical evidence of its effectiveness. The majority of analyses conducted by researchers have not shown an effect on poor women's childbearing. Nonetheless, state welfare representatives often held definitive opinions about the effectiveness, benefits, and disadvantages of the policy. Most stated that administrative and economic requirements may outweigh potential benefits. Our analysis of key human and reproductive rights documents demonstrates that the family cap is in conflict with many of the covenants' articles. Discussion: Our research points to the lack of rigorous evaluation of state policies intended to influence poor women's fertility. The notion of human and reproductive rights was absent from welfare officials' deliberations about the policy. We situate these findings in an historical context of US governmental attempts to regulate childbearing among poor women and women of color.