Child Maltreatment Prevention Should Start Before Conception

April is Child Abuse Prevention Month, and the recent report from the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) urges the nation to stop waiting for a child to be maltreated before intervening with services and supports.

But when talking about child abuse prevention, CECANF and most others miss one of the most crucial opportunities: before a child is even conceived.

Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy, gave a lecture last December that made this point forcefully. She reports being struck by “the total absence of pregnancy planning, spacing and prevention in virtually all discussions of how to improve overall child and family well being …” As she put it, many groups concentrate on services after the child is born, but rarely do they mention the time when decisions about whether and when it should take place.

There is no lack of research on the connection between pregnancy timing and child maltreatment. There is a strong association between child maltreatment and the mother’s age at the birth of the child. California researchers Emily Putnam-Hornstein and Barbara Needell found that babies born to mothers who were under 20 were twice as likely to be reported to child protective services (CPS) by the child’s fifth birthday as those born to mothers 30 or older.

Among children referred to CPS by age five, almost 18 percent were born to a teenage mother and 50 percent were born to a mother younger than 25. Among children with no CPS contact, only 8 percent were teen births and 30 percent were born to a mother under 25.

There is also strong evidence that family size and child spacing are correlated with child maltreatment. Putnam-Hornstein and Needell found that children who fell third or higher in the birth order were more than twice as likely to be the subject of a report as first children. Moreover, a large study published in 2013 found that women who gave birth to another child within 24 months of the previous child were 80 percent more likely to have a substantiated CPS report.

And setting the research aside for a moment: Anyone who has worked for or with CPS, or in foster care, knows the prevalence of larger families with closely-spaced children in the system.

So if it is not the lack of research, why do supporters of child maltreatment prevention usually fail to include family planning and contraception in their suggestions? In part, Sarah Brown says of child advocates in general, it may be that they simply don’t think of it. But in large part, says Brown, it is because they fear getting in trouble and becoming mired in controversy. In addition to the fear of bringing abortion into the discussion, this discussion makes many people uncomfortable because of fears of conjuring up past attempts to control the population of poor or minority groups.

But family planning and contraception need to be included in the child maltreatment discussion. We know so little about what works after birth to prevent child maltreatment, but we have made great progress in teen pregnancy prevention. Many factors, including economic recession, MTV shows, and fear of HIV may have contributed to the decline in teen pregnancy and parenthood.

But public and private initiatives to provide education and availability of effective contraception have probably played a part as well. Imagine if we could expand that work to focus on young adult women as well. Imagine a public health campaign explaining the benefits of planning, spacing and timing pregnancy to prospective mothers “so that your children can be healthier and have a better chance in life.”

CECANF Commissioner Judge Patricia Martin is to be commended for including teen pregnancy prevention, especially in high-poverty neighborhoods and among youth in foster care, as one of the recommendations in her dissenting report. She stresses the inclusion of young men in these efforts. It is too bad the main report did not include this recommendation.

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Marie K. Cohen
About Marie K. Cohen 68 Articles
Marie K. Cohen (MPA, MSW) is a child advocate, researcher, and policy analyst. She worked as social worker in the District of Columbia's child welfare system for five years. She is a member of the Citizen's Review Committee for the DC Child and Family Services Agency and the DC Child Fatality Review Commission and a mentor to a foster youth. Follow her blog at, on Facebook at Fostering Reform or on Twitter@fosteringreform.