Preventing Repeat Pregnancies by System-Involved Moms

Last week, I wrote about the need to address teen pregnancy among youth in foster care. This week, I focus on repeat pregnancies among mothers who are already involved with the child welfare system. This includes mothers with children in foster care and those who are being supervised by the child welfare agency due to abuse or neglect.

Among the saddest news for me as a social worker in the District of Columbia’s foster care system was to hear that a mother whose child was in my caseload was pregnant again. There was the teenage mother, herself in foster care, who was not visiting her son consistently or complying with court orders. Still a teenager, she got pregnant again, perhaps in the hope of keeping this child.

There was the mother struggling against her addiction to crack cocaine. Her first three children were living with her own mother, but she could take no more. One or two were with the father. The sixth was with a foster parent who was trying to adopt him. And now she was pregnant with the seventh.

Some of these women continue to give birth and to have the children removed, over and over. I have witnessed mothers who were drug addicts, selling sex for drugs, and others who were trying to cement a relationship with a new man or replace the children who were taken away.

But we have no idea of what proportion of the caseload they account for because this data is not collected. The federal government does not even require the states to collect data on how many children each mother in the system has had. We have no idea how many mothers with a child in foster care get pregnant again or how many of these children end up in foster care as well.

This is a very sensitive subject. It would not be acceptable to most people if judges ordered mothers to use contraception and told them that another birth would reduce their chances of getting their children back. But there are meaningful steps that could be taken without depriving women of their rights to self-determination.

Mothers could be encouraged to use Long Acting Reversible Contraceptives (LARCs). As I wrote last week, many primary care clinics do not provide access to LARCs, and they should be made available at clinics that take Medicaid patients and uninsured patients and training provided to staff in how to insert them.

While a court couldn’t order mothers to use LARCs, it could offer a financial incentive to mothers who agree to have a LARC inserted. It could be a sizeable incentive, considering the cost that the birth of a child to most of these mothers saves in welfare, Medicaid, or foster care payments.

Perhaps many readers would object to this attempt to influence a woman’s reproductive decisions. But I’m guessing that those who are directly involved in caring for these children would agree with me.

One of my clients, a three-year old girl, was born to a drug-addicted mother who abandoned her at the District of Columbia’s family homeless shelter. The maternal grandmother was raising the first two children but was exhausted and ill, so her sister stepped up to the plate. She and her husband created a wonderful home for the little girl, but they were still hoping that mom would come back one day clean and sober so they could have the retirement they had dreamed of.

Then came the dreaded news that mom was pregnant again. A cousin in Texas agreed to take the next newborn. But she was also on her way to D.C., to track down mom in the streets and persuade her to get her tubes tied. There was nobody else to take another child, and this was not a family that allows its children to be taken in by strangers.

I don’t know if the cousin succeeded in her mission. But I hope she did.

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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.