We Know How Poverty Hurts Children. It’s Time to Intervene.

This piece is authored by Tonya Pavlenko, a Research Analyst at Center on Poverty and Social Policy (CPSP) at Columbia University.

In the last year I’ve sat across from several hundred expectant mothers who are living in poverty. I meet them in overcrowded apartments, drafty shelter rooms, or the public library if things are too unstable at home. Over the course of an hour I ask them a series of very personal questions about their health, their financial and employment history, their relationships, and hopes for their baby’s future. I’m there to gather data for an evaluation of a poverty intervention program called Room to Grow, a program that aims to give expectant mothers the supports they need to help them and their newborns thrive. The program couples parenting supports from clinical social workers with valuable material goods that make parenting easier – think diapers, clothes, books, strollers, and the like. This is the beginning of a randomized controlled trial where we will study the impacts of the intervention, comparing mothers and babies who receive services from Room to Grow and those who do not—with the goal of being able to measure the capacity of this intervention to alleviate the symptoms of poverty for some of New York City’s most vulnerable mothers.

When I first began studying poverty I started with a common assumption—that it’s a relatively stagnant condition. The poor remain poor and the cycle of poverty endlessly churns across new generations. While this situation is true for many, the assumption of a fixed poor population is too reductive. The latest research demonstrates the transience and reach of poverty: 46% of New Yorkers have experienced poverty for at least one year. In 2013, 9% of New Yorkers remained poor across two consecutive years, while equal numbers entered or exited a spell of poverty in just one of those years. The implication is clear: poverty is movable, and interventions can help people escape.

Though we typically think of things like job loss or a pay cut as precursors to poverty, a surprisingly common trigger is the birth of a new baby. Consider Cara Williams. At 23, she is engaged and pregnant with her first child. On my way to meet Cara I take two subway lines and a bus, then walk 20 minutes through the blustering cold—the apartment she shares with her brother and cousin is on the outskirts of Brooklyn. While I walk I realize that this is part of her commute every day; to make rent in a city with some of the most expensive housing, she has been pushed to the outskirts. Loose trash blows at my feet; I notice a frayed wire hanging down the side of her apartment building, the cord precariously caught in some rusted window guards. There’s a buzzer system, but it doesn’t work—the steel door requires a mere shove and I’m inside a lobby that reeks of urine and mildew. A few people shuffle past, they look weary; they know I don’t live here, but give a friendly nod and hold the elevator door.

Cara greets me—her belly swollen, eyes tired—and guides me to the bedroom she shares with her cousin. It’s cramped. Everything is always cramped; often poverty is clutter in the midst of scarcity. There are two twin mattresses, separated by a night stand that has a careful arrangement of peanut butter jars, ramen noodle cups, and prenatal vitamins. Tacked above her bed is a print out of a sonogram next to a photo of her fiancé.

After graduating from high school, she had been working at a department store and taking some classes towards an Associate’s degree. Things were going well, her supervisor liked her and hinted about an upcoming promotion to a management position. When her first bouts of extreme morning sickness hit, however, Cara was forced to take time off from work. Unable to keep any food down, she was either at home suffering from weakness and dehydration, or at work running to the bathroom. It did not take long for her secret to come out. Instead of congratulations, however, the news of her pregnancy quickly replaced the potential for a promotion with a pat on the back and the understanding that she would be gone soon, with no maternity benefits and no guarantee of employment after the birth of her baby.

Cara had planned to work up until the ninth month of her pregnancy so that she could save as much as she could for herself and her child.  Her doctor insisted, however, that she go on bedrest or risk a premature delivery. Like almost any expectant mother, Cara did what was best for her baby and followed the doctor’s orders. With each hour of bedrest, she noted the $11.50 less she’d have for diapers, books, and baby food.

With her food stamp benefit as her only income since leaving work, she now officially lives in poverty.  And what is particularly harrowing about the poverty that follows birth is that there is no shortage of scientific data on the profound impact of poverty on child health and development. Studies have linked poverty during birth and infancy to impeded cognitive development in childhood as well as lower educational attainment and lower earnings later in life. The physical manifestations of poverty are also rampant—poverty is associated with a myriad of health conditions, including: low birth weight, premature birth, higher rates of morbidity and mortality, and chronic illness.

I’ve come to see that what’s needed is not more research into the problem, but research into solutions; rigorous measurements and analyses on what works to lift impoverished families out of poverty and what can prevent the most vulnerable from entering into poverty in the first place. What can funders and policymakers get behind; what trails can America start to blaze with social innovation?

Assistance programs for vulnerable families almost exclusively separate monetary support from social support. For example, many hospitals and nonprofits will offer parenting and prenatal classes for underserved mothers, but then send their clients home without the needed resources to put the lessons into practice. You can teach an expectant mother that reading aloud to her baby is crucial for cognitive development, but that lesson does not address the fact that the food stamps she receives—her only income while she’s been laid off from her part-time job for being pregnant—do not pay for a stack of baby books; they barely even pay for the food she needs to survive. On the flipside, once-a-year income-support policies like the Child Tax Credit (CTC) and the Earned Income Tax Credit (EITC) offer sporadic cash to families without any social support to back it up. While families should have autonomy over their cash expenditures, social and therapeutic support can help parents take advantage of reduced financial distress in order to better advocate for themselves’ and their children’s needs.

Though the impact of tax credits and parenting programs for disadvantaged moms are well known, there is a major gap in understanding the short and long-term impacts of interventions that fuse financial support with parenting supports. This is why I find a program like Room to Grow so compelling. Mothers in the Room to Grow program form a relationship with a clinician—a social worker who meets with them every three months and stays in contact over the course of three years. During in-person visits, mothers like Cara work with their clinician to set goals, work through obstacles, and learn about their child’s needs and developmental milestones. At each visit, mothers also receive concrete material goods that help meet their needs for the particular phase of their baby’s development—over the course of 3 years, she receives $10,000 worth of in-kind support.

As I wrap up the interview with Cara, I ask her a final few questions about hopes she has for her baby’s future. She smiles: “I want him to know he is loved. And in life…I want him to achieve the things I just didn’t have a chance to,” she says. While the stories I hear are different, the answers to the last few questions rarely stray from these sentiments. I thank Cara and give her a hug before I leave. The next time I’ll talk to her is when her baby is 10 months old for the first round of study follow-up. By that time her son will be learning his first words and pulling himself up to stand; absent innovative programs like Room to Grow, it’s likely his first steps will be in the narrow space between two twin mattresses.

Under the direction of Chris Wimer and in partnership with Room to Grow, the Center on Poverty and Social Policy is currently conducting a randomized controlled trial of the Room to Grow program, an innovative poverty intervention that supports mothers and babies in the first three years of life. 

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