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Chapter 10. The Effects of Welfare and Child Support Policies on Maternal Health and Well-Being
- Russell Sage Foundation
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Chapter 10 The Effects of Welfare and Child Support Policies on Maternal Health and Well-Being Jean Knab, Irv Garfinkel, and Sara McLanahan I n 1996 the U.S. Congress passed the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), substantially reducing a family’s rights to income support. PRWORA removed the entitlement to government-provided cash assistance and increased states’ incentives to reduce welfare caseloads. At the same time it increased private responsibilities by encouraging greater work effort from mothers and more child support payments from nonresident fathers. The PRWORA provisions raised concerns within the medical community and among other advocates interested in the health and well-being of at-risk families. The changes to cash welfare and child support policies had potential direct and indirect consequences for women’s health. Most directly, by removing the entitlement to welfare, many feared that poor women would lose their health insurance coverage. While PRWORA included a provision to hold Medicaid eligibility constant , the administrative barriers to implementation for program staff and the confusing new rules suggested that many eligible women might lose coverage. Less direct effects of welfare reform on maternal health were also of concern. Advocates feared that increased work requirements and stronger child support enforcement might increase maternal stress, leading to increases in mental health problems. They also expressed concern that stronger child support enforcement might expose mothers to more violence from fathers while stricter welfare requirements might make it harder for mothers to escape violent partners (Kaplan 1997). Finally, advocates feared that substance abusers and women with mental health problems would be disproportionately harmed by the new policies (American Psychological Association 2001; Metsch and Pollack 2005). Research to date has generally focused on the impact of welfare reform on the health insurance coverage and health care utilization of low-income women. Some / 281 studies have found that more restrictive welfare policies are associated with small reductions in health insurance and, in some studies, indications of less health care utilization (Bitler, Gelbach, and Hoynes 2005; Holl, Slack, and Stevens 2005; Kaestner and Kaushal 2003). There is little evidence, however, that stricter welfare policies have had a negative impact on mothers’ health. Indeed, one study found that reductions in welfare caseloads were associated with improvements in one health behavior: reductions in binge drinking (Kaestner and Tarlov 2006). This chapter replicates and extends previous work on the impact of welfare policies on maternal health in several ways. First, we examine a broader range of outcomes than has been covered in previous studies. Second, we use data from the Fragile Families and Child Wellbeing Study (hereafter referred to as “Fragile Families ”), which is a recent longitudinal study of unmarried parents and their children . To date, most of the research on the effects of welfare reform on maternal health has either used data from the Behavioral Risk Factor Surveillance System (BRFSS), which is a national data set, or data from one or a handful of states. Thus, trying to replicate some of the previous analyses using a different national data set is a useful exercise. A third extension is that no previous study has looked at the effects of child support enforcement on health outcomes. Since stronger child support enforcement was part of welfare reform, and since these two sets of policies may have complementary or offsetting effects on maternal health, it makes sense to examine them together. Finally, whereas prior studies looked at the effects of welfare reform on maternal health, we examine the effects of specific postPRWORA policies to determine if policies that encourage high levels of welfare participation are associated with poorer maternal health and health behavior. The Fragile Families study has a number of strengths that make these data attractive for studying the effects of welfare and child support policies on maternal health. The study, which oversamples nonmarital births and asks mothers a large array of questions about their health and health behaviors, provides extensive information on the population of women who are most likely to be affected by welfare and child support policies. Moreover, because the study is longitudinal, we are able to examine the association between changes in welfare use and child support receipt and changes in mothers’ health. Finally, the cities in the Fragile Families sample were drawn via a stratified random sample that was designed to capture the extremes of welfare and child support policies and labor-market conditions.1 Thus, differences in state policies that affect the likelihood that a mother is on welfare...