"The Baltimore study was initiated in 1966 as an evaluation of a comprehensive care program for adolescent mothers located at Sinai Hospital, a large community-based institution located in the northwestern part of the city. In the early 1960's, Sinai, like many other urban medical centers throughout the country, experienced a noticeable shift in the composition of its obstetrical population. A growing proportion of women delivering babies were young, unmarried blacks. This trend resulted in large part from the rapid decline in fertility among older women, especially within the Jewish population that had been the hospital's main clientele. At the same time, because of a rapid migration of blacks from the central city to northwestern Baltimore, the hospital was suddenly delivering the babies of between two and three hundred pregnant adolescents each year, the majority of whom were poor and black.

Alarmed by this trend, several public-minded physicians at Sinai designed a special program for pregnant adolescents to offer comprehensive medical and social services aimed at improving the quality of prenatal and neonatal care provided to the mothers and their offspring. This program, along with several others sponsored by the Children's Bureau at the same time, represented a bold experiment in social and health intervention to reduce the high levels of repeat pregnancy and infant mortality and morbidity sometimes associated with adolescent fertility (Howard, 1968, Klerman and Jekel, 1973).

In 1965, the Great Society was still in ascendancy, and a strong commitment existed to breaking the cycle of poverty by offering assistance to the socially and economically disadvantaged. Teenage childbearing was identified as a strategic link in the perpetuation of poverty. Some visionary program planners believed that reducing the medical complications associated with early childbearing, discouraging school dropout, providing vocational assistance, delaying additional pregnancies, and offering parent education would decrease economic dependency of the young mothers in later life and create more favorable opportunities for their offspring. (For a more detailed discussion of the political origins of the issue, see Furstenberg [1976] and Vinovskis [1981])." (1)

Thus, Sinai Hospital of Baltimore opened its Adolescent Family Clinic (AFC), a special program offering prenatal and postpartum care to adolescents who were pregnant for the first time, in 1965. "The AFC program included an intensive effort to encourage contraceptive use in the postpartum period. In the course of providing prenatal services - medical examinations, nutritional information, social counseling and training for parenthood - participants were instructed in birth control techniques. Weekly group meetings, conducted throughout the prenatal period, gave them an opportunity to discuss their attitudes and concerns about using contraception. Following delivery the young parents were offered a choice of contraceptive methods. Most elected to use the pill, reflecting the preferences of the AFC staff for this method.

All pregnant girls younger than 18 who entered the hospital were eligible to participate in the special program; however, the small staff could not accommodate everyone who wanted it. Therefore, about 40 percent of the 399 girls who entered were assigned, on a random basis, to the hospital’s regular prenatal program.

No special effort was made to urge the girls in the regular prenatal program to use contraception before or after their babies were born. However, birth control services were available to them and most in fact, requested and received contraceptive assistance. Among the prenatal group 80 percent started using a method as compared to 92 percent of the AFC mothers. Thus, the difference between the two groups was principally in the degree of encouragement and education provided in the two programs."(2)

Follow-up

"As a precondition for funding ameliorative services, the Children's Bureau required that comprehensive programs be systematically evaluated. In the case of the Sinai Hospital program, the evaluation eventually led to a 5-year follow-up of a cohort of 403 adolescent mothers and their firstborn children. The study contrasted their transition to adulthood to the experiences of their classmates who delayed childbearing. The follow-up also measured the impact of early childbearing on the life chances of the teenage childbearers and their offspring. Individual differences in the adaptation to early parenthood were explained as a function of the Sinai Hospital prenatal program, characteristics of the young parents, assistance provided by their families and friends, and services offered by welfare agencies in Baltimore (Furstenberg, 1976, 1981; Furstenberg and Crawford, 1978)." (1) The Baltimore women and children have since been re-interviewed in 1983-84, 1987, and most recently in 1995.

The five year follow-up in 1972 ended the first phase of the Baltimore Study. It wasn’t until 1982 that the idea of re-interviewing the families was considered again. The 17 year follow-up was conducted in 1983 and 1984. In addition to retaining some questions from the earlier surveys for comparative purposes, the new survey included questions from the National Survey of Children, a nationally representative study aimed at understanding the development and well-being of adolescents and their parents’ parenting styles. The 17 year follow-up also introduced the use of life-history calendars to record the major events of each respondent’s life including childbearing, education, employment, welfare use and marriages. The life-history calendars completed during this survey period collected retrospective data back to the beginnings of the first survey in 1966. Life-history calendars were used again in the two most recent follow-up surveys conducted in 1987 and 1995.

Extensive data were collected from medical records and through interviews from the young mothers (Generation-2), and their children (Generation-3) one three, and five years after birth and then again when the children were in their mid-teens and early adulthood. In addition, information has been collected from the parents of the teen mothers (Generation-1) during the first pregnancy and the grandchildren of the teen mothers (Generation-4) during the two most recent surveys. Throughout the study, the mothers and children were compared to contrast populations--initially to classmates of the teenage parents and later to youth from national surveys. (For more detailed information see the design).

A full range of demographic data, including extensive life-history calendars of the young mothers has been maintained beginning with the Time 5 interview (on average 17 years after delivery) when the parents (G-2) were in their early thirties and the children (G-3) in their mid-teens. The seventeen, twenty, and twenty nine-year follow up interviews also explored a wide range of attitudes, beliefs, knowledge, and behavior about the life situations of both the G-2's and G-3's including educational and work histories, marriages and partnerships, childbearing, relations with family and extended kin, mental and physical health, participation in religion, politics and community involvement. We also collected data from the parents and children about their life aims and perceived opportunities, commitment and progress in school and work, family, sibling and peer, and sexual relationships, substance abuse and other anti-social behaviors. In addition, supplementary studies have added observational and qualitative information on a sub-group of the G-3's who had become parents.

Over the years the results of the Baltimore Study have been reported in numerous publications. (See the publications section for a complete listing). The initial phase of the study examined the consequences of early childbearing on the young mothers and their children. In recent years, the analysis of the data has focused more on the sources of diversity within the sample. The data from the project provide a tremendous repository of information about the attributes of communities, families, and individuals that lead to success in the face of adversity.