Sunday Review
The Way to Beat Poverty
AS
our children were growing up, one of their playmates was a girl named
Jessica. Our kids would disappear with Jessica to make forts, build a
treehouse and share dreams. We were always concerned because — there’s
no polite way to say this — Jessica was a mess.
Her
mother, a teen mom, was away in prison for drug-related offenses, and
Jessica had never known her father. While Jessica was very smart, she
used her intelligence to become a fluent, prodigious liar. Even as a
young girl, she seemed headed for jail or pregnancy, and in sixth grade
she was kicked out of school for bringing alcohol to class. One neighbor
forbade his daughter to play with her, and after she started setting
fires we wondered if we should do the same.
Jessica
reminded us that the greatest inequality in America is not in wealth
but the even greater gap of opportunity. We had been trying to help
people in Zimbabwe and Cambodia, and now we found ourselves helpless to
assist one of our daughter’s best friends.
One
reason the United States has not made more progress against poverty is
that our interventions come too late. If there’s one overarching lesson
from the past few decades of research about how to break the cycles of
poverty in the United States, it’s the power of parenting — and of
intervening early, ideally in the first year or two of life or even
before a child is born.
Within
four weeks of conception, a human embryo has formed a neural tube,
which then begins to produce brain cells. As the brain is forming, it is
shaped by the uterine environment in ways that will affect the child
for the rest of his or her life. A mother who drinks alcohol may leave
her child with fetal alcohol syndrome or, less serious, fetal alcohol
effects. A study by Ann Streissguth at the University of Washington
found that by age 14, 60 percent of children born with fetal alcohol
syndrome or effects have been suspended from school or expelled. Almost
half have displayed inappropriate sexual behavior such as public
masturbation.
Children
with fetal alcohol effects account for 1 percent of births; 20 percent
of births in America are to mothers who smoked during pregnancy. These
babies have smaller head circumferences on average, and because nicotine
increases the testosterone in the woman’s uterus, some theorize that
this may lead to a greater penchant for aggressiveness, particularly
among sons. Patricia A. Brennan of Emory University found that when a
mother smoked a pack a day during pregnancy, her offspring were more than twice as likely to be violent criminals as adults.
Likewise,
when a pregnant woman is exposed to lead from old paint or from air
pollution, her fetus absorbs it in ways that impair the development of
the brain. Some research suggests that the rise of crime in the mid-20th
century may have been caused in part by the increasing presence of lead
in the environment, and that one factor in the decline in crime from
the 1990s on was the phasing out of lead from gasoline (and thus from
air pollution) beginning two decades earlier.
The
lifelong impact of what happens early in life was reinforced by a
series of studies on laboratory rats by Michael Meaney of McGill
University in Canada. Professor Meaney noticed that some rat mothers
were always licking and grooming their pups (baby rats are called pups),
while others were much less attentive. He found that rats that had been
licked and cuddled as pups were far more self-confident, curious and
intelligent. They were also better at mazes, healthier and longer-lived.
Professor Meaney mixed up the rat pups,
taking biological offspring of the licking mothers and giving them at
birth to the moms who licked less. Then he took pups born to the
laissez-faire mothers and gave them to be raised by those committed to
licking and grooming. When the pups grew up, he ran them through the
same battery of tests. What mattered, it turned out, wasn’t biological
parentage but whether a rat pup was licked and groomed attentively.
The
licking and grooming seemed to affect the development of brain
structures that regulate stress. A rat’s early life in a lab is highly
stressful (especially when scientists are picking up the pups and
handling them), leading to the release of stress hormones such as
cortisol. In the rats with less attentive mothers, the cortisol shaped
their brains to prepare for a life of danger and stress. But the
attentive mothers used their maternal licking and grooming to soothe
their pups immediately, dispersing the cortisol and leaving their brains
unaffected.
A
series of studies have found similar patterns in humans. Scientists can
measure cortisol in an infant’s saliva, and babies turn out to be
easily stressed. Anything from loud noises to hunger to a soiled diaper
floods the child’s brain with cortisol. But when Mom or Dad hugs the
child, the stress and cortisol almost disappear. If a baby is in a
bassinet and gets a shot, its cortisol level soars; if the mom is
holding the baby, the cortisol level rises, but much more modestly.
Dr. Jack P. Shonkoff, founder of the Center on the Developing Child
at Harvard University, has been a pioneer in this research. He argues
that the constant bath of cortisol in a high-stress infancy prepares the
child for a high-risk environment. The cortisol affects brain
structures so that those individuals are on a fight-or-flight hair
trigger throughout life, an adaptation that might have been useful in
prehistory. But in today’s world, the result is schoolchildren who are
so alert to danger that they cannot concentrate. They are also so
suspicious of others that they are prone to pre-emptive aggression.
Dr. Shonkoff calls this “toxic stress”
and describes it as one way that poverty regenerates. Moms in poverty
often live in stressful homes while juggling a thousand challenges, and
they are disproportionately likely to be teenagers, without a partner to
help out. A baby in such an environment is more likely to grow up with a
brain bathed in cortisol.
Fortunately, a scholar named David Olds has shown that there are ways to snap this poverty cycle.
Mr.
Olds began his career working with 4-year-olds, but then decided that
many children were already traumatized and damaged at that age, so he
needed to start earlier. He founded an initiative that became Nurse-Family Partnership,
dispatching nurses to visit low-income, disadvantaged families and
offer counseling on child-rearing. The nurses begin visiting during
pregnancy, urging moms not to drink or use drugs while carrying a baby.
One
nurse, Stacy, worked with a pregnant 17-year-old named Bonnie, who
lived in a dirt-floor basement apartment. Bonnie smoked, drank, got into
fistfights and regularly collided with the law. When Stacy suggested
that Bonnie stop smoking, Bonnie threatened to slap her. “This baby’s
taken everything else away from me,” Bonnie raged. “It’s not going to
take away my cigarettes.”
It
turned out that Bonnie had been abused as a child and had, as a
babysitter, abused others as well. During one of Stacy’s visits, she
broke down and confessed her fear of abusing her own child — “especially
if it’s a crier.” Stacy suggested some coping mechanisms and wrote down
the name of an older woman living nearby whom Bonnie could call for
help. Stacy taped the paper to the wall, ready for a crisis. Bonnie did
call the older woman, who helped out, and against all odds Bonnie ended
up taking quite good care of her baby — which may be why that child
ended up graduating from high school many years later. These nurse
visits continue until the child turns 2, with the nurse encouraging the
mom to speak to the child constantly, to read to the child, to show
affection. Later there are discussions of birth control.
The
visits have been studied extensively through randomized controlled
trials — the gold standard of evidence — and are stunningly effective.
Children randomly assigned to nurse visits suffer 79 percent fewer cases
of state-verified abuse or neglect than similar children randomly
assigned to other programs. Even though the program ends at age 2, the
children at age 15 have fewer than half as many arrests on average. At
the 15-year follow-up, the mothers themselves have one-third fewer
subsequent births and have spent 30 fewer months on welfare than the
controls. A RAND Corporation study found that each dollar invested in nurse visits to low-income unmarried mothers produced $5.70 in benefits.
So
here we have an anti-poverty program that is cheap, is backed by
rigorous evidence and pays for itself several times over in reduced
costs later on. Yet it has funds to serve only 2 percent to 3 percent of
needy families. That’s infuriating.
There
are a couple of lessons we can learn from David Olds and from other
programs with a solid record of proven effectiveness. First, it is
critical to intervene early, in the crucial window when the brain is
developing and the foundations for adult life are being laid. That means
helping women avert pregnancies they don’t want and, if they become
pregnant, helping them deflect dangers such as drug use, alcohol and
tobacco.
James Heckman, a Nobel Prize-winning
economist at the University of Chicago, says that our society would be
better off taking sums we invest in high school and university and
redeploying them to help struggling kids in the first five years of
life. We certainly would prefer not to cut education budgets of any
kind, but if pressed, we would have to agree that $1 billion spent on
home visitation for at-risk young mothers would achieve much more in
breaking the poverty cycle than the same sum spent on indirect subsidies
collected by for-profit universities.
Second,
children’s programs are most successful when they leverage the most
important — and difficult — job in the world: parenting. Give parents
the tools to nurture their child in infancy and the result will be a
more self-confident and resilient person for decades to come. It’s far
less expensive to coach parents to support children than to maintain
prisons years later.
What
does that mean for all of us? We wish more donors would endow not just
professorships but also the jobs of nurses who visit at-risk parents; we
wish tycoons would seek naming opportunities not only at concert halls
and museum wings but also in nursery schools. We need advocates to push
federal, state and local governments to invest in the first couple of
years of life, to support parents during pregnancy and a child’s
earliest years.
As
for our children’s friend, Jessica, she’s now 20. She was taken in by a
wonderful foster family in high school and began to thrive. She became
the first person in her family to go to college, but then the money ran
out after freshman year, so she’s working and planning to go back to
school later. We think she’ll pull it off — but her troubled journey
underscores that it’s always better to help young children at the front
end, rather than try to undo the damage later.
If you want to help, here are a few organizations whose work on early childhood has impressed us.
NURSE-FAMILY PARTNERSHIP is a proven home-visitation program that gives at-risk kids a shot at reaching the starting line. nursefamilypartnership.org
REACH OUT AND READ
supports pediatricians who hand out books to low-income children during
doctor visits, with instructions about bedtime reading. Careful studies
show that the parents read to the children more often and the children
end up with larger vocabularies — all for just $20 per child per year. reachoutandread.org
SPRINGBOARD COLLABORATIVE
provides intensive summer school for disadvantaged children, so that a
three-month loss in reading level turns into a 3.3-month gain. A donor
can sponsor a child for a summer for $350.
SAVE THE CHILDREN provides home visitation, screening and literacy programs for young children. A sponsorship is $28 a month. savethechildren.org
Nicholas Kristof, a columnist for The New York Times, and Sheryl WuDunn are the authors of “A Path Appears,” from which this essay is adapted.
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