Inequities Compounded

Pressing Into an Open Future

In 1989, I (SmithBattle) drove into a working class neighborhood to conduct her first interview with Cary (who was White), and her boyfriend Tim and Tim’s father (who was native Hawaiian). After meeting family members, the couple and I walked to their bedroom in a converted garage with their infant son, Jake. Cary described a difficult childhood. After her parents divorced when she was 4, she lived with her emotionally abusive mother and step-father. When her mother was convicted of a crime, 14-year-old Cary moved with her sister to the home of her paternal grandparents, where her father also resided. Cary described being close to her father until he died several years later of drug-related problems. At age 17, and 5 months pregnant with Jake, she moved into Tim’s household and transferred to a high school with a nursery. She graduated on time while Tim completed a vocational program and began steady work. Cary and Tim married 2 years after Jake’s birth; they bought a home 2 years later and had three additional children. As their family expanded, Tim remained the primary breadwinner with Cary caring for friends’ preschoolers at home. When Tim became unemployed in 2008 for three months, Cary began to care for elders in their homes. At Time 6, their annual income was between US$100,000-US$150,000.

In early interviews, Cary and Tim reported that parenting transformed their lives. Tim in particular said that he would have ended up in trouble like all his friends without the responsibility of parenting. Cary feared that she might become like her mother, but she also described imitating Tim’s father who was gentle and patient with young children and showed considerable skill in parenting practices and routines. Over three months of data collection at T1, I had many opportunities to see how Cary was absorbed into coherent family routines that were absent in her own childhood (SmithBattle, 2008). When Cary and Tim moved into their own home, Cary maintained Tim’s family’s routines; they ate dinner together; children helped with chores; and get-togethers with the extended family were regular events. Cary also drew on Tim’s legacy for cultivating “good persons.” When I asked her at T3 what she wanted for her children, she replied, “I don’t need lawyers, doctors, rocket scientists. That would be great but I don’t need that. I need happy, well-adjusted kids who have the value of family and good morals. If they were to go into the grocery store and they saw an old lady who needed help, I want them to help” (SmithBattle, 2008, p. 527). This ethos was reflected in expectations that children help and participate in family and school activities. Cary provided a strong example by volunteering at her children’s schools, where she and Tim were recognized as good parents: “We always say we’re lucky because our kids are good. And one teacher told us, ‘You only get lucky once. It’s not luck in your family. You’re a good family and you’re great parents.”

At T4, Cary described changing her parenting practices in response to 13-year-old Jake: “He’s a changed person. I could tell the way he’s changed; I have to change how I parent him. Because he’s really growing into his own person and I don’t want him to not wanna come to me later.” She elaborated, “Especially with him, I spend probably four hours a month talking with him when everyone else is asleep. I sit on his bed and we talk about different things. And I tease him about different things to get conversations going. So I spend a lot of time talking with him so that we can get close. Cause I had talked a lot with my dad” (SmithBattle, 2008, p. 528). In this passage and others, Cary describes refining her parenting practices as her children grow up by drawing on Tim’s legacy and her father’s example. Her mother’s example also shapes her practices: “Tim always had a tight knit family….But I think we talk more than Tim’s family. I just think it also has to do with me not having a relationship with my mother. I would die if my kids didn’t wanna have a relationship with me.”

I interviewed 13-year-old Jake for the first time at T4. He had a 3.8 grade point average and was active in extracurricular activities. This is how he described his mother: “I love my mom. She’s cool. I just don’t like it when we have to do chores and stuff. (laughs) But she’s cool. She helps me out in school if I have problems. She’ll help me clean my room. She’ll pretty much help me with anything” (SmithBattle, 2008, p. 529).

Cary was quite deliberate in addressing sexuality with her children from the time they were young in response to TV content or pets giving birth. When Jake entered adolescence, she stressed respectful relationships, telling him, “Remember, a girlfriend is always somebody’s sister . . . . You have sisters too, how would you want a little boy to treat your sister?” When she suspected that Jake at age 17 and Dee, his girlfriend of a year, were sexually active, she sat them down for a “long conversation” and said: “‘I was pregnant when I was 17 and I know realistically that things happen, and I’m going to tell you that there’s no excuse to have a baby. Now, I’m not saying I want you guys to do anything. I think that’s the smartest thing but…there are ways to avoid pregnancy and diseases.’ Dee said, ‘You’re so good because my mom would have made me break up with Jake if she thought I was having sex.’ I said, ‘Well . . . I’m going to be realistic that things could happen. But there’s also things that do not need to happen and a baby’s one of them. It’s not that if that happened we would be unsupportive, but you have too much to do before you have a baby . . .’” Several months later, Jake informed Cary that Dee was pregnant. Here is Cary’s response to the news: “Jake told me Dee was pregnant and he wanted to stay home, but I told him, ‘No, you’re going to basketball practice. If anything, you’ve got to be more serious now than ever.’ And I talked to Dee….She was crying, and then she said she’s sorry. I said, ‘Sorry for what? I know you love Jake and Jake loves you and everything’s gonna be ok. Of all the little girls out there, I’m glad that it’s you. We’re all gonna be ok.’ She cried and said, ‘Thank you so much for saying that.’” When Tim returned home that evening, his conversation with Jake echoed his father’s conversation with him 17 years earlier: “It wasn’t difficult [talking to Jake], only because of the way my dad handled it with me. I had that same exact talk. [I told Jake], the conversation we’re about to have, you owe this all to your grandfather . . . I could’ve run the streets and not ever been attached to anybody again, but because he supported me [when we were pregnant with you], that was the biggest thing.”

A week later, Jake asked Cary if she was ashamed of him, “Because all you do is cry now.” Cary’s response emphasized the life-changing significance of parenting and her faith in Jake’s capacities: “I said ‘No way. I’m sad because you’re gonna be a parent and I know how hard that is. I know what a good thing it is, but I know how hard it’s gonna change your life. You’re always gonna be my son, but you’re not gonna be my baby anymore and I’m sad to lose that relationship with you.’ And I said, ‘You have no choice but to be a good daddy because of the example you’ve had, and the way you handle the relationship with your daughter and with Dee is going to prove to yourself and to everyone what type of person you are. As far as I’m concerned, your dad and I have already done our job, because you’re a good human being . . . . So now whatever else comes along the way we just deal with it. Dad and I made it through it, I know that you guys will be okay too.”

Jake has lived up to Cary’s expectations. As I learned at T6, Jake and Dee graduated from high school on time. After Kaylee was born, Jake attended community college, and Dee enrolled in a technical school with grandmothers babysitting Kaylee. When Jake received a full scholarship to a distant college, the couple reluctantly agreed that he would attend while Dee and Kaylee remained behind. But after one semester of separation, the couple married so they could live in Jake’s dorm. Jake at 22 years of age will complete his bachelor’s degree in a year, and Dee, also 22, will continue her education when Kaylee begins school. As I learned from their interviews, they were anticipating a promising future.

Drifting Into a Tenuous Future

New City was home for the poorest families in this study, including 5 of the 6 black families and one white family. Compared to adjoining communities, New City was primarily black, economically depressed, and known for its high dropout, unemployment, and crime rates. Its reputation for gang violence was reflected in grim statistics, frequent media stories, and participants’ reports of drive-by shootings. As one grandmother put it, the future “stopped dead at adolescence” as teens were absorbed into gangs or drug activity. In the context of a foreshortened future, motherhood offered emotional connection, a familiar identity and a safer alternative than running the streets, although avoiding danger altogether depended on each teen’s situation, with all but one of the children’s fathers using or selling drugs. Teen mothers also faced greater educational barriers in New City than in surrounding communities since the high school’s nursery was restricted to babies under five months of age.

Vera was 38 years old when she and her daughter Maya, the teen mother, began the study. A string of childhood adversities began for Vera at age 11, when her parents divorced and she and her mother moved to New City to live with an aunt and abusive uncle. At T1, Vera described being beaten by her mother whenever she received grades less than a B; she also recalled thinking to herself as a child, “Lord, please don’t ever let me treat my kids like I’ve been treated.” Years later, she found it difficult to listen to her two teenage children, reasoning that “I couldn’t talk to my mom. That’s why I talk too much to my kids.” Being silenced and invisible emerged as a strong theme in this family story.

Upon graduating from high school, Maya’s mother, Vera, received a full scholarship to attend a state university. She was the first in her family to attend college, but as one of the few black students on campus, “it got real lonesome and scary” as she faced racist incidents. Becoming pregnant at age 18 by a boy back home provided a “valid excuse” to leave college. To Vera’s dismay, both sets of parents insisted on “a shotgun wedding without the shotgun.” Her marriage proved to be the first of many “raggedy relationships.” One of her mother’s comments seemed relevant to her own life: “We can’t find no [good] men, we just got to get us one from the gutter and clean him up.” Within 6 months of giving birth to Maya, and with her husband “running amok,” Vera divorced, moved into her own apartment, and worked to support herself and Maya. Without a reliable partner, Vera lived a “trial and error life” as a single, working mother of two children. Nevertheless, she made it clear that the responsibilities of mothering curbed “her appetite for running the streets” and provided an anchor that she might otherwise have lacked.

Almost two decades later, her 18-year-old daughter became pregnant after missing some birth control pills. As a disengaged student with few interests, parenting filled up Maya’s day with welcome responsibilities: “When I wasn’t a mom, I didn’t have much things to do. Just go to school and come home. One of these days, you got to expect all these responsibilities, so you might as well do it ahead of time.” Given her poor academic record and learning difficulties, it was no surprise that Maya dropped out of school when Trina aged out of the nursery at five months.

Vera reacted to Maya’s pregnancy with a tinge of resignation: “I’m glad that I’m a grandma early, so I can still run with my grandchild.” She quit her job of 10 years during Maya’s pregnancy, and was very involved in caring for Trina. Maya, however, rarely referred to conflicts over Vera’s advice and supervision. In a moment of unusual self-disclosure at T1, Maya said, “It usually be kind of hard to talk to my mom because…she don’t understand me. She don’t want me to do this or that, and it’s kind of hard to talk to her about things. . . . She don’t listen, she just talk on and on and hardly let me say anything.” Vera in fact worried that Maya was “passive, easily intimidated, and doesn’t speak up,” and wondered if she had perhaps contributed to Maya’s submissiveness. Maya’s passivity created a paradox for Vera: “I want [Maya] to lean on me, but not lean on me.” When pressed, she explained that Maya’s passivity could put her and Trina in danger, especially in a place like New City. Her fears were confirmed when Maya moved out to live with a new boyfriend with a prison record. She and Trina returned home within a few months when he became abusive. This was the first of many tumultuous relationships for Maya and a pattern of returning home when relationships with unreliable partners ended.

By T3, Vera, Maya, and her three children had moved to a more diverse and safer community. Trina attended a better elementary school where she learned to read with remedial help, but her academic progress and her interest in school declined when her learning difficulties were no longer addressed. When I interviewed her at T5, I learned that she rarely attended school, had been arrested for shoplifting, and had an abortion at age 15. Now 16 years old, she selected a picture of a masked person with the caption of “The Invisible” to talk about her life: “I’m drawn to [this picture] because… that’s how I feel with my life, like nobody sees me, nobody appreciate my feelings. I feel like I’m just not even there…. People just pass by me and just don’t care about how I feel, and they don’t help me out in my situations that I need to be helped to make my life better” (SmithBattle & Leonard, 2006, p. 356). Two years later, Trina gave birth to Tyree; his father was never involved even after paternity was established. A couple years later, she moved from Maya’s home to a subsidized apartment and enrolled in a program to earn her high school diploma while Tyree attended preschool. By the time I reinterviewed her at T6, Tyree was 3.5 years old and had been sent home three times for being “the little school bully.”

By T6, Maya had married for the second time and was living with her husband and two younger teenage children. She reported that the family’s annual income was US$21,000-US$30,000, based on her husband’s wages and her unemployment benefits. She had worked for short spells in low-skill positions. Maya and Vera visited often and talked daily by phone. When I asked Maya how she felt about her mother’s involvement in her life at T6, she expressed ambivalence and anger over Vera’s ongoing intrusiveness: “I like her being in our life, but sometimes she tries to take over and … that makes me feel like I’m not doing what I need to do . . . . Sometimes I’ll just agree with her, because she’s very argumentative and it doesn’t make the situation any better by arguing. So I’ll just say okay, if that’s how you want it, that’s fine . . . . Sometimes I’ll feel angry, because this is my household, this is my kids, and this is how I want things done. But she don’t like to listen . . . . I wanted somebody to listen to me [growing up].”

The family’s vulnerability is reinforced by thin family routines (SmithBattle & Leonard, 2006). When I asked Maya at T6 to describe what they did together as a family during her childhood, she said: “Everybody did their own thing mostly. I was mostly with my friends.” Little has changed in her current household: her 13-year-old daughter is rarely at home and family members eat dinner as they watch TV in their separate bedrooms. Dinner at Trina’s home is similar: “I’ll eat in my room and I’ll have (3 ½ year old) Tyree eat in his room, put newspaper down on the floor so he don’t make a mess. We both eat in our room.” Trina expressed some reservations about this practice: “I feel it’s important that everybody eats dinner together as a family. That’s what families do, eating together, talking, enjoying your food . . .” When I asked her where she had learned that, she answered, “Watching TV.” Trina imagines eating together, but she lacks family practices from her own childhood or models that show her how.

Nevertheless, parenting has changed Trina’s sense of her and Tyree’s future and reordered her priorities: “It matured me a lot. It made me stronger as a person, think about the future more. I think about my son, make sure that he sees me doing good in my life . . . I’m more into school . . . so my son have a good life. I don’t want him to go to jail.” While these commendable goals call for a new direction, the future for Trina and Tyree appears tenuous and ill-defined. Without past experience or current models to follow, she must invent a future and new parenting practices in opposition to her past: “I try to do the opposite with my son. What I really don’t remember or didn’t get, I try to do it with him and have him do more things.” While her past sets up what she wants to avoid as a parent, creating new practices based solely on imagination (or TV), and without support, encouragement and mentoring from a nurturing adult, prove daunting. For example, Trina described the following exchange with Tyree at 3 ½ years of age:

Tyree’s behavior remains inexplicable to Trina. His attempts to be recognized echo Trina’s unsuccessful bids for attention at T5 when she admitted to doing “stupid things, stealing and fighting…and when they find out, they’ll eventually be focused on me. So basically to get their attention” (SmithBattle & Leonard, 2006, p. 356). While Trina yearns for meaning, connection, and a promising future, her world provides few opportunities or relationships that would help her elaborate a more promising future.

Cumulative Advantage and Disadvantage

Teen mothers have been blamed for a host of social problems, including poverty, “broken” families, crime, welfare costs, and poor maternal-child outcomes (Furstenberg, 2007). As studies have controlled for mother’s childhood disadvantage, the dire consequences typically attributed to early childbearing have been substantially reduced. This newer evidence challenges the traditional view that postponing parenting past the teen years improves maternal-child outcomes. Outcomes for low-income, disadvantaged teens are not likely to improve unless and until the childhood disadvantage that predisposes so many teens to become pregnant is adequately addressed (Harden et al., 2007; SmithBattle, 2009). By taking advantage of a socially diverse sample of families, the findings presented here support this more nuanced view. Both cases highlight how divergent outcomes for teen mothers and their children are linked to the cumulative effect of social advantage or disadvantage that is overlooked when outcomes are located in the teen mother alone (Furstenberg, 2007; SmithBattle, 2007b). For teen mothers like Maya, disadvantage begins before birth and early inequities are compounded over time by their families’ lack of social capital, and by inferior schools, familial and community violence, dangerous neighborhoods, and restricted educational and employment opportunities. Precisely because teens like Maya inherit a shabby future at birth, mothering offers the hope of a fulfilling adult identity, with fathers often absent or on the periphery. In spite of Maya’s academic difficulties and alienation from school, she does not drop out of high school prior to pregnancy, like the majority of teen mothers (Pillow, 2004), but leaves when 5-month-old Trina can no longer attend the nursery. She never returns to school and works occasionally in menial positions. She marries twice. Her second marriage is tenuous for reasons common to low-income, black couples (Edin & Reed, 2005). Having inherited many social disadvantages, Maya’s daughter, Trina, has sex and an abortion at age 15 and gives birth to Tyree at age 17. Although she longs to be a good parent, she lacks the relationships and resources that scaffold a promising future. Because the world she inherits is so constrained, she relies on trial and error to create a world for Tyree and returns to school in hopes of improving her future and setting a good example for her son. Reengaging with school may provide a stepping stone that alters her life-course, but her progress will be complicated by competing demands and structural constraints that contribute to social and health disparities and intense family-work conflicts (Ammons & Kelly, 2008). Further, without the relational support and mentoring of a caring adult, Trina will find it difficult to summon the resources to effectively parent her own son, given her own feelings of inadequacy and invisibility. After all, safe housing, access to good schools, higher education, and gainful employment are in short supply for low-income parents of any age. In spite of our individualistic mythology, mothers cannot extricate themselves from a precarious world by hard work, sheer will, or rational thought alone; nor can they undo structural inequities that are woven into educational, social welfare, and health services (Berlin, Furstenberg, & Waters, 2010; SmithBattle, in press). Without a reliable safety net and upstream policies that reduce social inequities, the most vulnerable parents end up repeating the past, in spite of their hopes and aspirations (SmithBattle & Leonard, 2006).

At T1, Cary was a paradigm of inventing a future from an impoverished past (SmithBattle, 1995). Like Maya, she experienced a difficult childhood, but early adversities were tempered by loving grandparents and the emotional and material resources of Tim’s working-class family. The responsibilities of parenting set Tim on a path of reduced risk taking and initiated a cascade of positive and corrective experiences that repaired Cary’s past (SmithBattle, 2006). Both she and Tim completed high school (with a nursery for Jake), and Tim received vocational training that led to gainful work through family connections. Their marriage of almost 20 years is a throwback to a bygone era when fathers were the sole family breadwinner and wives remained home or worked part-time to raise children. The family’s many strengths are rooted in a coherent social world, a loving extended family rich in practices and rituals, corrective experiences (for Cary), safe neighborhoods, and decent schools. Their children are moving into adulthood from a cushion of safety, recognition, and social advantage. Unlike Trina, Jake is pressing into an open future in spite of early parenting much like the teen mothers at T1, including Cary, who relied on supportive families and community resources to elaborate their strengths and aspirations (SmithBattle, 1995).

While parenting accelerates Trina’s and Jake’s transition into adulthood, and alters their lives profoundly, their radically different trajectories and future possibilities cannot be understood apart from their social contexts. Poor outcomes are compounded for Trina by family adversities and social inequities but are ameliorated for Jake by the emotional and social resources available in his family and community. He draws on these resources to complete high school as a teen parent, attend college, and gain occupational skills. Like many other college graduates, he and his wife may rely on their families’ financial support and social connections to find employment during a recession. Maya (and Vera) also provide a safety net for Trina, helping her with childcare and transportation, but their social and educational vulnerabilities cannot ameliorate Trina’s formidable challenges, especially as the safety net is dismantled and funding for childcare and job training, already woefully inadequate, is reduced further (SmithBattle, in press). The strong contrast between both cases supports the growing consensus that it is not teen parenthood per se that leads to poor outcomes but the relative advantage and disadvantage during childhood that differentially shape the transition to adulthood, even in the event of teen parenthood. These findings also add to the literature regarding the reproduction of class inequalities in the transition to adulthood (Aronson, 2008; Swartz, 2008).

Social disadvantage and adverse childhood experiences (ACEs) are prevalent among teen mothers (Kennedy, Agbenyiga, Kasiborski, & Gladden, 2010; SmithBattle, 2007b) and their children (Carothers, Borkowski, & Whitman, 2006), and the latter are associated with unfavorable health and social outcomes at mid-life for middle class adults (Felitti et al., 1998; Hillis et al., 2004). Hillis and colleagues reported that teen mothers with no or few ACEs fared as well on a range of outcomes at mid-life as older childbearers, while outcomes worsened as the number of ACEs increased. A graded relationship was also found between ACEs and the risk of teen fathering (Anda et al., 2002). These two reports from the landmark Adverse Childhood Experiences Study surveyed middle class adults enrolled in a health maintenance organization on the adversities they experienced growing up. The checklist of ACEs included abuse/neglect, growing up with one parent, or in a household with domestic violence, mental illness, drug or alcohol problems, or crime (Felitti et al., 1998). ACEs have been linked to chronic health conditions in middle-class adults (Felitti et al., 1998) and to learning difficulties and obesity in low-income children (Burke, Hellman, Scott, Weems, & Carrion, 2011). Unfortunately, the prevalence of ACEs has rarely been studied in low-income populations, including disadvantaged teen parents. Testing and revising the ACEs instrument with low-income samples is sorely needed to capture the adversities that disadvantaged children experience in their homes and communities. Such a tool could be used to screen pregnant and parenting teens for ACEs, with comprehensive services and mentoring provided to those with a high score in hopes of modifying the lingering effects of childhood adversity.

ACES were prevalent in Cary’s and Maya’s childhood, but Cary, like other teen parents, made considerable gains over the life course when resources and supports were available (Clemmens, 2003; SmithBattle, 2009). Support and linkages to comprehensive services were also crucial in interrupting negative risk chains among homeless teen mothers who had experienced multiple adversities and social disadvantage as children (Kennedy et al., 2010). Unfortunately, the most disadvantaged teen mothers live in areas where services are least available (Han & Stone, 2007).

These two cases underscore the need for nurses to contextualize a teen parent’s vulnerabilities (Browne, Doane, Reimer, MacLeod, & McLellan, 2010) and his or her strengths and resilience (McDermott & Graham, 2005). While teen parenting can promote positive life changes, new priorities and reduced risk taking may falter in the context of enduring social inequities, the lingering effect of childhood adversities, stereotypes of teen mothers, and limited family, partner, or community support (SmithBattle, 2009). Persistent disadvantage tends to undermine aspirations, reinforces depressive symptoms, and contributes to social exclusion (Furstenberg, 2007; Whitley & Kirmayer, 2008). Further, new research shows that chronic, unrelenting stress in early childhood caused by, for example, extreme poverty, repeated abuse, family violence or severe maternal depression, can be toxic to the developing brain, leading to a chemical “signature” on the genes which affects whether and how genes are expressed, with long-lasting effects on mental and physical health, learning, and behavior. Conversely, nurturing, protective, and stable relationships promote epigenetic changes that facilitate healthy emotional and cognitive development and the capacity to learn. These epigenetic changes in the brain can even be transmitted from one generation to the next, contributing to the compounding effect of social disadvantage (National Scientific Council on the Developing Child, 2010). Until disadvantaged children are provided with the relationships, supports and social policies that ameliorate their early circumstances, they will continue to experience distinct disadvantages relative to their middle class peers (that are encoded in their brain function and architecture) that actually promote early parenthood. Unfortunately, with few exceptions (Kennedy et al., 2010; Tough, 2011), teen mothers’ adversities are currently either ignored or compounded by schools and social welfare policies and systems (Duffy & Levin-Epstein, 2002; Pillow, 2004; SmithBattle, 2007a).

Parenting will continue to provide a transition to adulthood when there are few compelling reasons or alternatives for low-income youth to avoid pregnancy. As the economic prospects for low-income youth are further eroded by the recession, the offshoring of manufacturing jobs, and the relative lack of investment by the U.S. in child care, education, health care, and employment (Aronson, 2008; Berlin et al., 2010), we can hardly expect already beleaguered families to help their children prolong the transition into adulthood. And, even if teens successfully avoid parenting till their 20s, they are unlikely to fare much better than their peers on health or social indicators, as long as early childhood adversities and disadvantage are ignored or reinforced over the life-course, and first-generation low-income students are “locked out” of postsecondary education (Aronson, 2008). Reducing the social and health disparities common to low-income families requires reversing a long string of flawed U.S. policies on sexual health, education, welfare and taxation that have widened the gaps between the richest and poorest children in the U.S. Shoring up families and communities on the economic margins must reverse these trends so that children reach young adulthood with a promising future. Doing less will consign young adults to the periphery of family and economic life, even if they avoid parenting till their 20s (Furstenberg, 2010b).

Given the small sample size, attrition over time, and limited ethnic diversity, some patterns may have been missed. The quality of the data and the credibility of the findings were enhanced by the inclusion of multiple family members and interviews, verbatim transcription, systematic analytic procedures, and consensual validation by the second author. The strengths of the study ultimately depend on the clinical uptake of findings in educational and health care settings and moving upstream to reverse widening social inequities.

Conclusion

Our understanding of the social determinants and consequences of early childbearing has expanded as researchers have followed families over time and controlled for background factors. These healthy developments challenge many of the negative assumptions of early childbearing and the premises of U.S. policies (Furstenberg, 2007; SmithBattle, in press). The cases reported here alert clinicians to wide variations in how teen mothers and their children negotiate adulthood and parenting and how they respond to the possibilities and constraints available to them. Both families also reveal the social contexts of cumulative advantage and disadvantage that remain hidden when social inequities and vulnerabilities are framed as personal or family deficits and pathologies. Clinicians have an important role to play in helping teen parents and their children elaborate the possibilities available to them with support, referrals, and advocacy, while recognizing and validating the daunting challenges that low-income youth face in becoming young adults and parents in the context of an increasingly unlevel playing field. Clinicians also have a role to play in advocating for social policies that support and promote parenting and the healthy development of children, as well as more equitable life opportunities for all American children. Policies that support positive environments for pregnant women and very young children will reduce the risk of intergenerational transfer of negative epigenetic changes as well as family habits and practices that can lead to impaired health, diminished learning capacity, and poor parenting of the next generation.