“Second Chances” for Adolescent Mothers: Four Decades of Insights and Lessons on Effectiveness and Scale-up of Jamaica’s PAM

Figures & data

Figure 1. WCJF model of intervention.

Table 1. Documents from which information was sought.

Author, year and title	Type of document and publication status	Objective	Study approach
Powell and Jackson (1979), Report of the evaluation of the Women’s Center	Programme evaluation, unpublished	To assess the PAM in the first year of operation	Analysis of WCJF routine service records; interviews with current and former students
Powell Government of Jamaica (1980), Report of the evaluation of the Women’s Center Program for Pregnant Teenagers and Adolescent Mothers	External programme evaluation, unpublished	To assess the results of the PAM after the first two years	Analysis of WCJF enrollment data and utilization records; interviews with beneficiaries
McNeil et al. (1983), The Women’s Center in Jamaica: an innovative project for adolescent mothers	Programme evaluation, peer reviewed	To assess the effects of the WCJF’s PAM on school reentry of adolescent mothers, contraceptive initiation, and use, and use of life skills counseling services	Analysis of WCJF routine service records; interviews with current and former students
McNeil et al. (1990)	Unpublished	Economic evaluation of PAM	Program Data
Cost-benefit analysis of WCJF’s Programme for Adolescent Mothers	Unpublished	To determine the economic and social impacts of PAM after 15 years running	Survey and interviews (former clients and non-clients, baby-fathers, and mothers), cost-benefit analysis (economic evaluation)
Brown (1999), Preventing secondary pregnancy in adolescents: A model programme	Unpublished	To determine the impacts of WCJF PAM on former students	Tracer study; quantitative and qualitative survey of former students—at least 8 years after leaving the exiting the Center’s activities
Caleb-Drayton (1999), Recidivism among Jamaican teenage mothers: A historical cohort study, 1995–1998	Grey/Unpublished (doctoral dissertation)	To assess the effect of WCJF programme on the incidence of repeat pregnancies between 1995 and 1998 and educational attainment of programme participants	Historical Cohort Study
Barnett et al. (1996), Case study of the Women’s Center of Jamaica Foundation Programme for Adolescent Mothers	Unpublished	To investigate the social and economic gains arising from PAM	Survey and interviews (former clients and non-clients, baby-fathers, and mothers), cost-benefit analysis
Drayton et al. (2000), The impact of the Women’s Center of Jamaica Foundation programme for adolescent mothers on repeat pregnancies	Peer reviewed	Comparative analysis of PAM beneficiaries and non-attendants on repeat pregnancy and school completion after reentry	Historical Cohort approach
McNeil (2002), As My Mother Taught Me: The Jamaica Women’s Center Story	Published	Autobiography of founding director of WCJF	Life History
Drayton et al. (2002) The Health Belief Model as a predictor of repeat pregnancies among Jamaican teenage mothers	Peer reviewed	To determine prevalence of repeat pregnancy in PAM population	Historical Cohort Study
Simpson (2011), The return of teen mothers to the formal school system: redeeming the second chance to complete secondary education	Unpublished	To determine factors associated with completion and non-completion of secondary school among PAM beneficiaries	Qualitative mixed method tracer study
Williams (2014), Evaluation of the Institutional Capacity of the Women’s Center of Jamaica Foundation	Unpublished	To assess the internal capacity of WCJF to provide services to its clients	Mixed methods—desk review, capacity assessment, IDIs, & FGDs

Figure 2. The ExpandNet/WHO framework for scaling up.

Table 2. Core elements of PAM.

Element (Year introduced)	Target beneficiaries	Implementer	Partners	Objectives
Core programme components
Continued and supplemental education classes (1978)	Adolescent mothers	WCJF	MoE	Ensure that pregnant adolescents and new mothers can continue their education. Teach reproductive health and parenting skills.
Counseling (1978)	(i) Adolescent mothers (i) Families of adolescent mothers (i) Baby-fathers	WCJF	Ministry of Labor and Social Security; National Family Planning Board; National Parenting Support Commission	Provide emotional and social support to adolescent mothers. Contribute to a supportive home environment. Support the development of shared responsibilities among adolescent mothers, baby-fathers, and families. Build parenting skills for adolescent mothers and baby-fathers Offer continuous psycho-social support for mothers who have been reintegrated into secondary schools
School placement (1978)	(i) Adolescent mothers (i) Families of adolescent mothers	WCJF	MoE School principals School guidance counselors	Place new mothers back into school at an appropriate level. Place adolescent mothers who are outside of school-going age into other institutions of learning/vocational training Demonstrate benefits of reinstatement of adolescent mothers within the formal school system to support the establishment of a formal school reintegration policy.
Childcare and parenting skills building (1978)	(i) Adolescent mothers	WCJF	Child Development Agency Office of the Children’s Advocate Office of the Children’s Registry	Provide childcare for PAM beneficiaries to allow those who went back to mainstream secondary schools, to leave their children in safe hands while they attend classes Support adolescent mothers to build their childcare and parenting skills. Counsel baby-fathers on supportive male responsibility in childcare.
Family planning counseling and services (1978)	(i) Adolescent mothers (i) Baby-fathers	WCJF	National Family Planning Board Family Planning Association of Jamaica	Counsel adolescent mothers on the importance and on methods of family planning. Link adolescent mothers to health facilities for family planning counseling and services (the Adolescent Center in Kingston started on the spot FP services) .
Additional programme elements
Vocational skills training and job placement (1978)	(i) Adolescent mothers (i) Baby-fathers	WCJF	None	Enable older adolescents to enter a trade Promote financial independence Reduce intergenerational poverty Contribute to broader economic growth in the country
Exam preparation support (1980)	(i) Adolescent mothers	WCJF	MoE	Help adolescent mothers study and prepare for the national exams
Supports PAM beneficiaries to pursue higher education after completing secondary school (2018)	(i) Adolescent mothers	WCJF	AIDS Healthcare Foundation	Offer continuous psycho-social and financial support for mothers who have been reintegrated into secondary schools Support the pursuit of tertiary level education through bursaries

Figure 3. Phases of PAM scale-up.

Table 3. National policy/programme activities supporting PAM.

Year	Policy intervention
1975	Bureau of Women Affairs
1978	Women’s Center of Jamaica Foundation
Government of Jamaica, 1980	The Education Act
1983	National Population Policy
1989	Human Resource Development Programme
1990	Special Projects Unit
Government of Jamaica, 2004	National Youth Policy
Government of Jamaica, 2004	Child Care and Protection Act
2009	The Vision 2030 Development Plan (2009–2030)
2013	Reintegration Policy

Table 4. Record of students from 1978 to 1981.

Record	April 1978–Dec 1979	Government of Jamaica, Jan 1980–Dec 1980 Government of Jamaica, 1980	Jan 1981–Dec 1981	Total
School placement (secondary, high and vocational)	150	82	64	296
Dropped out of programme	30	38	10	78
Awaiting placement	23	2	22	47
Total	203	121	99	423

Source. (McNeil et al., 1983).

Table 5. Sites of WCJF operations.

Location of main center	Outreach sites
Kingston	St. Margaret’s (Kgn. 11), Jones Town
Mandeville	Santa Cruz (St. Elizabeth- satellite site)
Montego Bay	Lucea (Hanover)
Port Antonio	Highgate (ST. Mary)
St. Ann’s Bay	Ulster Spring (Trelawny) Duncans (Trelawny)
Savanna-la-Mar	Darliston (Westmoreland)
Spanish Town	Kellits Outreach
Morant Bay Center
Junction Outreach
Denbigh

Table 6. Findings on key PAM studies.

Evaluation Studies	Methods (sample size and sampling approach)	Key findings
McNeil et al. (1983), The Women’s Center in Jamaica: an innovative project for adolescent mothers	Secondary analysis of monitoring data Qualitative interviews (sample not indicated)	95% of beneficiaries enrolled between 1978 and 1981 had not transitioned to second births 69% of beneficiaries were placed in secondary, high and vocational schools between 1978 and 1981
McNeil et al. (1990)	Costing of PAM	Costs US$437 for one girl for one academic year Costs US$83 per year for providing care for a pregnant adolescent for nursery school
WCJF (1995), Tracer study on ex-participants of the Women’s Center of Jamaica Foundation (WCJF)	Sample size 400 (250 from Kingston & 150 from Mandeville) from a total of 1,800 PAM beneficiaries between 1978 and 1990. In-person and mailed questionnaire administration	About half (50.7%) of beneficiaries had only one child. Average of 5 years spacing between first and second births 73% completed secondary school 21% had gone on to complete higher school All the children of the beneficiaries were attending school at different levels (basic school = 22%; primary school = 14.5%; 43% = secondary school and 15.5% = technical and comprehensive high schools)
Handa (1993), Cost-benefit analysis of WCJF’s Programme for Adolescent Mothers	Not available	323 teens births averted among beneficiaries ∼$5,494,212.3 social and private benefits accruing from PAM ∼$555,412.2 savings to the health system
Barnett et al. (1996), Case study of the Women’s Center of Jamaica Foundation Programme for Adolescent Mothers	Review of enrollment data FGDs – 11 participants	16,500 girls enrolled between 1978 and 1994 1.3–1.4 repeat pregnancy annually Programme beneficiaries assert that programme offers supportive, non-judgmental environment for reclaiming their lives
Drayton et al. (2000), The impact of the Women’s Center of Jamaica Foundation programme for adolescent mothers on repeat pregnancies	260 primiparous adolescents 12–16 years from Kingston, St Andew, St Catherine and Manchester parishes randomly selected from vital records	Sample of 206 12–16-year-old adolescents who gave birth in 1994 and interviewed in 1998 Incidence of repeat pregnancy was 37% compared with 60% among non-participants. Programme participation reduced the risk of one or more repeat pregnancies by 45%; programme participants were 1.5 times more likely to complete high school than non-participants.
Williams (2014), Evaluation of the Institutional Capacity of the Women’s Center of Jamaica Foundation	Desk and literature review In-depth elite interviews (sample not indicated) FGDs (sample not indicated)	Per capita cost of continuing education for WCJF’s girls at $ 86, 785 compares favorably with $ 117, 248 at the wider population level signals an efficient programme

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