Introduction
Research Questions
- To what extent do the impacts of MotherWise on women’s relationship skills and attitudes persist at 30 months?
- What are the impacts of MotherWise on women’s relationship outcomes at 30 months?
- What are the impacts of MotherWise on the well-being of women and their children at 30 months?
Many healthy marriage and relationship education (HMRE) programs serve individual adults rather than couples. Such programs aim to help participants form and maintain healthy romantic relationships and avoid unhealthy relationships, regardless of their relationship status. However, there is little rigorous evidence on the ability of HMRE programs for individual adults to improve participants’ outcomes and none on the ability of these programs to improve outcomes over the longer term. The few existing studies of HMRE programs for individual adults either use quasi-experimental methods, examine short-term effects, or examine programs that serve populations or operate in settings that are dissimilar to those of federally funded HMRE programs.
To help build the evidence base on the diverse set of HMRE programs serving individual adults, this study examines MotherWise, a relationship skills program for women with low incomes who are pregnant or have just had a baby. The University of Denver in Colorado received a five-year grant from ACF’s Office of Family Assistance in 2015 to deliver the program, which aims to empower women with the knowledge, skills, and attitudes they need to make informed decisions about healthy relationships. The program included a core group workshop made up of six weekly four-hour sessions, individual case management, and an optional couples’ workshop. An earlier report found that, after one year, MotherWise had improved women’s relationship skills and attitudes and reduced the likelihood that a woman had an unintended pregnancy during the year after study enrollment. This report examines the program’s impacts on women’s outcomes 30 months after study enrollment.
Purpose
This report is the third in a series on the implementation and impacts of MotherWise. It describes the program’s impacts 30 months after women enrolled in the study. These impacts were estimated by comparing the outcomes of women who were randomly assigned to either a group that was offered MotherWise services or a control group that was not. The report also provides information on program implementation and costs and documents the study methods. An earlier report presented findings on the program’s one-year impacts, based on a follow-up survey of women one year after they enrolled in the study. Another report provided detailed information on the program’s design and implementation during the first year of the study. Mathematica and Public Strategies conducted this study as part of the Strengthening Relationship Education and Marriage Services (STREAMS) evaluation for ACF.
Key Findings and Highlights
- MotherWise had persistent positive impacts on women’s relationship skills and one of the two measures of relationship attitudes at the 30-month follow-up. Compared to women in the control group, those who were offered the MotherWise program reported significantly better romantic relationship skills and conflict management skills and higher levels of disapproval of couple violence at 30 months, consistent with the one-year impacts on these outcomes.
- MotherWise increased relationship stability at the 30-month follow-up. During the 30 months after study enrollment, women in the MotherWise group experienced fewer relationship transitions—the total of their relationship start-ups and breakups—than did women in the control group.
- The program had no impacts on other relationship outcomes measured in the study. Women in the MotherWise and control groups reported similar levels of intimate partner violence, co-parenting quality, and maternal and child well-being at the 30-month follow-up. Women in both groups were equally likely to have experienced at least one unintended pregnancy during the 30 months after study enrollment.
- Exploratory analyses suggest MotherWise did not affect the likelihood that women were in a romantic relationship with their child’s father at the 30-month follow-up; among those who were, it did not improve their relationship quality. MotherWise also did not increase father involvement.
Methods
Between September 2016 through December 2018, 949 women enrolled in the study. To be eligible for the study, women had to be at least 18 years old and either be pregnant or have delivered a baby in the previous three months. The study team randomly assigned women to either (1) a group that was offered the MotherWise program or (2) a control group that was not offered the program but was free to seek other services available in the community. For the impact analysis presented in this report, we used data from a baseline survey that was administered at the time of enrollment and a 30-month follow-up survey. A total of 748 women responded to the 30-month follow-up survey, for a response rate of 79 percent. Response rates were similar between the program and control groups.
Recommendations
MotherWise took a unique approach to offering HMRE services to individual adults—serving exclusively expectant and new mothers with low incomes. The positive and persistent impacts on women’s relationship skills and attitudes, and the emergent positive impacts on women’s relationship stability over the 30-month follow-up period, suggest that this approach holds promise.
The findings of this study offer some encouraging results about the longer-term effects of MotherWise. At both the one-year and 30-month follow-ups, MotherWise improved women’s relationship skills and attitudes—the outcomes it most directly aimed to affect. MotherWise largely succeeded in equipping women with the skills and attitudes needed to make more informed and healthy decisions about relationships—and this success lasted beyond the short term. It also increased women’s relationship stability over the 30-month follow-up period. MotherWise did not have persistent impacts on other outcomes, such as unintended pregnancy and co-parenting quality.
Why did MotherWise succeed in improving relationship skills, attitudes, and stability 30 months after enrollment? The positive effects on relationship skills and attitudes might be due to the program’s strong implementation, the program’s focus on a well-defined service population, or delivering the program at a time in life when women might be particularly open to taking stock of their family and relationship choices and working on their relationship skills and attitudes. In turn, the program’s impacts on relationship skills and attitudes could have helped women make more careful decisions about whether and with whom to begin or end a romantic relationship and to effectively navigate challenges within relationships that might otherwise have led to more transitions.
What factors might have limited the success of MotherWise in influencing other outcomes? Some outcomes—such as co-parenting quality, intimate partner violence, and relationship quality—might be difficult to improve without also working directly with co-parents or romantic partners. More intensive engagement with the partners and co-parents could potentially help programs have greater success in achieving sustained effects. Although MotherWise offered an optional couples’ workshop, take-up was low for this program component. Future programs that plan to implement a model similar to MotherWise might consider strengthening this component. We also found that MotherWise did not improve the measures of maternal and child well-being we examined. We cannot rule out that positive impacts on maternal and child well-being could emerge at a later point, especially in light of the observed impacts on relationship stability. Even so, programs that aim to improve these well-being measures might need to offer services that directly address them. Finally, for many outcomes, we observed some fade-out between the one-year and 30-month follow-up. To increase the likelihood that program effects persist, programs could consider reengaging participants after they complete the core workshop.
The findings of this study suggest that programs like MotherWise hold promise because they can improve certain outcomes of expectant and new mothers with low incomes beyond the short term. However, HMRE programs can vary in their service population, focus, content, structure, and targeted outcomes. More research is needed to develop a more complete picture of the longer-term effects of HMRE programs for individual adults on the full range of populations they serve.
Citation
Patnaik, Ankita, Katie Gonzalez, and Robert G. Wood (2022). Healthy Marriage and Relationship Education for Expectant and New Mothers: The 30-Month Impacts of MotherWise, OPRE Report #2022-240, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.