The Child Support Improvement Project: Paternity Establishment, Chapter 3

     CHAPTER III

              BASELINE RESEARCH:
              PATERNITY ACKNOWLEDGEMENT IN COLORADO IN 1991

	Is in-hospital paternity acknowledgement effective?  To answer this question, it is first necessary to generate a baseline portrait of paternity acknowledgement prior to the introduction of hospital-based efforts.  We accomplished this in Colorado by commissioning the Department of Health to produce a data tape containing information on the state's 12,668 out-of-wedlock births during 1991.  This time period clearly preceded the initiation of project and legislative activities in Colorado aimed at enhancing paternity acknowledgement.
	Within the constraints of the data available on the birth statistical abstract file, we conducted an analysis of the characteristics of parents who opted to acknowledge paternity versus their non-acknowledging counterparts.  This analysis also examined patterns for the four Denver facilities in which the paternity intervention was subsequently implemented.

A.	Highlights from the 1991 Analysis

	There were 12,668 out-of-wedlock births in Colorado in 1991.  They disproportionately occurred to Latina and African-American women who resided in Denver. Like the nation as a whole, unmarried mothers in Colorado tended to be poorly educated with only 18 percent having more than a high school education. Nearly half (45 percent) had at least one other living child at the time of the 1991 birth.
	Father's name was entered on the birth certificate in 23 percent of unmarried births in 1991. Within three years of the birth, another 6 percent had a father's name added as a result of a court order. Overall, the likelihood of a father acknowledging paternity on a voluntary basis increased if the baby was White rather than of minority racial or ethnic status. Similarly, voluntary acknowledgement increased with mother's educational level, her employment during pregnancy, and the absence of prior births. Voluntary paternity acknowledgement did not vary with factors such as maternal age, prenatal care, low birth weight, abnormalities of the newborn or prematurity.
	Selected characteristics of unmarried births in Colorado are discussed in greater detail below.
	The 12,668 out-of-wedlock births in Colorado in 1991 comprised 23.6 percent of the total births in the state for that year.
	Women with unmarried births ranged in age from 12 to 49 years with an average of 22.7 and a median of 20.5.  Over a third of the women were in the 18-21 year range.
	Babies born to unmarried women were primarily White (54 percent), although Latinas (30 percent) and African-Americans (13 percent) were over-represented relative to their distribution in the state's population. In 1991, Whites comprised 73 percent of all Colorado births, while Latinas and African-Americans comprised 18 percent and 6 percent, respectively.
	The average number of years of education for unmarried mothers was 11.5. Only 18 percent of the women had more than a high school education.  Approximately 42 percent had less than high school education and the remaining 40 percent had completed high school but had not gone beyond.
	Forty-two percent of the women reported working during at least a portion of their pregnancy.   There was not enough information on annual income or occupational category to gain insights on these patterns.
	Approximately a year following the birth, the father's name was entered on the birth certificate in 23 percent of unmarried births in 1991.  This included voluntary acknowledgements as well as those achieved by court order.  By three years post-birth, the paternity establishment rate had increased to 29 percent.  Again, this includes voluntary acknowledgements and court-ordered establishments.
	A few demographic characteristics available from the birth certificate correlated with the presence of the father's name. For example, a name was more likely to be entered if the mother was White (27 percent) rather than African-American (18 percent) or Latina (20 percent).  The likelihood of the father's name being entered increased with the mother's years of education.  Thus, names were added in 29 percent of the cases where mothers had more than twelve years of education versus 20 percent of the cases where mothers had less than twelve years of education.
	Women who had more than one previous birth were less likely to have the father's name entered (18 percent) than were those women with only one prior birth (22 percent) or no prior births (25 percent).
	There was no indication that entering the father's name on the birth certificate was influenced by prenatal care patterns, low birth weight, abnormalities of the newborn or prematurity.
	There was little variation in the percentage of cases with the father's name entered on the by county of birth or mother's county of residence.

B.	Highlights from the 1991 Analyses of the Four Project Hospitals

	Colorado's paternity demonstration project was conducted at four Denver area hospitals. These facilities had different voluntary acknowledgement rates prior to the start of the project. In 1991, voluntary acknowledgement rates in participating hospitals ranged from 13 to 24 percent.  Within three years, another 11 to 14 percent of unmarried births at each hospital had paternity established by court order.
	Not surprisingly, unwed mothers who delivered at these four hospitals had different demographic characteristics that appeared to track with voluntary acknowledgement patterns. In general, the highest voluntary acknowledgement rates occurred at the hospitals with the highest rates of maternal education and employment. Voluntary acknowledgement was also associated with the absence of other living children, and White racial identification.  Conversely, hospitals with the lowest voluntary acknowledgement rates tended to have patient populations that were heavily non-White, poorly educated, unemployed and had other previous births.
	Rates of voluntary paternity acknowledgement and court ordered establishments at the four participating hospitals in 1991 are presented in Table III-1. Characteristics of the unmarried mothers who delivered at the four project hospitals are summarized in Table III-2. These patterns are discussed below.
	There were 4,260 unmarried births in 1991 in the four hospitals that participated in the paternity demonstration project:  Denver General, Mercy, St. Joseph and University.
	A comparison of the major facilities in Denver in which the project was subsequently implemented revealed sharp differences in the degree to which the father's name voluntarily appeared on the birth certificate.  The lowest rates occurred in Denver General where only 13 percent of unmarried births had a father's name on the birth certificate.  At the high end was Mercy, with a voluntary establishment rate of 24 percent.
	Differences in paternity establishment rates across the participating hospitals appeared to be largely the result of differences in the patient populations that were served.  For example, there were significant differences in the average education level of the women served in hospitals participating in the pilot, and education is known to correlate with voluntary paternity establishment.  In Denver General Hospital, only 6 percent of unmarried mothers had more than twelve years of education. At Saint Joseph, just over a quarter (26 percent) of the mothers had more than a high school education.
	Another significant difference in the participating hospitals was the racial profile of mothers delivering out-of-wedlock babies.  At University and St. Joseph Hospitals, 49 and 44 percent, respectively, were White.  At Mercy, the proportion of Whites was 24 percent.  And at Denver General, the proportion of Whites was only 12 percent.  Mercy had the highest proportion of African-American women (37 percent).  Delivering mothers at Denver General were overwhelmingly Latina (61 percent).
	Unmarried mothers delivering at the four project hospitals had significantly different employment patterns during pregnancy with 53 percent reporting employment at St. Joseph compared with 20 percent at Denver General.  These differences persisted even when we restricted the analysis to mothers aged 19 years or more.
	Unmarried mothers delivering at the four project hospitals had different numbers of prior births.  Mothers at Denver General Hospital were significantly more likely to have other living children (57 percent) than their counterparts at St. Joseph (35 percent) and University (49 percent).
	There were no significant differences in the average age of unmarried mothers delivering at the four participating hospital sites.  Across all four sites it was 22.3 to 22.8 years.

	Table III-1
	Voluntary Paternity Acknowledgement Rates and Court Orders
	in Project Hospitals in 1991 Pior to the Demonstration

	Table III-1 omitted.



	Table III-2
	Selected Characteristics of Unwed Mothers
	Delivering in Four Project Hospitals (1991)

	Table III-2 omitted.

C.	Summary

	An analysis of 1991 births to unmarried mothers in Colorado revealed that the father's name was voluntarily placed on the birth certificate in 23 percent of the cases within the first year of the baby's life.  Within three years following delivery, the proportion of establishments stood at 29 percent. Voluntary paternity acknowledgement was correlated with certain demographic characteristics of the mother.  This included ethnicity, education and numbers of prior births.  Paternity was more apt to be acknowledged voluntarily among White mothers, educated mothers, and mothers with no or only one prior birth.
	These patterns are reflected in the demographic profile of unmarried mothers who delivered at the four participating hospitals in the paternity demonstration project.  In 1991, prior to the start of the demonstration project and the initiation of routine, in-hospital presentations about paternity, voluntary acknowledgement rates ranged from 13 to 24 percent at project hospitals.  These rates varied with the educational, racial and employment profile of the unmarried populations served at each facility.  The lowest voluntary acknowledgement level occurred at the hospital site with the highest proportion of mothers who were:  non-White; poorly educated; had many prior births; and the lowest levels of employment during pregnancy.  Conversely, acknowledgement levels were significantly higher at hospitals where mothers were more apt to have at least attended high school, worked during pregnancy, and had fewer numbers of prior births.