Introduction
Despite a steady decline over the
past 20 years (1), the teen birth rate in the United States remains the highest
in the developed world with 3 in 10 American teenagers becoming pregnant before
the age of 20 (2). Sexual education in
the United States is an extremely controversial topic, with persistent conflict
between supporters of abstinence-only and supporters of comprehensive sexual
education in schools. Abstinence-only programs teach students that abstinence
from sexual activity is the only morally correct choice until marriage, and do
not provide information about contraceptives (3). In contrast, comprehensive sex education
educates students about contraceptives and their ability to protect against
STIs and pregnancy in addition to explaining that abstinence is the best form
of birth control and STI protection (3). One popular public health intervention
in abstinence-only education is the “Baby Think it Over” program, in which
students must care for an electronic infant simulator. Realistic-looking dolls
are given to high school students for an extended period of time, usually
between three days and a week, to show them what life is like as a teen parent.
The simulators cry for a variety of reasons, require diaper and clothing
changes, regular feedings, and human contact. The device records data such as
how long the baby cries for before being picked up and how often it is fed to
ensure students are fully participating (4). The intention of the program is to
show students how difficult caring for an infant is to discourage them from
engaging in premarital sexual activity. Numerous studies have found the program
to be ineffective (5,6,7), and others found the program to do more harm than
good, with more girls wanting to become a teen parent after the intervention
was complete (8). It is no surprise that
‘Baby Think it Over” is not an effective means of teen pregnancy prevention as
it does not consider the motives and influences that shape a teen’s decision-making
process and behavior.
“Baby Think it Over” Does
not Address Why Teens Get Pregnant
Infant simulator programs are not an
effective intervention to lower teen pregnancy rates because they do not
properly engage with the reasons why teenagers have sex. Very few teenagers
plan or attempt to get pregnant.
Optimism bias, or believing that one’s self is less likely to experience
an event or develop a condition, is a well-documented phenomenon in humans (9). People assume their risk for getting pregnant
is lower than another person who is having the same amount of sex with the same
amount of protection. Teens do not think their sexual activity will result in
pregnancy, even if they are partaking in known risky, unprotected sex. As the Theory
of Reasoned Action explains, a person’s behavior relies on their attitude
toward the behavior, subjective norms, and behavioral intention (10). The
students participating in “Baby Think it Over” already know that being a teen
parent is not a desirable outcome. However, they do not think that a pregnancy
will actually happen to them. Infant simulator programs are often used in areas
and schools that experience little to no teen pregnancy. If the student does
not see pregnancy as a valid threat it will not influence their sexual
decisions. According to Psychological Reactance Theory, teens will prioritize
their freedom to engage in sexual behavior over the threat of teen pregnancy (11).
Since these teens underestimate their risk of pregnancy and do not realize how
life changing it would be, they assume pregnancy is not a large threat toward
their current freedoms and lifestyle. Their behavior will be determined to a greater
degree by their desire to protect their sexual freedom then a fear to protect
themselves from pregnancy.
Despite the advice of parents,
abstinence education in schools, and the influence of religious morality, 62%
of American high school students will become sexually active before graduation (12).
Several factors play a role in this statistic, including the influence of media
and peer pressure. However, much of the decision to become sexually active can
be based on physical and psychological need. Maslow’s hierarchy of human needs
categorizes the factors that direct human behavior into a pyramid of needs (13).
The bottom four levels of the pyramid are the deficiency needs, meaning a
person must satisfy these needs before they can move on to fulfilling the top
of the pyramid (13). These four categories are physiological, safety,
belongingness and love, and esteem (13). Sex is considered to be a basic physiological
need in adult human bodies, along with the love of friendship and sexual
intimacy, self-esteem, confidence, and respect from others (14). Teenagers have
mature bodies and a physiological desire for sex. Their physical desire, paired
with a basic need for sexual intimacy, guides many toward sexual relationships.
In addition, self-esteem and confidence can often be improved through
fulfilling sexual experiences. Many teens may also feel they are more respected
by their peers or society once they are sexually active. Once their deficiency
needs are met, a person can move on to growth needs like morality, problem solving,
and acceptance of facts (13). Teens are
discouraged from sexual activity for moral reasons like religion as well as to
reduce their risk for STIs and pregnancy. A person will not be able to make
decisions based on morality or cultural disapproval while their deficiency
needs are not being met. Using an infant
simulator to show teens the problem of how difficult teen parenting is will not
prevent them from fulfilling their deficiency needs.
“Baby Think it Over” Fails
to Provide Means to Avoid Pregnancy
Abstinence-only programs try to
reduce teen pregnancy by stressing abstinence as the only alternative to
pregnancy. Abstinence is the only perfect method of birth control, yet students
who receive abstinence-only sexual education have higher rates of teen
pregnancy (15). Students who were taught
with abstinence-only programs will often not know how or why to use birth
control properly if they do decide to have sex, increasing their risk for
pregnancy. As discussed above, the scare
tactic of threatening teen parenting is not effective enough to keep teens from
having sex. In order to reduce teen pregnancy, students must understand why
pregnancy occurs and how to prevent it by effectively using contraceptives. Infant
simulator programs do not acknowledge birth control or discuss how to prevent
pregnancy with safe sex to students.
According to the Theory of Planned
Behavior, people’s control beliefs affect their decisions. A person believes it
will be easy for them to perform a behavior when they can easily control or
access the factors necessary to establish the behavior (10). Teenagers who have
never learned about contraception will have a harder time reducing their risk
of teen pregnancy. They do not know what types of contraceptives are the most
effective and may not know how to use them or where to buy them. If their only introduction to condoms are in
the media and hearing friends talk about them, it will be embarrassing to ask
how to use one. Media depictions of sexual activity do not usually discuss
birth control; only the passion and pleasure are shown. The teen’s idea of “normal” sex is what they
have seen in media, and they will not consider it necessary or “normal” to use
contraceptive. If the student thinks it will be hard or awkward to obtain
contraceptives, they will not use them and increase their risk for pregnancy.
In
Social Cognitive Theory an intervention must address three factors in order to
change a person’s behavior: self-efficacy, goals, and outcome expectancies (16).
In order to prevent teen pregnancy, the students must feel that they have
control over their sex lives, and are able to protect themselves from
pregnancy. Students participating in an infant simulator program will be able
to protect themselves with abstinence. Once they decide to have sex, they have
no behavioral capability to control the safety of their encounter. Without the
agency to properly use birth control, teens will continue to get pregnant. They
have no observational learning from discussing how to have safe sex. If a model
of a sexual relationship that used contraceptives is discussed in class, the
students will be able to remember how to protect themselves while having sex
because they can compare themselves to a realistic example of how to
successfully avoid pregnancy.
“Baby Think it Over” Does
Not Show the Real Experiences of a Teen Parent
The strategy to infant simulators is
that they will show students the hardships that accompany teen parenting,
leading the teens to abstinence. Unfortunately, the simulated experience does
not show life as a teen parent, it only inconveniences students for a few days.
The student does not need to pay for diapers, clothes or food, does not go
through the physical pain of pregnancy and childbirth, and does not need to
worry about telling their family and friends they are becoming a parent. The
simulators are not real, making it hard to associate the activity with an
infant. The inconvenience, despite being a fraction of what teen parents
experience, seems even less severe due to optimism bias and the Health Belief
Model. As a result of optimism bias, the
participants will assume that even if they had a child, the experience would
not be as hard as it seemed (9). Students will assume their child would never cry
during the night or need to be changed at an inconvenient time. According to
the Health Belief Model, a person’s behavior is the outcome of many factors
including perceived severity, perceived benefits, and perceived barriers (10).
Students caring for an infant simulator will not see the situation as severe as
it really is while being affected by optimism bias. When a student is walking
around with and caring for an infant simulator, they get attention from their
peers, but often in a positive way. Many teenagers think it is funny to see
their friends walking around with a doll, and will have fun pretending with
them and joking around for a few days. Many of their peers will also be caring
for a simulator, making it a social norm to carry a fake baby around. The
participants can all give each other moral support and advice. The student’s
parents often will help them with the project. Teachers of other classes know
that students taking part in a simulation will have less free time and may
offer extra help or homework extensions. These benefits do not exist for teen
parents. The situation will not create a
fun opportunity for joking with friends, and it will not become an accepted
norm to be a teen parent. Few or none of their friends will be able to relate
to their situation or be able to offer support. Help from family and teachers
will be less frequent as the parent will need assistance indefinitely. Communities
often see teen parents as irresponsible, but students taking part in an infant
simulator program are given positive attention. The student will also not
experience many of the other barriers common in a teen parent’s life. The
student will only need to give up free time and social activities for a few
days. They will not be financially responsible, need to find a job or daycare,
and can care for the simulator in their current living situation. Most teen
parents will lose all of their free time to caring for their child and work and
no longer be able to socialize with their peers. A baby is a significant
financial burden that requires many teen parents to drop out of high school to
find a job to pay for their child’s basic needs. The teen’s living situation
may not allow them to stay there with a baby due to room or parental
disapproval. These enormous stresses are not shown to students with infant
simulators. When students assume the consequences of teen pregnancy are not
severe, are given positive benefits and support from their community, and are
not shown the harsh barriers that keep teen parents from living a comfortable
and stress free life, they will not change their behavior to abstinence in
order to avoid a teen pregnancy (10). The students do not believe the outcome
of teen pregnancy is demanding as it truly is, and their behavior will reflect
on this belief.
How Can Teen Pregnancy Be
Reduced?
In order to reduce teen pregnancy,
infant simulator and abstinence-only sexual education programs must be replaced
by mandatory comprehensive sexual education in schools. The state of
California’s teen birth rate dropped 60% with mandatory comprehensive sexual
education in schools (17). Comprehensive sexual education programs do not only
instruct students how to use contraception. Teachers emphasize that abstinence
is the only 100% effective contraceptive and students learn about STIs and
their symptoms. In order to design an intervention that will reduce teen
pregnancy rates as much as possible, comprehensive sexual education must be
expanded to tackle the social and cultural dynamics that surround teenagers and
sex. Learning about abstinence and proper use of contraceptives must be paired
with frank discussions about why teens do not use birth control and how they
can change the habit. Conversations
about why students decide to have sex and what a healthy sexual relationship
looks like gives students a model of safe sexual behavior. Showing students what life is like for teen
parents in the most realistic way possible will help teens realize how large an
impact a child would have on their life.
Discuss Why and How
Students Have Sex
According to Psychological Reactance
Theory, a person’s behavior depends on their perceptions of how the behavior
will threaten their freedom, and how important that freedom is to them (11). Many
teenager sees their freedom to engage in sexual activity as much more important
then the threat of becoming pregnant. Asking that sexually active students use
contraceptives instead of remaining abstinent is much more balanced with teens’
risk of pregnancy. Students will react to this intervention much more successfully,
as the freedom to not use contraceptives is not nearly as vital to teenagers.
When a population that would be engaging in unprotected sex begins to use
contraceptives, the teen pregnancy rate will fall.
Discussing the difference between
healthy and unhealthy sexual relationships will also help students take control
of their own reproductive health through Social Cognitive Theory. Conversations
in class about why people choose to have sex and what makes a person feel ready
to be intimate with a partner helps students have confidence in their
decisions. Explaining what is bad or what is terrific about relationships
displayed in the media can show students what to look for in a respectful,
caring partner. Teaching students the importance of contraceptives in a healthy
sexual relationship will help students normalize their use and associate them
with a successful sexual encounter. Stressing the uniqueness and individuality
of everybody’s own sexual existence prevents alienating students who are having
sexual experiences outside of their peers’ norm. Communication and positive
role models will help students find self-efficacy and feel confident in their
sexual decisions (16). When a teen feels confident, they will more likely
communicate with their partner to ensure they are being properly protected, or
wait to become sexually active until they are ready (19).
Teach Proper Use of
Contraceptive for Risk Reduction
Helping students become confident
users of birth control will ensure that they use it in all of their sexual
encounters according to the Theory of Planned Behavior (10). People will be more likely to change their
behavior when they think it will be easy to do so. In order for more teenagers
to have safe sex, it must become easier for them to use contraceptives. When
students learn about their proper use in school, it will be easy for them to
confidently use a condom or other method correctly. Increasing teenagers’
access to birth control is also necessary to decrease teen birth rates. Teen
girls are unable to go on prescription birth control without going to a doctor
first. Many of these students cannot pay for the extra prescription or feel
awkward asking their parents’ permission to start medication. Anyone can
purchase condoms from a variety of locations, but it can be an embarrassing and
expensive experience. Providing condoms at school can be a great solution, but
many parents, politicians, and community leaders object to the practice.
Educating students where they can go to get free condoms or buy condoms in a
more private environment will make it much easier for students to access
contraception. Once the students feel comfortable accessing and using a birth
control method, they will use it more often (10). The increased rates of birth
control use will in turn lower the teen pregnancy rate.
Teaching students to remain
abstinent for moral or social reasons will be unsuccessful under Maslow’s
hierarchy of human needs, as they must fulfill their basic deficit needs before
growth needs like morality. Reframing the issue as a safety concern will allow
teenagers to consider contraceptive use while considering sex, instead of after
as a moral one (14). Humans need to
protect the security of their body, and both pregnancy and STIs will have
negative effects on a person’s health. Talking to students about the realistic
risks for harmful STIs like Chlamydia can help them to realize their health
will be much safer with contraceptives. It is unrealistic to expect a teenager
to take the time to consider moral obligations while in a sexual situation, but
many will think about the importance of protecting their health before having
sex, increasing the rate of birth control use and preventing what would have
otherwise been an instance of unsafe sex.
Acknowledge the Struggle of
Teen Parents
It is impossible for a teenager to
understand and experience the life of a teen parent without becoming one. The novelty and fun of “Baby Think it Over”
lead to inaccurate assumptions about life as a teen parent. However, a
student’s perceptive can still be changed to a more realistic one through the
Health Belief Model. The perceived benefits, severity, and barriers to a teen
pregnancy are best shown through the everyday lives of teen parents.
Unfortunately, it is hard to show students exactly what these lives are like.
Teen parents that have turned into motivational or even cautionary speakers are
outside the majority of teen parents in that they have usually received a high
school or college degree and have a good-paying job. Over 50% of teen mothers
do not graduate from high school, and less than 2% graduate college (18). 80%
of teenage couples that become parents break up (18). Shows like “16 and
Pregnant” and “Teen Mom” show the hardship these teenagers face, and have led
to 5.7% reduction in teen births. Watching a few episodes or a documentary
following the struggles of teenage parents and discussing how hard their lives
are will help students realize the severity of their situation and how many
barriers they face. When the students realize how hard life is for teen parent
they will more likely use it as a consideration in their behavior.
Conclusion
Teenage pregnancy is a public health
crisis in the United States. Although well intentioned, abstinence only sexual
education programs like “Baby Think it Over” do not provide the means to
successfully reduce teen birth rates. What’s more, students are often taught to
avoid premarital sex for moral reasons, are not introduced to any methods of
contraception, and experience an incorrect representation of the life of a teen
parent. Teenagers will continue to have sex, but will do so unprotected,
continuing the high rates of teen pregnancy. Switching to a comprehensive
sexual education program that addresses the reasons why teens have sex, how to
use birth control, what a healthy sexual relationship is like, and what the
life of a teen parent truly is will inspire much more change in behavior. As
teens increase their use of birth control, the teen pregnancy rate will decrease
to a more appropriate number.
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