Sunday, December 23, 2012

Baby, Think This Program Over: A critical view on the Baby Think It Over Program in High Schools – Devon Ligo

When teenagers celebrate their twentieth birthday, many of them do not imagine a baby sitting on their lap.  However, this is the reality of 500,000 girls across the country every year.(1) Over 80% of these pregnancies are unplanned and place a huge financial, social, and emotional burden on families and the U.S. (2)
One program, aimed to fight these grim statistics, is called Baby Think It Over (BTIO).  This program has been incorporated into community centers, health classes, and child development classes across America.  Students receive a RealCare ® baby to look after for 24-48 hours.  This baby is electronic and senses when the “mother or father”/student feeds, burps, or changes its diaper with a specialized wrist band (3).  These dolls cost over $300 each, and come complete with lesson plans, diaper bags and different outfits for the babies. (4) The moderator of the project can later check the student’s results in regards to amount of time the baby cried, the environment of the baby, and if the baby was neglected.  Many times students will be graded based on their “parenting” abilities, and have to write papers and do assignments based on their time with the baby.  This program aims to lower the number of teenage pregnancies across the U.S., and prevent teens from engaging in unprotected and underage sexual intercourse. (4). 
Critique 1- Theory of Reasoned Action- Rationality and Intention
The Baby Think It Over Program is based upon the Theory of Reasoned Action (TRA).  The TRA takes into account a person’s attitude about a behavior and social norms, which aid in their intention to later perform a behavior. (5) This model assumes that people make decisions after thinking about a behavior rationally (6).  This model takes into account that we live in a social environment, which can influence our behavior, as well as our attitudes about an outcome.  (6).  However, a severe flaw in this theory is its assertion that people will intend to perform an action and then follow through. (6).  The stronger the intention to engage in a behavior, then the more likely a behavior will happen, due to motivation and effort to achieve this behavior. (7) But, the timing between this intention and the action can vary.  (6).  One day, a person may have the urge to eat healthy and figure out a comprehensive weight loss plan, but two weeks later the person may stray away from their desired behavior.  This example shows how the model is flawed when examining individuals’ behaviors some time after an established intention.
            The TRA is ineffective for teenage programs such as Baby Think It Over because teens rarely follow through with original intentions.  The program attempts to give teenagers an experience that will cause them to think about their actions and shape their intentions in the future.  Supporters of BTIO assume that after taking care of a baby for an extended period of time will cause teens to be highly motivated to abstain from unprotected sex.  A study by Didion and Gatzke found that almost all students interviewed felt a baby would impede on their social lives and relationships with family.(9).  They also report students’ reactions to living with the doll, which included strange looks from others, embarrassment and inability to wake up in the middle of the night (9).  This feedback shows that students were taught a strong lesson, and would therefore not become pregnant in the future.  However, in one school where RealLife simulators were used, a father reported four girls out of eighty in his son’s class became pregnant before eighth grade graduation (10).  Showing that although students may have been taught a lesson due to BTIO directly after the intervention, their behavior was not impacted in the long run.  This violates the theory of reasoned action because their intention to not have sex waned over time and did not lead to the desired behavior: lower rates of teen pregnancy.
            Another flaw in this theory is that it assumes people are rational when making decisions.  The model follows a linear format and is based upon the fact that people think rationally about actions and consequences. (6).  It is rather obvious that people do not think rationally, because people are still smoking and still overeating even though they are aware these behaviors are killing them.  Teenagers especially do not think rationally.    The Baby Think it Over program fails to take this into consideration.  Advocates of the program think that this realistic project that will impact student’s lives in the future when contemplating premarital sex.  However, when teens are in the “heat of the moment” they are going to forget their health class and are more likely to make irrational decisions.  A study confirms that when people are sexually aroused they are less likely to make concrete decisions such as using a condom.  (11). 
            This same logic can be used in the critique of BTIO.  Even though students have been taught comprehensive lessons about the consequences of not wearing a condom, sexual arousal will lead to riskier activities.  Due to the severe weaknesses in the theory of reasoned action in regards to rationality and intention, the BTIO program is ineffective in controlling teenage pregnancy.
Critique 2- Psychological Reactance- Taking Away Freedoms
            Another downfall of the Baby Think It Over program is restraining teenagers’ liberties.  Brehm defined the psychological reactance theory as “‘‘the motivational state directed toward the reestablishment of [a] threatened or eliminated freedom’’ (16).  Many times social influences can threaten a person’s autonomous decisions, attitudes and behaviors. (17).  This can be seen in the BTIO program.  Teachers and school administrators that enter into this project oftentimes require students to take care of the baby, thus, taking away their liberties.  Using psychological reactance theory, it can be determined that teens will act negatively to the program, since they want to reestablish freedoms.
Students are forced to take care of this simulated baby, limiting their autonomy, which can result in avoidance of the message or a response opposite of the intended message. (16). Responses posted on a blog after partaking in the BTIO project showed the frustration of giving up independence, “Ive (sic) been tired all weekend and haven’t been able to do anything I’ve wanted to do.” (13).  The student that wrote this blog may not understand the purpose of the program and may be unchanged or evade the overall goal of BTIO, since they were unable to freely make decisions that weekend.
Psychological reactance may produce a “boomerang effect”, where people do the opposite of the intended action (17).  This effect should always be taken into consideration when devising a new public health intervention or campaign.  This logic can be used when discussing the BTIO program because students are tied down to a baby, which can make them rebel and have unprotected sex.  Over time, unprotected sex could later lead to teenage pregnancy, the outcome BTIO wants to avoid.  The purpose of sexual education classes is to inform students about making the right decisions, not requiring them to care of a fake baby. 
            Studies show that positive messages are much more effective than negative messages (14).  BTIO creates a negative message to teenagers by making them realize that if they have unprotected sex, they will have a baby and their life would be over.  Watching homemade YouTube videos about students that are embarking on this project, it is easy to see they are often annoyed with the amount of times the baby cries (18).  This demonstrates a pessimistic view of sexual activity, attempting to show that sex will always lead to a baby.  There is no sense of empowerment.  The project’s desired goal is to make teens fail so they will not want to engage in underage sex, because they have had experience with a baby.
            Framing in public health has become an important way to pass policies and get public support for a certain issue.  (22).  With framing, many underlying core values are exposed for specific issues that help promote or condemn an intervention or campaign.  This was proven to be the case for control in the tobacco industry.  Big tobacco companies were winning over consumers with core values such as “free speech”, “fairness”, “freedom”, and “autonomy,” in order to keep selling harmful cigarettes. (22).  In contrast, anti-tobacco supporters were framing the issue based on healthy living, and consumer protection. (22) The tobacco companies have been winning because of their strong frames; causing public health advocates to re-work campaigns in order to make a bigger impact.  The BTIO intervention frames teen pregnancy around the core value of fear.  The lives of teens would be seriously impacted if they had a baby and this is what the BTIO program shows firsthand.  The opposing side to BTIO would be those that endorse unprotected sexual activity.  Core values would include feelings of ecstasy and elation.  As shown with the anti-tobacco framing tactics, the core values for BTIO are not as strong as the opposition.  This then would lead to ineffective programs, which is confirmed by a teen birth rate stagnating over the past few years. (23).
            Since BTIO has been framed around taking away freedoms, psychological reactance theory tells us that a person will be reluctant to accept the program (16).  Therefore, programs need to be more focused on intrinsic worth and promoting safe sex in a way that does not impinge upon teenager’s autonomy.  To a teenager, independence is one of the most sought after aspirations in their young adult lives, and a program should never take that away.
Critique 3- Sense of Ownership of a Baby
            In contrast to critique 2, the BTIO program also results in a sense of ownership of the baby, which could actually make teens want to get pregnant.  One blog post reads, “But my week has been good and I think I’m to attached to my baby I don’t want to give it back.” (13).  Once a person establishes ownership of a particular object or idea, they will very reluctant to give this item back.  In Predictably Irrational, Ariely explains, “The more work you put into something, the more ownership you begin to feel for it.” (15). This is how students may feel after they had to wake up several times in the night to feed their simulated baby.
            Psychological ownership shows how people feel that possessions become a part of them, and will have trouble giving an object or idea away. (19) Many of the students name their baby and dress them in different outfits.  This further shows a sense of ownership for the doll and allows them to believe that they are capable of having a baby.
            When a person has ownership over something, they satisfy the need for control- “that is MINE.” (19).  At the end of the BTIO program, teenagers may feel this sense of ownership and desire to have the baby back because of their need for control.  This can backfire on the original intention of the program and contribute higher rates of teen pregnancy.
 A study explains, “In addition to producing intrinsic pleasure, control over the environment may produce extrinsic satisfaction as certain desirable objects are acquired.” (19).  Students therefore may be engaging in unprotected sex after partaking in the program because they are not internally satisfied after losing their simulated baby.  They want to get back what they lost and will in turn, become pregnant with a real baby.
Alternative Intervention- Create a Movement
            In order to improve BTIO, schools need to revamp the entire program and rethink sexual health.  In order to be most successful, schools need to create a movement in order to get their point across.  For a program to be effective it needs to be comprehensive and multifaceted.  A program exists called Safer Choices, which aims to limit STDs and teen pregnancy and cities across the U.S. (20) The program involves people of the community, teachers, school administrators, parents and students.  Propaganda is distributed in the form of shirts, buttons, and posters to help reinforce the message.  Students write about safe sex in the school newspaper, and form student groups that wish to spread the message.  Safer Choices incorporates many different aspects into the project, which are successful in getting the message out to students (20).
            The program that replaces the existing BTIO project should incorporate these elements to get students involved in their sexual education.  The program should get the entire student body involved and endorse the message in a simple logo or phrase.  This would make the program successful because people would instantly know the message and internalize how they can make a difference. 
            The new program should repair all the problems that existed in the BTIO program.  This would include embracing the core value of freedom in contrast to the fear principle present in BTIO.  It should also include students advocating for safer sex programs, and owning the right to make safe choices.  And lastly, the program should accept that teens are irrational and learn how to better predict their behavior.
Ownership of Safer Sex Behaviors
Students themselves should act as activists to help promote the message.  The social learning theory asserts, “If a particular pattern of behavior is performed by a model, and if that pattern is identified as problem-solving, rewarding, or in some other way desirable to its consequences, the probability that it will be adopted by an observer is increased.” (25).  This should be considered when looking at alternatives to BTIO.  If a number of students join a program that promotes sexual health, and rebel against teenage pregnancy, other students will also follow.
            Behavior, as described by Gladwell in the Tipping Point, is contagious. (26).  Like the Hush Puppies example used in his book, when people start to adopt certain behaviors, a tipping point occurs and the fad, idea, or style takes off like an epidemic.  This same logic can be used when developing a program in place of BTIO.  If several students initiate a movement to protect themselves during sexual intercourse, their peers will catch on, and soon the entire school will be apart of the campaign.    
            In the new program, there should be no electronic baby, flour sack, egg, etc. to instill a sense of ownership in teenagers.  Instead, a teenager should feel a sense of ownership in sexual health knowledge.  With a comprehensive sexual education program, teens would be deterred from unprotected sex because they have a sense of pride from partaking in a successful program.  A good example of this is the Eighty-Four program in Massachusetts.  This campaign brings together young teens that want to live their lives tobacco free. (27).  Implementing a similar program to teens in high schools will unite them to make smart choices when it comes to sex.
As Ariely explains, “ownership simply changes our perspective.”(15).  If students are given knowledge and confidence in contrast to a fake baby, they will have ownership over safe behavior and not the desire to possess a baby of their own.
Using Freedom as a Core Value
             As shown earlier with big tobacco companies framing the issues is vital in public health policies.  Instead of the fear core value used in BTIO, a program should hone in on what teenagers value most: independence, freedom, and autonomy. 
When framing an issue it is important to understand how people think so you can get a better appreciation for what people care about most. (24).  Therefore, the introduction of a new program should advocate self confidence and let teens know that they are on control of their actions.  This will allow for teens to freely make the decision to practice safe sex based on what they have learned.
Instead of strapping teenagers down with a fake baby, a new program should be developed that makes freedom the core value.  Many students report they need more communication skills in sex ed classes (21).  With the BTIO program, students do not get a chance to discuss sexual relationships with others because they are immediately given the consequence of actions: a baby.  With knowledge about open communication between partners, teenagers will learn how certain actions can lead to pregnancies or sexually transmitted diseases.  This will successfully use independence as a core value because it will be the student’s own decision to engage in risky behaviors when they fully understand the consequences.
            High schools making condoms available to students would further support the core value of freedom.  It is proven that much of the decline in teenage pregnancy has been due to increased availability of contraceptives (28).  If a school makes condoms readily accessible for students, they are more likely to engage in safer sexual behaviors.  The choice to receive and use these condoms is entirely up to the teenager.  This reinforces the value of autonomy because they are actively taking a role in their sex lives without the feeling of fear. Empowerment is the greatest feeling we can bestow upon teens when they think about how to live a healthier life.
Embracing Irrationality
            In contrast to using the impractical Theory of Reasoned Action (TRA), it would be best for a program to take advantage of irrational behavior and make programs accordingly.  To review the TRA, it takes into account a social environment, but infers that intention will ultimately lead to behavior (6).  For teenagers especially, this is not the case.
            Instead, the program to replace BTIO should incorporate ideas from the diffusion of innovations theory.  The theory brings about five very important aspects: (29)
 1) “people pass through stages in the adoption process,”
2) “diffusion takes time, often a long time,”
3) “people can modify the innovation and sometimes discontinue its use,”
4) “perceived characteristics of the innovation influence adoption”,
5) “individual characteristics influence adoption” (29)
            The characteristics of this theory based on the paper by Valente and Fosados, show that people can pass through different phases at different times.  As also discussed in the Tipping Point (26), there will be early adopters, which will later lead to a point where the intervention just takes off, with laggards on the opposite end of the spectrum.  This shows how we can take advantage of irrationality.  If we are able to figure out the “tipping point” of a certain intervention then a program could be a success.
            With the replacement of BTIO, then new proposed intervention must incorporate early adopters into planning which can aid in making the program a success.  Targeting students in a school that would be considered “early adopters,” those that motivate others, would help get more people involved and spread the message.
Since this theory takes place on the group level and understands that people are not rational, it would be essential to incorporate this into a new intervention.  The TRA purely thinks on an individual level, and does not consider the impact of transforming millions of minds in comparison to only one.  BTIO as well, only considers people on the individual level.  Instead, a program should target many people to adopt a certain behavior to live a healthier life.
It is also necessary to create a program where teens are able to think logically in “the heat of the moment.”  Many times people are unable to think properly when they are in enthralled with sexual desire, which can lead to bad decisions. (11).  A program must therefore understand this thought process and promote skills that can help people think clearly about an action that can lead to bad consequences.  BTIO teaches a lesson before an action has already occurred, whereas a new program should initiate good prevention strategies when a teen is most vulnerable to irrational behavior.
            Teenage pregnancy is one hundred percent preventable.  Better programs are needed in order to deter students from engaging in unprotected intercourse.  The Baby Think It Over Program severely places limitations on teens, which leads to a misinterpreted message about taking care of a child.  A new program should incorporate all the shortcomings of the BTIO program.  These include: emphasis on freedom, sense of ownership about sexual health, and understanding what can make teens adopt certain behaviors.
(1) Ventura, Stephanie J., Sally Curtin, and T. J. Mathews.  “Teenage Births in the United States: National and State Trends, 1990–96”.  National Vital Statistics System, CDC. (1998). 
(2) “Facts on American Teens' Sexual and Reproductive Health” Guttmacher Institute (2012)
(3) Website- RealCare Baby Simulators 
(4) Somers, Cheryl and Mariane M. Fahlman. “Effectiveness of the 'Baby Think It Over' Teen Pregnancy Prevention Program.” Journal of School Health. 71:5 (2001)
(5) Hale, Jerold J., Brian Householder, and Kathyrn L. Greene. The theory of reasoned action. In J. P. Dillard & M. Pfau (Eds.), The persuasion handbook: Developments in theory and practice  (2003) pp. 259-286. Thousand Oaks, CA: Sage 
(6) Individual health behavior theories (chapter 4).  In: Edberg M. Essentials of Heath Behavior: Social and Behavioral Theory in Public Health.  Sudbury, MA: Jones and Bartlett Publishers, 2007, pg. 35-49.
(7) Ajzen, Icek. “Theory of Planned Behavior.” Organizational Behavior and Human Decision Processes. (1991), 179-211 
(9) Judy Didion and Helen Gatzke.  The Baby Think It Over™ Experience to Prevent Teen Pregnancy: A Postintervention Evaluation. Public Health Nursing.  21:4 (2004). p331-337.
(10) Meyer, Peter.  “Baby Think It Over.” Education Next 7:1 (2007).
(11) Ariely, Dan and George Loewenstein. “The heat of the moment: the effect of sexual arousal on sexual decision making.” Journal of Behavioral Decision Making. (2006) 19:2. 87-98.
(13) Website- Baby Think It Over Blog-
(14) Lewis, Ioni M, Barry Watson, Katherine White and Richard Tay.  “Promoting Public Health Messages: Should We Move Beyond Fear-Evoking Appeals in Road Safety?” Qualitative Health Research. 17:1 (2007) p. 61-74
(15) Ariely, D. Predictably Irrational, the Hidden Forces that Shape our Decisions. Harper Collins, 2008. Print.
(16) Rains, Stephan and Monique Mitchell Turner.  “Psychological Reactance and Persuasive Health Communication: A Test and Extension of the Intertwined Model” Human Communication Research. 33. (2007) 241-269.
(17) Silvia, Paul.  Deflecting Reactance: The Role of Similarity in Increasing Compliance and Reducing Resistance.  Basic and Applied Social Psychology, 27, (2005) 277-284
(18) Ringold, Debra Jones. “Boomerang Effects in Response to Public Health Interventions: Some Unintended Consequences in the AlcoholicBeverage Market” Journal of Consumer Policy 25: 27–63, 2002.
(19) Pierce, Jon, Tatiana Kostova and Kurt Dirks.  “The state of psychological ownership: integrating and extending a century of research.” (2002).
(20) Kirby, Douglas, Elizabeth Baumler, Karin K. Coyle, Karen Basen-Engquist, Guy S. Parcel, Ron Harrist, and Stephen Banspach. The “Safer Choices” Intervention: Its Impact on the Sexual Behaviors of Different Subgroups of High School Students.”  Journal of Adolescent Health (2004) 35:442– 452.
(21) “Summary of Findings- Sexual Education in America.” Kaiser Family Foundation (2000).
(22) Siegel, Michael and Claudia Menashe. “The power of a frame: An analysis of Newspaper Coverage of Tobacco Issues- United States, 1985-1996.” Journal of Health Communication (1998) 3:4 307-325.
(23) Wind, Rebecca. “Following decade-long decline, U.S. pregnancy rate increases as both births and abortions rise.” Guttmacher Institute. (2010) (
(24) “ The Art and Science of Framing an Issue.” Gay & Lesbian Alliance Against Defamation (GLAAD) and the Movement Advancement Project (MAP). (2008)
(25) DeFleur, M.L., and Ball-Rokeach, S.J. Theories of Mass Communication (5th edition), Chapter 8 (Socialization and Theories of Indirect Influence) pg. 202-227.  White Plains, NY: Longman Inc., 1989.   (25)
(26) Gladwell, M.  The Tipping Point: How Little Things Can Make a Big Difference.  Boston: Little, Brown and Company, 2000 p. 3-14.
(27) Website- (27)
(28) “U.S. Teen Pregnancy Rates Decline As Result Of Improved Contraceptive Use” Science News. (2006)
(29) Valente, Thomas, W and Raquel Fosados. “Diffusion of Innovations and Network Segmentation: The Part Played by People in Promoting Health” Sexually Transmitted Diseases. 33:7 (2006)

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At January 18, 2014 at 2:54 PM , Blogger Art&Spirit Readings said...

This article makes many valid points about getting rid of the BTIO and substituting more empowering and positive health programs.

One very important part of those programs should be building teens self esteem! It makes a huge difference in their behavior and self concept.


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