Tuesday, January 1, 2013

Thinking Through “Baby Think It Over”: A Proposed Intervention for Teen Pregnancy Prevention--Kate Reed


“Baby Think It Over” is a parenthood-simulation program created by Reality Works, Inc. that is used mostly in middle schools as a mechanism to prevent teen pregnancy.  Students are each given an infant simulator named RealCare Baby – a lifelike, life-size baby doll with computerized responses.  According to Reality Works, the doll is set to cry at varying intervals, cueing the students to feed, burp, diaper, or comfort it.  An internal computer monitors how often and how quickly the students respond to the crying, as well as if the doll is shaken, dropped, or otherwise handled roughly.  It even senses if the students do not support the “infant’s” neck.  The teens keep the doll over a weekend in order to experience some of the demands of infant care. 
At its peak, “Baby Think It Over” was used in more than 12,000 school districts and health and service organizations in the US (RealityWorks).  Schools that decide to participate can adjust the program to fit their needs; it is up to the individual school or program to determine which students will participate – girls and/or boys, older or younger. Some schools and programs are unable to use “Baby Think It Over” due to the enormous cost of the program; each infant simulator costs around $700, and schools must also buy baby care supplies and replace infant parts every few years (RealityWorks).  Baby Think It Over” is unable to provide statistics showing that its doll works – the company wants to collect the data but for now it relies on “strong anecdotal evidence” (Drawbaugh).  In terms of wanted teen pregnancies, the program has been found to have either no effect on the desires of students to be teen parents or to actually increase the number who want to (Kralewski).  Infant simulators are an expensive and complex intervention for teen pregnancy, and their effectiveness is questionable.  One paper states that “simulated experiences can be a powerful strategy for effective learning about complex decisions regarding the risks of sexual activity and the realities of parenting” (Didion), while another paper argues that the “effectiveness of using infant simulators to influence the perceptions of teens about the reality of teen parenting is minimal” (Herrman). 
 “Baby Think It Over” has three fundamental flaws that prevent it from ever being successful.  First, the program has no clear goal and bases its assumptions on the Theory of Reasoned Action.  Second, the program induces psychological reactance in its participants.  Third, the program is ineffectively delivered and gives mixed messages.  The proposed intervention takes a different stance on teen pregnancy prevention, and aims to correct for the three fundamental flaws of the “Baby Think It Over” program previously discussed.

Critique 1

         A major problem of the “Baby Think It Over” program is the lack of a clearly defined goal.  It wants to prevent teen pregnancies, but it does not distinguish between wanted and unwanted teen pregnancies.  It also does not specify whether the solution to teen pregnancy is safe sex or no sex at all.  Ostensibly, the goals of the project are to help students realize the responsibility of having a baby, and presumably that they need to wait before having children.  However, Richard Jurmain, the creator of the program, maintains that the main lessons learned from the program are not about values but "sleeplessness," which as he states, "is a compelling rationale for not getting pregnant” (Cheakalos).
The “Baby Think It Over” program is also based on the Theory of Reasoned Action, and therefore makes incorrect underlying assumptions about why teens get pregnant.  According to the Theory of Reasoned Action, people have rational decision-making processes and skills, and decsions are influenced by two factors: a person’s attitude towards the heavier and their perception of social norms (Edberg).  If the goal of the program is to prevent wanted teen pregnancies, then the underlying assumptions
are that teens actively choose to become pregnant, and that they want to become pregnant because they do not understand how difficult parenting is.  If the goal of the program is to prevent unwanted teen pregnancies, then the underlying assumptions are even more ridiculous: teens choose to have sex, and choose to have unprotected sex, because, again, they do not understand how difficult parenting is.  The problem with this is that human behavior is not always rational, especially when erections are involved (Ariely).  In fact, according to Dan Ariely’s book “Predictably Irrational,” subjects were more than twice as likely to engage in risky sexual behavior and 25 percent less likely to use a condom when asked in a “hot” aroused state than a “cold” non-aroused state.  Also, the majority of teen pregnancies are unplanned, meaning that no rational decision – at least about the difficulty of parenting – was made at all (Finer).

Critique 2

 A second problem with “Baby Think It Over” is the degree to which is induces psychological reactance in its participants.  The program gives students infant simulators to convince them to wait to have children, and therefore in order to be successful the program needs its participants to fail at their parenting tasks.  In reality, some students inevitably end up scoring highly, thereby defeating the whole purpose of “Baby Think It Over” – to prove that parenting is hard.  In fact many students state that they found “Baby Think It Over” to be easier than they expected it to be, and they believe that real infant care will probably be even easier (Kralewski).  More importantly though, according to the theory of psychological reactance, giving teens a message that they “cannot” do something – for example, be a parent – will make them want to do it more.  The theory posits that when people feel that a freedom is threatened, they experience a motivational state aimed at restoring that freedom (Silvia).  “Baby Think It Over” induces psychological reactance because it is attempting to take away teens’ freedom to have sex, something which nearly-mature bodies and still-maturing minds are intensely concerned with. 

Critique 3

         A final critique of the “Baby Think It Over” program is the way it is delivered – the instructor is not effective and the program has implicit mixed messages.  Because teens as young as thirteen take part in this program as a school project, it is important for the instructor to be relatable and respectable.  The instructor is often not relatable to the students due to age and race differences.  The program is also delivered with mixed messages: the students are told to take the project seriously and reflect upon the hardships of being a teen parent, but at the same time they are given bonus points if they take lots of pictures with their “baby” and create “family” photo albums (Borr).  As previously stated, although the program is based on a premise that students will fail, this is not always the case.  Not only do students often find the project to be easy, they also find it to be fun – some students throw baby showers and birthday parties for each other and their “babies” (Borr).  The mixed messages, combined with the fact that they are coming from a non-similar, not necessarily respected adult, do not create a strong lasting impression.

Proposed Intervention

         The proposed intervention aims to correct the fundamental flaws present in “Baby Think It Over” with a new intervention focused on empowerment and control.  The data is unclear on whether or not infant simulators have the potential to be effective in preventing teen pregnancy, even if the program surround the simulators is changed.  Therefore, the proposed intervention will abandon the use of infant simulators.  Also, because the proposed intervention is not assuming that teens get pregnant for lack of parenthood knowledge, an infant simulator is unnecessary anyways.
         In reality, teens get pregnant due to an interacting web of factors, but one of the most significant underlying factors is a feeling that they are not in control of their own lives.  The teenage brain is not fully developed, and teens are more likely to engage in risky behavior, think less about consequences, and focus on only immediate effects and consequences than a fully developed adult brain (Hedaya).  When teens feel that their futures are not under their own control, their inherent inability to think rationally is compounded.  In terms of sexual behavior, they are more likely to engage in unprotected sex, have multiple partners, and generally increase their risk for pregnancy (National Campaign).  The feeling of a lack of control arises from a number of factors such as low socioeconomic status, life stressors, living in an impoverished area, and community or cultural norms.  If teens live in an area where no one reaches their goals then the teens will not expect to reach their own goals either.  Likewise, if teens see their peers having children young then they will begin to think it is the norm.
         What the proposed intervention aims to do is break this cycle of learned helplessness by empowering teens.  The core value of the program is “control.”  Teens in high risk areas will be part of small focus groups, available at school or through community centers, where they will have discussions and do exercises that focus on empowerment and controlling their own lives. 

Defense 1

         The proposed intervention has a clearly defined goal: to make safe sex the natural choice in order to prevent unwanted teen pregnancies.  The intervention acknowledges that many teens will chose to participate in sexual activity, and rather than explicitly attempting to prevent that activity it will instead attempt to make it safe.  The intervention aims to prevent unwanted teen pregnancies because the majority of teen pregnancies are unwanted, and because the underlying factors in wanted teen pregnancies are far more complex and beyond the scope of the intervention.
         In order to make safe sex the natural choice, the intervention will focus on empowering teens to realize why safe sex is the best option for them.  The underlying assumption of the intervention is that unwanted teen pregnancies happen because of a lack of control.  According to Kathryn Edin’s book “Promises I Can Keep,” women who have no access to opportunities use children as validation; the unconditional love of a child and the attention they bring is a replacement for academic or professional success, intimacy, etc.  In a way “Baby Think It Over” reinforces this because other people often give participants excessive attention while they are caring for their “baby” (Borr).  To address this, the proposed intervention will empower teenagers to realize their opportunities, dreams, and desires, and that getting pregnant will reduce the control they have over their own futures.  This will be a lot more effective than patronizingly assuming that teens get pregnant because they are ignorant to the trials of parenthood. 

Defense 2

         Where “Baby Think It Over” induces psychological reactance by impeding on personal freedom, the proposed intervention will instead make teens induce psychological reactance on themselves by getting them to visualize themselves fulfilling their dreams, so if they do something that prevents those dreams, such as getting pregnant, then they are taking away their own freedom.  The intervention also aims to increase the number and kind of positive freedoms teens feel they have.  Many teens have an optimistic bias about teen pregnancy, thinking, “It won’t happen to me.”  Optimistic bias is the tendency of people to be unrealistically optimistic about their own future life events and the expectation of others to be victims of misfortune rather than themselves (Weinstein).  Even if teens do realize their susceptibility to the threat of teen pregnancy, they often have an inverse illusion of control and feel like whether or not they get pregnant is not under their control.  The illusion of control is an expectancy of personal success greater than is appropriately warranted due to an incorrect assumption of control over chance situations (Langer).  Therefore, an inverse illusion of control could be thought of as an incorrect assumption of chance in situations which one does have control over; learned helplessness in a sense (Langer).  The program will address these things by talking about different contraception choices as well as healthy relationship practices, showing teens that pregnancy is within their control and it is their freedom to exercise that control.
         It is also important that the program not increase the stigma of being a teen parent further.  Many teenagers in high risk areas have exposure to teen parents – they know teen parents, they were the child of a teen parent, etc.  Therefore, a program that is insensitive and not careful in its language and underlying messages will increase psychological reactance by angering and alienating the participants.  Furthermore, it is important for teens who are already parents to know that it is still possible, on some level, to achieve their dreams and desires.  The program does not aim to say “you cannot achieve your dreams with a baby;” it simply aims to say “reaching your goals is easier without a baby.”

Defense 3

“Baby Think It Over” struggles to leave a lasting impression on its participants due to its mixed messages and non-similar instructors.  Communications theory and the theory of psychological reactance both show that a message is more effective and persuasive if the person delivering it likeable, familiar, and similar to the target population.  Furthermore, the message itself should be clear and concise, have justification, and have positive associations.  For this reason, the program will be delivered by role-models who are similar in race and age to the target population, and likeable.  The program will also engage familiar community leaders to back the message, further increasing its effectiveness.  For example, if the program is being implemented in a school then a well-liked student body president will be involved in delivering the program.
This piece of the program is particularly necessary for encouraging condom usage.  Social expectation theory shows that individuals take behavioral cues from groups by observing the social norm (DeFleur).  Therefore, if the program makes condoms appear to be the social norm, they will in fact become the norm.  There are several ways in which the program will attempt to make condoms the social norm.  First, the familiar community leaders will endorse them.  Second, condoms will be readily available and free in schools, community centers, apartment complexes, and anywhere else the program is implemented.  Third, advertising for condoms that is created by the program will bear a promise of control over one’s own life and will contain popular music and images.  In this way, the program can attempt to alter social norms and make condom usage the natural choice.


         “Baby Think It Over” is a fundamentally flawed program for three reasons: it has unclear goals and incorrect assumptions based on rational behavior patterns, it induces psychological reactance in its participants, and it is delivered ineffectively and with mixed messages.  The proposed intervention to prevent unplanned teen pregnancy corrects for those fundamental flaws by setting clear goals based on accurate assumptions about teen sexual behavior, it is formatted to minimize psychological reactance, and it is delivered in an effective way following theories of communication and social norms.  Ultimately, the proposed intervention would enhance teens’ feelings of control over their own lives and help them to realize their life potential.  Combined with effective advertising and adjustment of social norms in the community, this would make safe sex the natural choice.

Works Cited
§  Ariely, Dan. Predictably Irational: The Hidden Forces That Shape Our Decisions. New York: Harper Perennial, 2009.
§  Borr, Mari L. “Baby Think It Over: A Weekend with an Infant Simulator.” Journal of Family & Consumer Sciences Education (2009). NATEfacts.
§  Cheakalos, Christina. “Shrieking Baby Doll Gives Jolt of Parenthood for Teenagers.” Editorial. Herald-Journal [Atlanta] (1994). Google News.
§  DeFleur, M. Theories of Mass Communication. White Plains, NY: Longman Inc., 1989.
§  Didion, J., and H. Gatzke. “The Baby Think It Over Experience to Prevent Teen Pregnancy: A Postintervention Evaluation.” Public Health Nursing (2004). PubMed.
§  Drawbaugh, Kevin. “Baby Doll Teaches US Teens about Parenthood.” Editorial. The Nation [Chicago] (1997). Google News.
§  Edberg, M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publisher, 2007. Course Reader.
§  Edin, Kathryn, and Maria Kefalas. Promises I Can Keep: Why Poor Women Put Motherhood before Marriage. Berkeley: University of California, 2005.
§  Finer, L.B., and Kost, K. “Unintended Pregnancy Rates at the State Level.” Perspectives on Sexual and Reproductive Health (2011).
§  Hedaya, Robert. “The Teenager’s Brain.” Psychology Today (2010).
§  Herrman, J.W., J.K. Waterhouse, and J. Chiquoine. “Evaluation of an Infant Simulator Intervention for Teen Pregnancy Prevention.” Journal of Obstetric, Gynecologic, and Neonatal Nursing (2011). PubMed.
§  Kralewski, J., and C. Stevens-Simon. “Does Mothering a Doll Change Teens' Thoughts about Pregnancy?” Pediatrics (2000). PubMed.
§  Langer, E. “The illusion of control.” Journal of Personality and Social Psychology (1975). Course Reader
§  National Campaign, The. The National Campaign to Prevent Teen and Unwanted Pregnancy. Web. [http://www.thenationalcampaign.org/]
§  Reality Works, Inc. Realityworks - Experiential Learning Technology. Web. [http://www.realityworks.com/]
§  Silvia, Paul. “Deflecting reactance: The role of similarity in increasing compliance and reducing resistance.” Basic and Applied Social Psychology (2005). Course Reader.
§  Weinstein, N. “Unrealistic optimism about future life events.” Journal of Personality and Social Psychology (1980).  Course Reader

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