Infant simulator programs which aim to prevent teenage pregnancy have become quite popular intervention techniques over the past few years. But their effectiveness at preventing teenage pregnancy has never been closely examined before.
Now researchers have conducted trials in schools in Perth, Australia, to investigate the Virtual Infant Parenting (VIP) program on pregnancy outcomes of birth and induced abortion in Australia. Their conclusion is quite grim; the infant simulator intervention did not work.
After adjusting for potential confounders, girls in the intervention group actually had a higher overall pregnancy risk than those in the control group and were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.
Students were randomly assigned in equal ratio to the intervention and control groups. Between 2003 and 2006, the VIP program was assigned to girls aged 13 to 15 years in the intervention group, while girls of the same age in the control group received the standard health education curriculum. The girls’ progress was closely monitored until they reached 20 years of age via data linkage to hospital medical and abortion clinic records. The primary endpoint was the occurrence of pregnancy during the teenage years. Statistical analysis was conducted to test for differences in pregnancy rates between study groups.
57 (86%) of 66 eligible schools were enrolled into the trial and randomly assigned in equal ratios to the intervention (28 schools) or the control group (29 schools). Afterwards, between Feb 1, 2003, and May 31, 2006, 1,267 girls in the intervention schools received the VIP program while 1,567 girls in the control schools received the standard health education curriculum. Compared with girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth.
97 girls from a total of 1,267 in the intervention group had reported being pregnant which equaled 8%, whereas in the control group only 67 girls out of a total of 1,567 reported being pregnant, or at least one abortion as the first pregnancy event (113 [9%] vs 101 [6%]).
After adjustment for potential confounders, the intervention group had a higher overall pregnancy risk than the control group. Similar results were obtained with the use of proportional hazard models. The results were published in The Lancet.
It was concluded that the infant simulator-based VIP program did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.
Teenage pregnancy has become a critical adolescent health issue. Infant simulator programs are used extensively in countries with all kinds of economies. High income, low income as well as middle income countries are using these programs to curb teenage sex and eventual pregnancies, but despite growing popularity no published evidence exists of their long-term effect. Not only that but pregnancy outcomes are generally associated with higher rates of preterm birth and overall poorer health conditions and serious medical complications.
Moreover, as a long term effect, mothers who were teenagers at the time of first birth have higher odds of utilizing social security and healthcare services than those with relatively older mothers, and most often than not, the teenagers fail to accomplish academically, career-wise and economically.
Hence government agencies tried to come up with an out-of-the box approach and quick. So the best they could up with was the infant simulator plan. Initial thoughts were that if a teenage girl took care of a simulated baby, the experience would be sufficiently profound and challenging to act as a reality check against the perils of teenage pregnancy. When educational interventions were involved, government agencies thought they had hit out of the park and funding started flooding in.
There were however many challenges that this controversial approach faced. The simulators were expensive, their effectiveness was unclear, published trials were small and inadequately powered, outcomes were variable and evidence for behavioral change was virtually negligible.
So the question is: why did the system fail?
There are four reasons. Firstly, the study only focused on the fairer sex and put the males totally out of the picture. Fathers, in situations of teenage pregnancy, are an anxious, stressed out and often a violent bunch. They are at a higher exposure to drug and substance use and are less educated than older fathers. They are therefore less likely to respond positively to a simulated baby for a week, and are more likely to skip out on the program.
Secondly, teenage pregnancy is an outcome, not a cause. History has suggested that people who indulge in sex at a young age, are usually faced with adversity in childhood. Interventions need to be put in place earlier than secondary school, focusing on the environment of the infant and the child. By the time the child reaches secondary school, they might feel the urge to reproduce as an evolutionary response to the fear they felt during their tough childhood.
Thirdly, some teenage girls idolize parenthood. This intervention technique exaggerates positive aspects whilst at the same time not putting enough focus on or attention towards the negative aspect of early parenthood. Teenagers who are put in charge of handling the simulated babies are given positive reinforcement by their fellow peers and family members.
This unexpected attention is taken for granted and mistaken for something more meaningful. More importantly, a doll cannot replace a real life baby no matter how expensive it is. A doll is not actually an accurate model to represent the problems of early age parenthood.
Finally, and most importantly, teenage pregnancy, although often labelled as a cause of social and economic burden, is more likely an association. Cohort studies have found little economic difference between sisters from disadvantaged backgrounds where one gave birth as a teenager and the other sister did not. The crucial causal factor is disadvantage, be it socio-economic, educational, or environmental.
When put into perspective, preventing teenage pregnancy is a lot more complicated than just assigning a doll. Both sexes need to be studied carefully. Programs need to assess kids at an early age. Special focus should be placed on troubled children who feel desolate since they are at a greater risk to be involved in risky behavior. There is no such thing as a quick-fix when it comes to teenage pregnancy.