Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Sunday, December 9, 2007

Think It Over, Baby: The Failure Of Current Teen Pregnancy Prevention Programs To Effectively Decrease Teen Pregnancy Rates – Sarah Christy

In the United States, teen pregnancy rates are higher than any other industrial nation. There are many schools of thought to why this has been a continuing problem from the 1980’s, until 1990 when teen pregnancy rates hit a major peak. It was at this point that public health officials began to implement programs in the schools that educated youth about the consequences of sexual activity, specifically unprotected sex.

When various types of teen pregnancy prevention programs, some abstinence-based and some contraceptive-based, were put into practice in the junior and high school arenas, pregnancy rates dropped about 27 percent between 1990 and 2000. This was a change from 116.3 pregnancies per 1000 girls aged 15-19 to 84.5 pregnancies per 1000 girls. However, the U.S. is still leading the industrialized world for the highest number of teenage mothers, and after ten years of prevention programming there appears to be a plateau moving toward a gradual rise again in teenage pregnancies. On the national level, teen pregnancy prevention programs have recently been unsuccessful at decreasing teen pregnancy rates because they are not incorporating three important social science concepts into their curricula.

Two Flavors of Prevention Programs

There are two types of prevention programs that cities and schools have used to educate youth about sex. One program that has been popular in certain areas of the country has been the abstinence-only-until-marriage approach. This method of education emphasizes the importance of waiting for sexual debut till marriage, discusses other forms of affection that can be shown in relationships, and encourages individuals to make promises to themselves and their families that they will abstain until marriage. Contraception, condom use, and protection against STDs are generally not discussed. Some programs will discuss contraception failure rates and show graphic STD slides to instill fear into youth of the possible consequences of sex can be.

This type of program is based on individual decision-making and provides little education about sexuality. Popular abstinence-only curricula throughout the states have been: Education Now Babies Later (ENABL), Why Am I Tempted? (WAIT), Family Accountability Communicating Teen Sexuality (FACTS), Choosing the Best Life, Managing Pressures before Marriage, and AC Green's Game Plan, among others. Eleven of these programs were evaluated in ten states by Advocates for Youth, a non-profit organization that focuses on youth empowerment. The evaluation found no abstinence-only program that produced statistically significant changes in sexual behaviors among program youth relative to comparisons (1). A few programs showed mild success at improving attitudes and intentions to abstain, but no program was able to demonstrate a positive impact on sexual behavior over time.

Another type of teen pregnancy prevention program available to youth is comprehensive sex education, education that promotes abstinence but includes information about contraception and condoms to build young people's knowledge, attitudes and skills for when they do become sexually active. This type of program promotes individual decision-making by educating youth about the options available to them if they choose to engage in sexual activity. Various birth control methods are discussed, including their success and failure rates, in addition to pictures of STDs to show the physical symptoms for such infections and how to protect against them. Although this approach appears to give youth more knowledge for making healthy choices, the current comprehensive sex education curriculum is not resulting in a significant reduction in teen pregnancy rates. In New Mexico, six comprehensive programs were evaluated in early 2006. This curriculum called SB 124 is the New Mexico Statewide Teen Pregnancy Prevention Program and was found to show an increase in teens having oral sex, an increase in their number of sexual partners, and an increase in the number of program participants that were pregnant or caused pregnancy (2). All of these results show that there did not appear to be a reduction in teen sexual activity, which can increase the chances of STD transmission and unintended pregnancies.

The Only Thing to Fear is Fear Itself

The tactics of most sex education programs that were implemented in the early 1990’s are still being used today to educate youth about their bodies and to deter them from engaging in risky sexual activities. One tactic that has been the most popular and has been used in both types of programs discussed above is fear. Fear is intended to be a persuasive strategy when using statistics of high teen pregnancy rates and/or showing graphic pictures of body parts with the different STD infections. Although fear may have worked well in the early 1990’s to make teens think twice when teen pregnancy prevention programs were brand new, fear has a tendency to wear out after awhile. Fear of the unknown, which is what abstinence-only programs push, does not empower youth to make well-informed decisions for themselves. It teaches youth that they are not in control of their own lives in regard to contracting a sexually transmitted infection; that if they slip up and do get one, then it’s their own fault and their problem. In the contraceptive-based prevention approach, fear is also insinuated when discussing birth control method failure rates and when discussing STDs and HIV, however youth are told how to prevent pregnancy and infection by various methods. Youth are given the power to choose what is best for them once they have all the facts about abstinence and contraceptives. However, fear is the main mode of prevention by informing youth of why not to do something or how to avoid that particular feared thing. If fear is what these programs are operating on as a strong force for sparking change, it is no wonder that current programs of both types have failed in getting lasting results since the fear tactic has special requirements for keeping its potency.

Fear is often explained as arousing a drive that will produce a response (3). The idea is that the more fear-arousing the content, the more effective the appeal is predicted to be. However, studies have shown that a low fear appeal may produce change in behavior more than moderate or high fear messages because these can trigger defensive avoidance (3). This is the tendency to ignore or deny negative consequences that are depicted in a particular message because people cannot relate or choose not to relate to such fearful results.

Even if youth did choose to deal with the consequences of sex through some type of “fear control” to reduce the emotion of fear, they may actually choose avoidance or choose to dull the impact of the emotion with the consumption of drugs or alcohol. If fear is going to be used as an effective strategy in encouraging change in behavior, there needs to be a proper application of threat, personal efficacy and response efficacy (3). Personal efficacy is an individual’s belief that they are capable of carrying out a particular action to avoid a negative outcome, and response efficacy is their belief in the impact that the recommended behavior will have on that negative outcome. A problem-solution format for the message may be effective, however in the abstinence-only programs where STD pictures are shown, there is reference to the problem but no solution. If condom use as a source of protection from such infections is not addressed as a solution, the fear tactic is useless because personal efficacy and response efficacy is not included in the message, and therefore will result in an individual not having any choice of how to fix the problem. Advocates of these programs may say that the only solution available is to abstain from sexual activity, but if there is no regard of personal efficacy to complete the task of abstinence in the first place, a young person may take the risk because they know that pregnancy or an STD may not be the result in each sexual encounter, or because they feel that this result is inevitable. In contraceptive-based programs, personal efficacy is addressed when it is explained that youth have the power to choose a contraceptive to prevent pregnancy, but they may feel powerless in their ability to obtain the contraceptive. In most states as a minor, they have little rights to obtain such prevention tools without parental consent, and they also may not have the means or the access to getting them even if they don’t require parental consent. Either way, personal efficacy is limited in the contraceptive-based approach. Response efficacy is also limited because youth may feel that the appeal of having sex in such a sex-driven pop culture makes abstinence seem unattainable. They may also recognize that contraceptives are not 100% effective in preventing pregnancy and that using one is too much of a hassle. The reward of having sex may be more appealing than the risk of having unprotected sex.

It is also noted that fear can fade out over time in individuals who hear the same message continually. “Prevention fatigue” can occur in individuals and populations, where the message about abstinence and safer sex has been repeated so often that people ignore or actively refuse it (4). After 10 years of this message in teen pregnancy prevention programs, the fear of the possible consequences of sex at a young age may not influence as much change as intended. Although it has been thousands of different youth throughout these 10 years that have heard the message about sex in one way or another, people pass the word to younger generations about what they learned and may actually dilute the effect of the fear. It may be diluted by older siblings, friends, or through popular media. As current youth are told what to fear when they are in a prevention program, they are also being told by media that there is nothing to fear and that sex is a normal part of being young. If youth perceive that sex is not something to be feared but is an experience that they should have, then hearing about how to prevent an unintended pregnancy grows tired after awhile. There is a constant influx of new ways that sex is appealing in our society today, but the fear implemented in our current prevention programs has not changed and so it naturally loses appeal through a fading out process. Fear is no longer a strong method that grips youth into a behavioral change and may actually create the appeal.

Rebel Without a Cause

In most programming, the conservative approach of a strict adult telling a young person what to do is flawed because young people have an innate sense to rebel, which can lead to an increase in sexual activity. Youth do not want to be told what to do our how to do things. They want to believe that they are approaching adulthood as individuals in their decision making and that they know everything there is to know about it (5). Youth want to find out who they are while expressing themselves, and as parents or other authoritative figures attempt to protect their youth from making bad choices that will detriment their futures, young people feel more tied down from developing into who they want to be. Resentment may grow toward adult figures, which can lead to youth automatically invalidating anything that prevention program adults say is good for them. For youth to be told by older, authoritative figures in teen pregnancy prevention programs that they are not to do something, the natural reaction is to do the opposite. The appeal of the unknown may cause youth to feel the necessity to try it with the intention of it happening once, but this will most likely lead to continual sexual activity that is wrought with guilt and may lead to unprotected sexual encounters. In our society, sex is a topic that is controversial and taboo even in the adult world. When youth see images in the media of how popular culture is rebelling against this taboo, youth feel that they should be able to rebel too (5). Young people may believe that it is them versus the rest of society, which is trying to stop youth from expressing themselves.

The persistence of problem behavior throughout the centuries combined with the magnitude of contemporary problems suggests that there is an inherent risk in being an adolescent (6). Many social scientists believe that a basic lack of control during adolescence leads to youth choosing risky behavior (6). Youth are encountering so many mixed messages from parent figures, adults at their school and other youth/adults in the media, which causes them to feel a lack of control in their own lives and may make them want to take control through their actions. Whether or not youth feel these actions are good for them, they will do them so that they can claim control in an environment where they have little control, specifically due to their age and due to being told what to do. It is also the destructive nature of risky sexual behaviors, such as unprotected sex, that motivates the behavior in the first place (7). Youth will rebel in a manner that seems counterintuitive, however, they are simply responding to the messages they are given by multiple sources.

They are taking control, making a statement, and not focusing on how it will affect their future but how it will affect them in the present. It is the psychological root that both types of teen pregnancy prevention programs have ignored. They have assumed that youth will make healthy choices because that makes the most sense to an adult, however a young person may not be thinking about what’s best for them in the long-run but what feels good right now and what appears to have no problems right now (6). Young people choose to be sexually active and choose to have unprotected sex because they are looking for control in an age where they have very little.

As they are searching for their identities during the teenage years, youth believe that the choices they make will help shape who they are. In evaluating the flaw of current teen pregnancy prevention programs to recognize the inherent drive for youth to rebel, it is important to acknowledge Labeling Theory (8). This theory says that when a person is labeled as being a part of a group, they take on the tendencies of that label. Their behaviors can be predicted based on the behaviors of the group labeled. If teenagers are referred to as irresponsible or rebellious, then it is no surprise that youth have taken on those stereotypes of their age group. The more that adults treat youth in a particular way based on their label, then youth are going to respond in that same manner. This pattern is seen in the criminal justice system; as criminals internalize their label of being dangerous or unfit in society, they start to accept the way society has caste them and respond in a way that is more rebellious. Youth may feel that there is no point to choosing healthy behaviors because they will always be put into the “irresponsible and rebellious” group due to their age. Since youth are often labeled as irresponsible, they may also feel that being a teenager means that they should be wild and irresponsible so that they do not miss out on the best years of their life before they have to take on true responsibility as adults. Prevention programs have failed to motivate youth to realistically take on a new label of responsibility, which has become increasingly difficult as society tells them they are irresponsible and will make bad choices.

Being a Part of the Group

Teen pregnancy prevention programs in this country have also failed to address the important social science aspect of the group dynamic by focusing their attention on the individual. There is a lack of acknowledgement in programming that sexual activity involves a group dynamic, and the continuous approach of it being an individual issue has resulted in very little changes in sexual behavior patterns on a large population scale. Although the sexual activity itself comes down to individuals making that choice to engage in it at the time, their overall views and choices about sex are influenced by the group of people who are surround them. This group dynamic includes peers, family, and can even be society as a whole. All of these social networks have an influence on an individual’s decisions. Current teen pregnancy prevention programs focus on educating individuals to make the right choice for their own bodies; however what an individual chooses to do with their body depends on what they want, what they feel is allowed, and what they feel is accepted. All of these factors are wrapped in the social networks of their environment, especially as a teenager when their identity depends on how other people see them, not necessarily how they see themselves.

Current programs have not incorporated the important theories that predict and can influence sexual behavior choices in youth. The Diffusion of Innovations Theory looks at behavior changes or behavior adoption across a population over time, predicting that early influential adopters of a behavior can influence adoption of that behavior by most of the group as time goes by (9). It matters who the early adopters are that will cause a change in behavior among some people, who will also influence behavior to others, etc. Eventually the power of the majority can make a particular behavior look good to everyone, just as fashion can have that same effect. This theory specifically puts the power of change into the group’s grip; since youth are known to be highly influenced by their peers in their decision making, this approach may actually cause change on a larger scale. So far we have seen that pressure on the individual choice is given heavy weight in teen pregnancy prevention programming, however, if it is recognized that the special population of young people are more influenced by their peers, then change can occur when the peers are used to bring on that change. Teen pregnancy prevention programs have not set a trend in abstinence or contraceptive use that has been contagious enough to cause large-scale adoption. There has not been a good use of early adopters or mass media to spark the trend in youth, and therefore we have not seen a major drop in teen pregnancy because there is too much emphasis on individual behavior change for a behavior that is heavily group influenced.

As teen pregnancy continues to be a problem throughout the United States, we may see a shift in thinking that this is a social norm, instead of the traditional thinking that it is something to be avoided by all young people. The problem with this is that teens having unintended pregnancies and children will have a detrimental effect on society and on the individuals involved. Young people that are not financially and mentally equipped for raising children could lead to an exhaust of public funding for the costs of raising a child. It could also lead to the upbringing of children in home environments that are not prepared for raising healthy individuals that will positively contribute to society in the future. The young parents themselves may also lose out on opportunities for future growth and advancement. Their health could be in jeopardy if they are not protecting themselves from sexually transmitted infections. All of these possible consequences of teen sexual activity are reasons for educational teen pregnancy prevention programs to be in place; however they currently have not had the large impact on change in behavior that advocates have wanted. There are still 1 million teen pregnancies every year that affect each individual differently. It is vital that current programming re-evaluate their focus on fear tactics, the lack of acknowledgment of teenage rebellion, and the direct push of individual choice instead of group influence in their program techniques if they want to see a major change in youth sexual activity. The consequences of teen pregnancy are lasting and do not only affect the individual parents but also everyone around them; our youth deserve better programs that will have a more positive influence on their futures.


(1) Hauser, Deborah. Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact. 2006.
(2) Lopez, Linda M. Reasons to Defeat SB 124—Statewide Teen Pregnancy Prevention Program. New Mexico Abstinence Education Coalition. 2006.
(3) Hale, Jerold L. and Dillard, James P. Fear Appeals in Health Promotion Campaigns. Theory-Driven Approaches. pg. 65-69
(4) Hart, G J, Williamson, L M. Increase in HIV sexual risk behavior in homosexual men in Scotland, 1996-2002: prevention failure? Pg. 73
(5) Bluhm, J. There’s No Single Face of Rebellion. Illinois Issues. 1999.
(6) Andrews, David W. Understanding Adolescent Problem Behavior.
(7) Siegel, Michael, and Doner, Lynne. The Importance of Formative Research in Public Health Campaigns: An Example from the Area of HIV Prevention among Gay Men. Marketing Public Health. Pg. 80
(8) Downs, WR, Robertson, JF, and Harrison, LR. Control Theory, Labeling Theory, and the Delivery of Services for Drug Abuse to Adolescents. Journal of Psychopathology and Social Sciences. Spring 1997.
(9) Edberg, M. Essentials of Health Behavior, Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett. 2007. Pg 58.

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