Baby simulator program may make teenage girls more, not less, likely to become pregnant

A teenage pregnancy prevention program involving a baby simulator does not appear to have any long-term effect on reducing the risk of teenage pregnancy. In fact, the study found that teenage girls who took part were more, not less, likely to become pregnant compared to girls who did not take part.

The Virtual Infant Parenting (VIP) program is an Australian adaptation of the US program RealityWorks. Intended as a pregnancy prevention program, the VIP program is delivered in schools and includes educational sessions (eg, the impact of not smoking, drinking or taking drugs on a healthy pregnancy, good nutrition, the financial costs of having a baby, sexual health, contraception, and respectful relationships), a workbook, watching a video documentary of teenage mothers talking about their experiences, and caring for an infant simulator over the weekend. The infant simulator is a doll that cries when it needs to be fed, burped, rocked or changed and measures and reports on mishandling, crying time, the number of changes and general care.

The use of infant simulator programs is common in developed countries and their use is increasing in low and middle income countries. Despite this, there is no robust evidence of their effectiveness. While some studies have looked at the effect on girls' intentions to get pregnant, or attitudes to pregnancy, no randomised trials have objectively measured the impact on pregnancy.

A total of 57 schools in Western Australia took part in the study. Schools were randomly allocated to receive either the VIP program (1267 girls), which is delivered by school nurses over 6 consecutive days, or to receive the standard health education curriculum (1567 girls). The researchers then linked this information to data from hospital records and abortion clinics. All girls were aged 13-15 at the start of the study and they were followed until the age of 20.

Compared to girls in the control group, girls enrolled on the VIP program had higher rates of pregnancy and abortion. 8% of the girls in the intervention group had at least one birth, compared to 4% in the control group. Similarly, 9% of girls in the intervention group had an abortion, compared to 6% in the control group.

"Our study shows that the pregnancy prevention program delivered in Western Australia, which involves an infant simulator, does not reduce the risk of pregnancy in teenage girls. In fact, the risk of pregnancy is actually increased compared to girls who didn't take part in the intervention" says lead author Dr Sally Brinkman, Telethon Kids Institute, University of Western Australia, Adelaide, Australia. "Similar programs are increasingly being offered in schools around the world, and evidence now suggests they do not have the desired long-term effect of reducing teenage pregnancy. These interventions are likely to be an ineffective use of public resources for pregnancy prevention."

The authors say that the study included a large number of teenagers, but caution that the overall participation in the study was quite low (45% in the control schools and 58% in the intervention schools), so there is no information about the girls who chose not to enrol. However, they say that participation in this type of intervention is voluntary in Australia, so the girls who did take part are likely to be an accurate reflection of those who would normally do so (eg, outside a trial). They also note that girls in the control group had on average a higher socio economic status and educational attainment, but when the research team re-ran the analysis to take these factors into account, they found that this had no effect on the findings.

Experts agreed a change in policy and education was needed. Young people need non-judgmental sex and relationships education and ready access to contraceptives, said Dr Rowe. Accessible reproductive health services are vital in reducing teen pregnancies.

Professor Dyson added it was important to educate teens to develop critical thinking skills and understanding of respectful and consensual relationships. “We have to treat them as capable people who are able to make decisions, not just threaten them with negative outcomes,” she said.

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