Thursday, May 6, 2010

Combating and Invariably Reducing the Rates of Unintentional Teenage Pregnancy: A Program Critique of MTV’s Teenage Pregnancy Intervention “16 and Pre

1) Introduction:
Unintended teenage pregnancy is a critical issue evident in society. The United States’ birthrate for teenagers ages fifteen to nineteen is 41.9 per 1,000 women, illustrating the dire need for innovative policy and program intervention aimed at reducing unintended pregnancies among this vulnerable age group (4). In an attempt to intervene and reduce the rate of teenage pregnancy, the cable channel MTV has implemented an intervention program whose popularity has far exceeded expectation yet whose success in reducing teenage pregnancy has remained rather questionable.
2) Scope of Problem:
Roughly half of adolescents in the United States are sexually active: 46 percent of teenage girls and 48 percent of teenage boys have reported being sexually active by senior year of high school and one in ten sexually active teenagers has reported engaging in sex with at least four partners within the past year (2). High rates of sexual activity coupled with the lack of adequate contraceptive use render many adolescents at increased risk for pregnancy. The United States teenage pregnancy rate is significantly higher than that of many other industrialized countries with rates two to six times greater than those in countries of Western Europe (12). By the age of twenty, over 30 percent of females have become pregnant at least once in their lifetime: 72 percent of these pregnancies are unplanned and 84 percent of these pregnancies are to unmarried females (15). Ninety percent of teenage mothers that give birth elect to raise their baby (2). Teenage mothers are more likely to drop out of high school, have large families, remain single parents, and never attain a college education (12). In fact, eight out of ten teenage mothers drop out of high school after having a baby (18). Infants of teenage mothers are more likely to be born preterm, have a low birth weight, have higher rates of infant mortality, experience neglect or physical abuse, have lower levels of cognitive attainment and proficiency, exhibit behavioral problems, have chronic medical conditions, rely more heavily on public assistance, become incarcerated, drop out of high school, become teenage parents, and be unemployed (4). The home environment of teenage parents often places the infant at increased risks due to: physical living conditions, decreased educational stimuli, and poorer quality of parent-child interactions (5).
Teenage pregnancy costs the United States taxpayers an estimated nine billion dollars per year (12). Of that, $1.9 billion per year is allocated towards increased public sector health care costs, $2.3 billion towards increased child Welfare costs, $2.3 billion towards state prison systems, and $2.9 billion in lost revenues and taxes from teenage mothers (12). Seven out of ten teenage mothers rely on welfare while Medicaid pays roughly 66 percent of the health care needs of teenage mothers and their babies (18). From the years 1991 to 2004 the estimated cumulative costs of teenage child bearing totaled: $161 billion (12).
Due to the lack of adequate use of contraceptive methods, adolescents are at an increased risk for pregnancy. Adolescents commonly cite the following reasons for failure to utilize condoms during sexual activity: odor affiliated with the latex, lack of lubrication, excessive lubrication, lack of condom access, difficulty disposing of the condom, the thickness and feeling of the condom, difficulty opening the package, diminished sensation, partner pressure to not use condoms, condom inexperience, overestimated belief that other teens are not utilizing condoms, and diminished perceived susceptibility to pregnancy and infection when engaging in unprotected sex (8). Teenagers in monogamous relationships are less likely to use condoms even when another form of contraception is not used (8). In addition, adolescents often cite ‘the power of passion’ as the predominant reason for failure to utilize condoms during sexual activity: these individuals state that rational judgment is often removed in the heat of the moment during sexual encounters (8).
3) Current Intervention:
As a means to combating teenage pregnancy, the cable television company MTV has partnered with the National Campaign to Prevent Teen and Unplanned Pregnancy to create a reality show titled: “16 and Pregnant” aimed at reducing United States teenage pregnancy rates. The show follows pregnant teenage mothers, their partners, and families as the teens struggle through pregnancy, delivery, and childcare to illustrate the perils and life-altering experiences of teenage parenting (1). The show recruits participants from its website, where pregnant adolescents desiring to participate can complete and submit an application (1). For those applicants that are selected, the teenage mothers are financially compensated for their time and filming begins around the start of the second trimester of pregnancy. The show’s executive producer, Morgan J. Freeman claims the show is targeted as a public service to minimize national teenage pregnancy rates (7). In addition, Freeman claims the casting directors spend a substantial amount of time screening applicants as a means to ‘weeding out’ those who want to be on the show solely to gain publicity rather than to share their experience as a pregnant teen (7). Ironically, the little information that is presented during the television show is presented in times when the majority of viewers have already flipped the channel or disengaged, such as immediately pre or post-commercial break.
In addition to the television program, the National Campaign to Prevent Teen and Unplanned Pregnancy distributes free copies of the show along with teenage-appropriate discussion guides to schools and other adolescent-affiliated organizations (7). These discussion guides contain brief summaries of each of the program’s television episodes, in addition to statistics and thought-provoking questions aimed at preventing teenage pregnancy (12). Furthermore, MTV has created a “16 and Pregnant” website, equipped with copies of the show’s episodes, photos of the teenage mothers and their babies (as well as a completely different section dedicated solely to pictures of the babies), soundtracks to the episodes, message boards, insider-alert news feeds, a link to casting information and applications to next season’s episodes, Facebook links, and links to purchase the season’s full episodes on DVD (12). The website also contains links to two additional MTV-affiliated websites: and
4) Critique of Current Intervention:
The show “16 and Pregnant” designed as an intervention to minimize the rates of teenage pregnancy has remained a repeated source of controversy and conflict. Critics not only question whether the show can actually dissuade adolescents from becoming pregnant but also question the ethics of using high-risk teenage mothers as public examples of ‘what not to do’ during an intensely vulnerable, life-altering time in these adolescent’s lives. Many critics have wondered whether the show’s participants truly comprehend the potential ramifications of being on a reality television show watched by millions of viewers (7). Detractors have also questioned MTV’s motives when creating and subsequently renewing the reality show for a second season: when does the program stop being an accurate depiction of the perils of teenage pregnancy and start becoming a means to raking in money, viewers, and overall net profits (7)? In addition to the ethical and moral questions associated with the show, public health practitioners have also cited a number of social science theories as to why the show will not actually fulfill its proposed goal of reducing the incidence rates of teenage pregnancy. There are three main arguments as to why MTV’s “16 and Pregnant” will not reduce United States unintended teenage pregnancy rates: (1) the program does an ineffective job of educating adolescents about teenage pregnancy prevention and fails to take into account the physiological state of the adolescent brain, relying on the program’s website to educate viewers (2) the program utilizes scare-tactics as a means to preventing teens from engaging in sexual activity rather than educating about contraceptives and pregnancy prevention and, (3) the program presents adolescent viewers with contradictory messages regarding teenage pregnancy and parenting.
a) Critique One:
Given the developmental state of the adolescent brain, the subtle means in which the television episodes educate adolescents about pregnancy prevention is ineffective and will not provide adolescents with the tools necessary to prevent pregnancy when in a sexually aroused state. During adolescence, the brain is not yet fully developed, remaining in a crucial state of physiological development. During this time, the amygdala controlling the brain’s emotional response is in a stage of advanced development while the brain’s frontal lobes, controlling the executive functioning, remains underdeveloped (10). Variation in brain development renders it increasingly difficult for teens to plan ahead for the future and make responsible, rational decisions regarding their bodies. This mismatch often motivates adolescents to follow their impulses and emotions when engaging in sexual activity (10). Therefore, adolescents watching “16 and Pregnant” may not perceive themselves at increased risk for pregnancy, and may not consequently feel the need to educate and prepare for contraceptive use prior to the onset of sexual activity. The fact that the television show does not incorporate an extensive educational component within the show, instead instructing viewers to access the show’s website for educational information renders many teens unlikely to access the website and gain crucial knowledge about pregnancy prevention.
In addition, the small amount of educational material that is presented to viewers during the course of the show is offered in a manner that does not prepare adolescent viewers to respond and protect themselves when in a state of sexual arousal (such as right before or during sexual activity). Material regarding pregnancy risk and prevention is stated as facts rather than in a way that is conducive to adolescent learning: adolescents may hear the material and assume that they would know better than to engage in unprotected sex because they material is presented while viewers are not sexually aroused. However, when adolescent viewers are placed in a situation of sexual arousal, the program’s educational means do not adequately equip them with the skills necessary to refuse unprotected sex and engage in safe sex negotiation.
In addition, presenting adult-generated information to adolescents (rather than peer-generated information) may generate Psychological Reactance, based on the theory that individuals adversely reacting to behavior recommendations may perceive these recommendations to impede on one’s autonomy, consequently causing the individual to rebel from suggested behaviors (12). Program contraceptive information created by adults but targeted to adolescents may cause adolescents to rebel from the suggested behavior changes, inevitably placing them at an even higher risk for pregnancy outcomes.
When in a non-aroused state (such as one that a viewer would naturally be in while watching the program), individuals tend to underestimate the influence of emotional arousal in terms of preferences and decisions, rendering them less likely to pay attention to the program’s cues and suggestions to view the website for prevention information (3). When the adolescent brain receives cues that are commonly associated with sexual intercourse (experiencing an increased state of arousal) there is increased motivation to engage in sexual activity, despite risks associated with pregnancy (3). Sexual arousal narrows the focus of motivation, creating a ‘tunnel vision’ effect where goals other than sexual fulfillment are overturned by the motivation and desire to engage in sex (3). This distorts judgment associated with the risks of unprotected sex: the state of sexual arousal influences the judgment and choice executive functions of the brain, causing adolescents to minimize the significance of other factors such as protecting oneself against pregnancy (3). Inevitably, the program’s educational tactics fail to provide viewers with the knowledge and skills necessary to avoid high-risk sexual encounters and risk of pregnancy.
b) Critique Two:
The television program focuses on informing teens to prevent pregnancy by avoiding sexual activity rather than by increasing regular use of effective contraceptives. The show utilizes a ‘scare tactic’ as a means of motivating teens to abstain from sex: this tactic is similar to those used in abstinence-only sexual education programs, rendering many viewers susceptible to proceeding based on inadequate knowledge (18). Not only has research proven that it is easier and more effective to change one’s contraceptive use than to change one’s engagement in sexual activity, research has also shown that it is extremely difficult to deter sexually-experienced teens from having sex (18).
The show’s use of scare tactics as a means to preventing teenage pregnancy is questionable: fear messages can be an ineffective means to promoting long-term behavioral change (such as involvement in sexual activity or contraceptive use), especially if the threat is perceived as irrelevant or insignificant to the adolescent viewer. In situations where the adolescent does not perceive oneself to be at risk for the occurrence (teenage pregnancy) there is no motivation for one to further process the program message and create a protective response (such as contraceptive use and education) (18). If the campaign only succeeds in scaring the audience, it will inevitably fail because it does not state how to explicitly prevent this induced fear from occurring (18).
In addition, the use of scare tactics often sends adolescent viewers the message that the majority of adolescents are engaging in unprotected sexual intercourse. When coupled with the lack of contraceptive education available during the hour-long episodes, adolescent viewers may fail to realize the need and availability of effective contraceptive methods, placing many viewers at increased risk for pregnancy. Social norms have a significant influence over adolescents. Perceived social norms establish the basis for how individuals, particularly adolescents, will construct and act out social expectations: individuals tend to adopt social norms and modify behavior to reflect those of the mass (6). If adolescent viewers perceive the majority of teenagers to engage in unprotected sexual intercourse, then these viewers are more likely to themselves fail to utilize contraception during sex. Inevitably, the show’s use of scare tactics to prevent teenage pregnancy not only fail to adequately educate viewers on contraception, but also provide a false sense of social norms incorrectly based on the idea that all teens are engaging in unprotected sex.
c) Critique Three:
The program sends adolescent viewers contradictory messages regarding teenage sex: while telling viewers to abstain from sexual activity, the show dually ‘glorifies’ teenage pregnancy by presenting viewers with teenage mothers who have evolved into ‘celebrities’. The show’s inability to send a consistent message to viewers that unintended teenage pregnancy is undesirable, places many vulnerable adolescent viewers at increased risk for pregnancy.
The program’s episodes sport teenage mothers receiving increased levels of attention from family and friends alike, while celebrating baby showers with extensive gifts, guests, and excitement. The season episodes and reunion episode present ample time for the teenage mothers to ‘show off’ their babies in adorable outfits, getting much desired attention. Viewers may become ‘awed’ by the adorable babies dressed in stylish outfits. Having teenage mothers bring out their infants while concurrently discussing teenage pregnancy prevention sends out conflicting messages to viewers as it is extremely difficult for teenage mothers to admit their baby was a mistake (rather than the best thing that has ever happened to them) post-birth. At the end of the shows, the teens, perhaps as a method of preserving their reputation, often repeatedly state how happy they are as mothers and how they feel an irreplaceable bond and love for their babies. Not only does this send conflicting messages to viewers, but it also may render particularly vulnerable teens more likely to yearn babies of their own as a means to filling a void and feeling loved, appreciated, and needed.
The show’s website further conflicts the message aimed at adolescent viewers: the website is eye-catching and trendy, containing fun, interactive components linking further resources for pregnant and teenage mothers. The site contains a section where pregnant and parenting teens can get free messages to their cell phones containing information to help the teen through the pregnancy and the baby’s first year of life. Viewers are motivated to text “baby” to the given phone number to obtain these fun, interactive messages. The website contains an entire section with photo galleries of images of the episode’s featured babies, dressed in adorable outfits guaranteed to gain the attention of adolescent viewers. These photos can be very distracting for teenagers, who may feel an inconsistent message sent by MTV: one should not become pregnant as a teenager, however, if one does, one will have an adorable baby and could potentially become a ‘celebrity’ featured on MTV. The teenage mothers featured on the show’s first two seasons have fan pages where viewers write affectionate and supportive messages to these mothers: in fact, the program’s Facebook page contains 161,976 ‘fans’ in support of the teen mothers. For adolescent viewers lacking adequate attention and affection in their present lives, these factors may attract and motivate them to become pregnant as a means to gaining likewise attention and support.
In addition, the show often perceives the teenage mothers as the victims while (in most cases) the teenage male involved in the pregnancy (often the boyfriend) evolve into the villain. This gender labeling sends the incorrect message to female adolescents that pregnancy prevention is solely controlled by the male, deterring female adolescents from accessing the program’s website to obtain further information about pregnancy prevention as a means to adequately protecting oneself.
According to Social Expectation Theory, which focuses on the idea that individuals conform to the norms of the society in which they are living, individuals are heavily influenced by media sources. The ways in which media sources (such as those previously mentioned) present people, social interactions, and social norms significantly affect and motivate individual behavior (6). Therefore, if teenage pregnancy is presented and perceived in an attractive manner by adolescent viewers, a significant proportion of these viewers may perceive unprotected sex, teenage pregnancy, and teenage parenting as attractive, popular social norms (6). Media such as the “16 and Pregnant” television show and interactive website are prime examples of sources influencing the behaviors and norms of its target audience.
In addition to the Social Expectation Theory, the Diffusion of Innovation Theory similarly explains the above concept. Diffusion of Innovation Theory is utilized to predict and explain the spread of behavior and social norms over a particular population (17). This theory suggests that ‘media and interpersonal contacts’ provide individuals with knowledge that influences one’s opinion and personal judgment (17). Therefore, adolescent viewers who conclude through the “16 and Pregnant” television show and website that teenage pregnancy is a positive and desirable norm are more likely to desire to themselves engage in activities that would likely result in becoming pregnant. If the program’s ‘cool, celebrity-like’ teenagers become pregnant and are now currently teenage mothers, other adolescents may be more inclined to adopt the same behaviors and consequences.
5) Proposed Intervention:
Research has shown that short, interactive videos, such as hour-long episodes of “16 and Pregnant”, do not alone have an effect on behavior such as increased usage of contraception or abstaining from sexual activity (12). Therefore, in order to ensure that MTV’s “16 and Pregnant” intervention program actually minimizes the rate of teenage pregnancy, efforts need to be made to alter the current intervention as a means to making it more effective, realistic, and efficacious. Program coordinators and project developers of MTV’s “16 and Pregnant” should make the following alterations to their program: (1) the program should increase the educational content presented during the actual television episode to model techniques conducive to the adolescent brain and learning (2) the program should cease use of a scare tactic as a means to preventing teenage pregnancy and instead focus on providing prevention strategies and resources and, (3) the episodes and websites must be edited and modified to prevent contradictory messages and viewer interpretation of teenage pregnancy. The following three defenses further explain the rationale for modifying MTV’s “16 and Pregnant” intervention program:
a) Defense One:
Currently, the program’s episodes do not contain adequate educational information about teenage pregnancy prevention, relying on the program’s website to guide viewers to further information. Given the underdevelopment of the adolescent brain’s cognitive executive functioning, viewers are often unable to foresee themselves as at risk for pregnancy, thus failing to access the website for further information (3). In addition, adolescent viewers remain in a physiologically un-aroused sexual state when watching the episodes thus failing to recognize that they may place themselves in high-risk sexual situations when in an aroused state and may not be adequately prepared to negotiate safe-sex practices (3). Therefore, educational components of the program should include techniques such as role-playing and condom negotiation to provide viewers with techniques that would be useful when placed in aroused, high-risk situations. This information should be presented using age and racially appropriate ‘models’ that teach and illustrate these techniques to viewers (4). Educational information should not be presented immediately pre or post-commercial break, as the number of viewers during these times may be minimized. By incorporating more information and educational techniques within the television episodes, the responsibility to access the program’s website for adequate information is not left up to the discretion of the adolescent viewer.
Adolescent sexual activity occurs sporadically and is often unplanned (3). If adolescents underestimate the likelihood that they will have sex, or the likelihood that they would potentially engage in unprotected sex when condoms are unavailable, they are likely to fail to take adequate precautions (such as accessing the program’s website) to prevent adverse occurrences (3). It is imperative to include further educational components to the program’s episodes combining role playing, safe sex negotiation, condom demonstrations, contraceptive information and access to adequately prepare teens to manage situations that may place them at increased risk for pregnancy (12). By integrating pregnancy prevention education techniques into every episode of the intervention program, contraceptive use becomes a social norm to the adolescent population, rendering them more likely to engage in proper and consecutive use, diminishing the prevalence of unintended pregnancies.

b) Defense Two:
Currently, the program’s usage of scare tactics to prevent adolescents from engaging in sexual activity relies on the belief that these scare tactics will deter adolescents from having sex and consequently does not provide adolescents with adequate information about how to prevent pregnancies from occurring if indeed sex does occur. The reality of the situation is that showing teenagers unrealistic situations that have a small possibility occurring do not prevent them from engaging in these behaviors (18). Therefore, it is imperative to equip viewers with the knowledge and skills necessary to prevent pregnancy when sexual activity does occur (5). It is much more difficult to stop teens who are already having sex from engaging in sexual activity than it is to delay first sexual encounter for teens that are not yet having sex (5). This education is especially prudent for teens who have already engaged in sexual activity because although sexually experienced adolescents are unlikely to cease sexual activity, they are likely to alter activity to reflect safer practices if provided with adequate and reasonable knowledge (5).
Replacing program scare tactics with educational techniques that enable viewers the ability to develop skills necessary to resist pressures relating to dating, sexual activity, and contraception will significantly reduce the number of unintended pregnancies (12). Providing viewers with effective contraception strategies that include discussion of where to access contraception and how to properly use the contraception while presenting information in the least embarrassing and most inexpensive manner will help to ensure program success (18).

c) Defense Three:
Creating an intervention program aimed at reducing teenage pregnancy will remain ineffective if participants are presented with conflicting messages about teenage pregnancy and parenting. Currently, the program’s episodes and website send adolescent viewers with conflicting messages, glamorizing teenage pregnancy in a way that may inevitably persuade some adolescents to intentionally become pregnant as a means to filling an emotional void and gaining attention.
By restructuring the episodes and website to minimize contradictory information, the show will allow adolescent viewers to focus on the underlying message regarding the financial, emotional, and social struggles associated with teenage pregnancy. In addition, it is imperative to make viewers understand that both the female and male are involved and responsible for protecting against unintended pregnancy: presenting the female as the victim while the male as the villain often place full responsibility for pregnancy prevention on the male, dissuading adolescent girls from advocating for themselves and their needs. It is imperative that female adolescent viewers take responsibility for safe sex practices to prevent unintentional pregnancy. Although it is important for the show to portray the reality of the relationships of teenage parents (the majority of teenage parents do not remain together and often times the female is left with the vast majority of responsibility) as a means to ensuring that female adolescents do not assume that the male involved in the pregnancy will remain committed to the female or the baby, methods need to be employed to empower female viewers to make safe sex decisions and prevent them from receiving contradicting and perhaps damaging messages about babies and life post-pregnancy.
It is necessary for the program to positively incorporate the Social Expectation Theory and Diffusion of Innovations Theory as a means to altering the social norms presented to adolescent viewers to prevent teenage pregnancy. Using these two theories, the program could alter the perceived social norms of the target adolescent population, sending a message that not only is teenage pregnancy undesirable, but the adolescent and larger population norm is to engage in methods to prevent pregnancy such as contraceptive use or abstaining from sexual intercourse. This can be done by presenting statistics and information about the number of adolescents who are not engaging in sexual activity: roughly 54 percent of high school seniors have not engaged in sexual intercourse (12). In addition, by including adolescents on each episode that self-identify as abstaining from sex or consistently using a long-acting contraceptive method, adolescent viewers are more likely to perceive these behaviors as the social norms. By making these individuals into teenage ‘celebrities’, adolescents are more likely to desire to replicate these actions and safe-sex behaviors (6). Use of these safe-sex teenage celebrities will further prevent contradicting messages for adolescent viewers. Use of these techniques through media such as the program episodes and website will ensure a positive impact and subsequent drop in teenage pregnancy rates (6, 17).
6) Conclusion:
The current contents of the MTV program “16 and Pregnant” aimed at reducing rates of unintended teenage pregnancy fail to address and combat its targeted issue due to three main reasons: (1) the program ineffectively educates adolescents about teenage pregnancy prevention during the television episodes, relying predominantly on the program’s website for educational references (2) the program’s scare tactics fail to educate teens about pregnancy prevention methods and contraception and, (3) the program sends contradictory messages about teenage pregnancy to viewers, glamorizing aspects of the program’s teenage mothers.
It is imperative that measures be taken to alter and improve the efficacy of the current intervention in order to effectively target and reduce teenage pregnancy. By integrating a heavier educational component into the program’s episodes, including more information regarding pregnancy prevention and contraception, and by minimizing the potential for viewers to obtain conflicting images about teenage pregnancy, the program will significantly improve its ability to combat one of public health’s greatest issues: unintended teenage pregnancy.


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