To lower teen pregnancy rates in the city, the mayor is relying on fear, guilt and shame. But how effective are such approaches in changing behavior?
The messages on the posters are not subtle, and they’re not meant to be: a crying toddler with the caption, “I’m twice as likely not to graduate high school because you had me as a teen,” reads one, while another shows a little girl saying, “Honestly Mom… chances are he won’t stay with you. What happens to me?”
Appearing in New York’s subways, these messages are part of a new campaign to reduce teen pregnancy in the city that has stirred significant controversy. Bronx councilwoman Annabel Palma, who had a son at age 17, said in a letter sent to the city’s Human Resources Administration (HRA) complaining about the campaign that “Its dismissive tone perpetuates hurtful stereotypes about teen parents and their children. Moreover, it discounts HRA’s own pregnancy prevention services and instead imbeds[sic] fear in those who are in the situation I was in not so long ago.” Though New York City Mayor Michael Bloomberg typically supports evidence-based public health initiatives, such as his ban on trans fat from restaurant foods after studies showed their health hazards, with this one, he may have missed that boat.
Bloomberg has defended the so-called fear campaign, which also includes a text message game where one pregnant teen is called a “loser” (it was originally “fat loser,” but that has been changed) by her best friend. He told the New York Times that the city’s message shouldn’t be “value neutral” about teen pregnancy and that he wanted to “send a strong message that teen pregnancy has consequences — and those consequences are extremely negative, life-altering and most often disproportionately borne by young women.”
But how effective are such strong, and negatively toned strategies in changing behavior? Research on other attempts to use shame to address obesity, smoking and drug addictions suggests that the results are not good.
With addictions, for example, research shows that shame is ineffective and often actually backfires. A recent study of 105 people in early recovery from alcoholism found that the more shame the drinkers displayed in recounting their last drinking episode, the more likely they were to relapse and the more they drank during that relapse.
A review of the research on using confrontation to shame and humiliate people in addiction treatment concluded that “Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations.”
A similar trend occurs with obesity: the more embarrassed a person feels about his weight, the more likely he is to gain, rather than lose pounds, according to one study of nearly 500 obese people. Earlier research also linked shame to worse outcomes in terms of successful behavior change.
Media campaigns against smoking have similarly failed with youth when their primary goal is to instill fear of distant consequences, such as lung damage or having a kid who won’t graduate high school. But there are ads that work, the research shows, and these focus on the near-term and offer concrete actions to take to address problems.
When it comes to sexual behavior among teens, there is little research that directly addresses the question of shame in influencing how sexually active they are, but data shows that abstinence-only sex education, which attempts to stigmatize early sex, often through religious messages, is not effective in preventing teen pregnancy. The highest rates of teen pregnancy tend to be in states and countries where abstinence-only education predominates and the lowest rates occur in states and countries where information about sex and contraception is provided in a nonjudgmental manner, which is the approach New York already uses in its schools.
And the message that teen pregnancy can lead to economic hardship and a greater chance of living below the poverty level is also more complex than the campaign implies. Research on pregnant teens suggests that, as Haydee Morales of Planned Parenthood told the Times, “It’s not teen pregnancies that cause poverty, but poverty that causes teen pregnancy.” Studies show, for example, that teen pregnancy is even more highly correlated with economic inequality than poverty alone, with greater inequality linked with a higher number of early pregnancies among the poor. New York City has one of the highest levels of inequality in the country.
Another issue that shame campaigns fail to address is the role of early childhood trauma in contributing to teen pregnancy. The more negative experiences a girl has — for example, neglect, physical, emotional or sexual abuse, growing up with an alcoholic or addicted parent or having a parent in prison— the more likely she is to become pregnant in adolescence. A study of 6015 girls enrolled in Kaiser Permanente’s health plan in California found that those who had seven or eight adverse childhood experiences were three times as likely to become pregnant as a teen, compared to those with none. In fact, for girls with the highest level of child trauma, the odds of teen pregnancy were a stunning 53%.
And negative childhood experiences don’t just affect girls’ risk. For boys, the odds of involvement in teen pregnancy were nearly tripled if they had five or more adverse experiences, compared to having none. Boys who had been sexually abused, another study found, were five times more likely to get a teenage girl pregnant, compared to those who hadn’t been abused.
All of this suggests that the factors that contribute to teen pregnancy are varied and complex, and that painting such early pregnancies as a shameful experience is not likely to be effective. Instead, the data support other strategies that may address some of the major reasons why teens get pregnant; and public health campaigns driven by such data, rather than moralizing, may have a bigger impact on teen sexual behavior.