A faint cry echoes from the next room, waking a young girl from her deep sleep. It gets louder. And louder. She rolls her dishevelled, pink sheets over for the third time this evening. Her eyes are crusty and heavy. Her arm knocks a metal jewellery hanger to the ground as she gets out of bed, rings and bracelets scatter the floor. As she drowsily tip toes over the clutter, she follows the now piercing sound. Gently picking the small figure up from their cradle, she ensures their head is well supported, before slowly rocking them back and forth to soothe them. No – it is not a real baby, it is actually an infant simulator, designed to give high school students a taste of the daily (and nightly) duties that come with parenting.
According to a recently released report from the Australian Institute of Health and Welfare, teenage mothers are not uncommon in Australia, despite teenage pregnancy rates dropping since 2005. Out of 308,887 babies born during 2015, 8268 were born to mothers aged under 20, equating to a birth rate of 11.4 births per 1000 women aged 15-19.
The Virtual Infant Parenting program (an adaption from the RealCare Baby or Baby Think It Over program as first established in the US) is currently being used within the Australian school curriculum. The program assesses high school students, typically those in child development classes, on tasks such as feeding, burping, rocking and changing infant simulators. With a focus on providing lessons on teenage pregnancy aimed at prevention, how effective is the VIP program?
Apparently, not very, according to a study published in the prestigious medical journal, The Lancet.
The study, Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised controlled trial in Western Australia, found the program to be achieving the opposite of its intended aim, after comparing results of girls aged 13-15 across 57 schools in Perth, who were randomly assigned to an intervention (28 schools) or control (29 schools) category for the project. The 1268 girls in the intervention schools received the program, while 1567 girls in the control schools received the standard health education curriculum. A higher proportion of girls in the intervention category (8 per cent, compared to girls in the control category 4), recorded at least one birth as their first pregnancy before turning 20, while nine per cent, opposed to six per cent, recorded at least one abortion respectively.
Lead researcher of the study and Telethon Kids Institute head of child health development and education Sally Brinkman says the program is not achieving its aim.
“Clearly we found that it doesn’t work. Why it doesn’t work, we don’t know and to a certain extent, that’s relevant for conclusion as the study is really, the program shouldn’t be operating anymore,” Dr Brinkman says.
“There is a belief that education systems and school systems in general have a responsibility to be implementing programs that they know that work, whereas now, there is clear evidence that [the program] doesn’t, so I would consider it, at a minimum, a waste of resources and potentially doing harm.”
Department of Education Statewide Services executive director Lindsay Hale says the department has notified school principals of the findings of the research.
“Public schools make local decisions about the use of educational resources and specific lessons based on the needs and interests of their students and the curriculum,” Mr Hale says.
“Principals will use these findings to inform their decisions about these simulators.”
Mr Hale says, in WA public schools, the VIP program usually has another purpose.
“Infant simulators are generally used in WA public schools as part of learning about employment in the childcare industry in Years 11 and 12, and not with the intention of reducing the risk of teenage pregnancy,” Mr Hale said.
In a review of the study by University of Notre Dame professor Julie Quinlivan, Magic dolls no quick fix for teenage pregnancy, the concept of girls idealising parenthood, an absence of sex education at a young age and lack of investment into disadvantaged children, whether due to socioeconomic, educational or environmental factors, are among potential conclusions as to why the program had mixed results.
Sure enough, repeatedly waking up in the middle of the night to feed their infant simulator a bottle of milk or change its old nappy did not seem to worry the young girls who partook in the study, who instead generally enjoyed the idea of playing ‘mother’ for a few days.
Dr Brinkman says: “When we’d done the questionnaires of the students, the vast majority of them enjoyed it and liked it. It wasn’t that they didn’t understand the aims of the program or anything of those likes, but they actually seemed to enjoy the experience of looking after the baby.
“People like [the program], you know, when I get these sorts of questions they keep saying, ‘we do lots of things that we like, even though we know that they’re not good for us’.
“It would not be what I would recommend, I would not recommend the use of the program, if you’re trying to reduce teenage pregnancy.”
Newman College student Ali Strack, who undertook the VIP program last year as part of her child development class, says although stressful at times, she enjoyed the experience of looking after the infant simulator and understood why some girls, including herself, did not want to part with with their ‘baby’ once the program ended.
Dr Brinkman agrees with Dr Quinlivan that socioeconomic factors should be considered when developing programs for schools based around parenting education or deterring teenage pregnancy.
“When you look at the things that are associated with teenage pregnancy, they’re broader socioeconomic factors, so you’re looking at the student’s education levels themselves and how successful they are in school, which then of course is clearly associated with their own socioeconomic positions – whether their parents are employed – it’s all of the social demographics, what we would call social determinants of health that are highly related to teenage pregnancy,” Dr Brinkman says.
“When you look at programs that are trying to impact teenage pregnancy within the school environment, the majority of those programs are not trying to support the broader socioeconomic predictors of teenage pregnancy.”
With potential barriers to the VIP program having been identified, what might the future hold for alternative teen pregnancy prevency programs in Australian high schools?
Curtin University School of Public Health research associate and lecturer Jacqui Hendriks says empowering those in low socioeconomic areas to have choice and pursue future life aspirations is an important strategy schools should use.
“I did some research quite a number of years ago where I interviewed a whole range of sexually active adolescents. A third of those had never been pregnant, but two thirds of that study, about 40 girls had been pregnant. 20 of them had chosen to terminate and 20 of them had chosen to continue with their pregnancy,” Dr Hendriks says.
“We were really interested to see out of those 40 girls who were sexually active at a young age and end up with a pregnancy, why had some chosen to terminate and why had some chosen to continue and it fell quite heavily along the socioeconomic line.
“For someone who has a lot of capacity in their life, is well supported, has a future life plan, is well educated, they were more likely to choose to terminate their pregnancy because they had future life goals and aspirations that they wanted to achieve and they felt like having a baby at that point in their life was going to derail that.
“The girls from the lower socioeconomic status who didn’t have a lot of capacity and support, they essentially, were in their last few years of high school wondering what was going to happen in their life…becoming a mother and having a baby who loves them and idolises them seemed like quite an enjoyable prospect.”
Another of Dr Quinlivan’s theories as to why the program is not having the desired outcome is because it was primarily directed at female students.
Dr Hendriks says any sort of relationship and sex education program given to young people should be delivered to both males and females.
“I think for majority of content we need to be teaching all students collectively at the same time, because it’s just as important for boys to hear the girls side of things and girls to hear the boys side of things and for them to hear the perspective of their peers in real time,” Dr Hendriks says.
“But I also acknowledge that there is benefits to occasionally splitting the genders and giving groups the safe space to talk about male specific issues and female specific issues.
“I definitely think there needs to be an expansion and we definitely need to be involving the young men in this conversation, but I wouldn’t be advocating for a role out of that particular model with the virtual babies.”