Australian Study Casts Doubt on Effectiveness of Infant Simulators in Preventing Teenage Pregnancy

Programs that aim to reduce teen pregnancy by training and requiring youth to care for lifelike infant dolls may not be effective, according to a school-based, cluster randomized controlled trial among young women in Australia. (1) Greater proportions of 13-15-year-old females who participated in a virtual infant parenting (VIP) program--which used infant simulators with realistic sleeping and feeding patterns--than of peers who received a standard health education curriculum experienced a live birth (8% vs. 4%) or an induced abortion (9% vs. 6%) by age 20. In analyses that accounted for factors that could affect these outcomes, VIP program participants still had a 40% higher risk than controls of experiencing a live birth, stillbirth or induced abortion by age 20. The trial was conducted in schools in the Perth metropolitan area of Western Australia between 2003 and 2006. Non-Catholic government and nongovernment schools were randomly assigned to deliver a VIP pregnancy prevention program or the standard health education curriculum to female youth in grades 9 and 10. The VIP program, Baby Think It Over, was adapted from a similar U.S. program; it aimed to delay pregnancy and to improve knowledge and awareness of preconception health issues. It was delivered by school health nurses over six days and entailed small group educational sessions, a comprehensive reference workbook, a video documentary of teenage mothers talking about their experiences, and caring for an infant simulator from a Friday afternoon through the following Monday morning. In the trial, a total of 57 schools were randomized--28 to the VIP program group and 29 to the control group; however, one intervention school was excluded because it did not recruit students according to the study's protocol. The overall rate of consent and participation of eligible female students was 58% at VIP program schools, translating to a sample of 1,267 teenagers, and 50% at control schools, translating to a sample of 1,567 teenagers. Investigators followed all participants until age 20, and ascertained their experience of a pregnancy event (live birth, stillbirth or induced abortion) through use of linked hospital and abortion clinic records. The investigators used binomial and Cox proportional hazards regression analyses to assess differences in pregnancy event rates between the study groups. At the time of trial enrollment, participants in each group had a median age of 15. The majority of participants in the intervention and control groups lived with both their biological parents (58% and 63%, respectively) and were sexually inexperienced (84% and 81%). Forty-two percent of youth in the VIP program group and 26% in the control group had a high level of socioeconomic disadvantage--that is, they were living in a household with a below-median socioeconomic index for their district. …