Challenging Dogma - Fall 2011

Monday, December 19, 2011

Teen Pregnancy in the United States: A Critique of 16 & Pregnant as a Public Health Intervention – Julia Venanzi

The teen pregnancy rate in the United states is at a record low; 39.1 births per 1,000 females compared to 61.8 births per 1,000 in 1991. However, this is still the highest rate of teen pregnancy of any of the developed countries. Teen moms are a greater risk for health problems, like preeclampsia. Children of teen moms are also at a higher risk of become teen parents. The abortion rate for teen pregnancy has almost decreased to 14.5% of all teen pregnancies in 2003 (1).
Lauren Dolgen, creator of the MTV shows 16 & Pregnant and Teen Mom describes their inception as follows;
“About three years ago, I was reading an article about teen pregnancy, and there was a statistic in it that kind of stopped me cold. It was 750,000 girls from the age of 15 to 19 get pregnant every year. And it just - it was like getting hit in the gut. And I realized this is happening to our audience, and it's happening to them, their friends, or girls at their school” (2).

MTV created the show with noble intentions, to bring teenage pregnancy into the culture conscience. Teenage pregnancy has long been a controversial issue in the United States, so featuring it in such open way on a major network certainly presented a risk. The problem with Teen Mom and 16 & Pregnant as a public health intervention lays in its execution. The show does not accurately show the demographics of teen pregnancy causing it to fail in its goal of creating characters the audience could relate to. The creators of the show did not foresee the media’s glorification of the teenagers featured on the show. The media spectacle that followed undermined the harsh realities the show aimed to portray. Lastly, by airing, Teen Mom and 16 & Pregnant on a channel where hook up culture and unsafe sex practices are commonplace, MTV sends teens mixed messages about sexual activity. While there has been some evidence that Teen Mom has helped create a dialogue about teen pregnancy, it is far from a perfect public health intervention.

Critique #1: Inaccurate understanding of target population

Creator of 16 & Pregnant, Lauren Dolgen, describes the development of the show, “we [the producers] wanted to keep it very pure and to, you know, really have it through the point of view of the girls that are going through this. They wanted to share their stories as kind of a teaching tool for other girls to avoid, you know, getting in that situation” (3). Here Dolgen displays her understanding of the importance of role models and the positive effects of having teens hearing a message delivered by their peers. The idea of using a spokesperson that is relatable to the target audience is a pillar of advertising and marketing theory. The theory strives to connect with the consumer and encourage them to imagine using their product (4). In the case of 16 & Pregnant, the creators had the right idea of using advertising theory to create a relatable scenario; however, the problem lays in their inability to accurately reflect the population most likely to become teen mothers.
African American teenage girls are almost three times as likely to become pregnant than their white counterparts (1). The Hispanic teenage birth rate was 70 births per 1,000 women in comparison with 25 per white non- Hispanic teens. Over three seasons, 16 & Pregnant followed 23 Caucasian teens, 6 African- American teens, and 6 Hispanic teens (5). In an interview in Time magazine, Tiera Brown, who is an African American teenage mom, said “"The girls on the show go out a lot," Brown says. "I rarely see them working. Some of the emotions they go through when [fighting with] their parents and not getting along with their baby's father, I can relate to. But other than that — all the good stuff — I can't relate." (6). While no intervention will be applicable to every situation, the lack of diversity on 16 & Pregnant seems glaringly specific. In defense of their casting choices, former executive producer of 16 & Pregnant, Liz Gately comments, “"If we did inner-city people who really had difficulty with their upbringing," she says, "we thought the public will discount this as, 'Oh, that doesn't apply to me” (3). Even if the racist implication that the “inner city” does not constitute a part of the general public is ignored, Gately’s statements show a grave misunderstanding about the nature of teen pregnancy in the U.S. If 16 & Pregnant’s actual goal were to reduce teen pregnancy in the United States a more accurate representation of teen pregnancy should have been presented on the show.
Another issue with 16 & Pregnant and Teen Mom is the focus solely on the women involved. The show is called Teen Mom not Teen Parents. By ignoring 50% of the population responsible for teen pregnancy, Teen Mom does a disservice to young women and allows young men to feel unequally accountable. Even stylistically, the show’s advertisements and introduction feature a “notebook” style of animation that would not be out of place in a 9th grade girl’s math notebook. By targeting the program toward women, it continues to propagate the idea that women shoulder the responsibility in a pregnancy. While both shows do feature the fathers, when possible, it does not seem to be an equal portrayal. Kayla Jackson and her child’s father, Mike Schwing were featured on season three of 16 & Pregnant. While the episode focuses mostly on Kayla and her tense relationship with her own mother and struggles with an eating disorder, we only briefly hear about Mike. In one scene Mike mentions in passing that he has dropped out of college in order to work to support his family. By glossing over this fact, 16 & Pregnant loses an important moment for Mike to connect with a male audience and show how becoming a teen father can derail future plans (5).

Critique 2: Glorification of pregnancy
Another problematic aspect of 16 & Pregnant is the subsequent glorification of the teens featured on the show. After appearing on the show, the teenagers are catapulted into the cultural conscious through tabloid covers, heavy social media presence, and online forums. Additionally, the teens featured on the show are compensated an unpublished amount by MTV. Whitney Purvis, featured on season 1 of 16 & Pregnant says that she was compensated $5,000 for appearing on the show (7). Dolgen states, “Yeah, we don't really disclose what our casts get paid, but the girls are compensated’ (3). While it is fair for the teens who allowed cameras into their lives during a very tumultuous time to be compensated, it’s hard not to see this as exploitation considering the significant financial struggles the teens face. While standing trial for domestic violence and negligence this January, Amber Portwood, of season 1, revealed that MTV pays her $140,000 per 6 month contract (8).
People, especially adolescents act irrationally when faced with difficult decisions (9). While all the teens have signed releases and allowed cameras into their lives it seems like MTV has taken advantage of a vulnerable population. Purvis states that she has meet other teens “who are wanting to get pregnant just to be on the show’ (Purvis). While the argument that 16 & Pregnant encourages copycatting behavior is likely unfounded, it is important to understand that teenagers are not thinking rationally about pregnancy. Media critic, Jessica Coen of, states “ MTV can be as objective as they want about it but once these women, these young women, are being followed by tabloids and on TMZ and on the cover of US Weekly it’s hard to view them as documentary subjects. They’re reality stars” (7). Coen brings up a valid point. These young women are no longer documentary subjects; MTV has turned them into reality TV stars. The series Teen Mom supposedly portrays the struggles of young mothers, but as the camera follows Farrah’s decision whether or not to get breast implants or Maci’s dating choices, Teen Mom veers towards drama and away from informative documentary. By making these women “stars,” MTV equates them with other celebrities who teenagers, sometimes misguidedly, emulate.
Additionally, for a show that prides itself on showing, “honest, unpleasant truth of teen pregnancy in America -- the whole truth” (2). 16 & Pregnant as an intervention fails to take into account the impact these teens have beyond the confines of the 60 minute show. While MTV has no control over their actions outside the show, the consistent tabloid presence and legal problems of multiple show participants factors into the power of the message 16 & Pregnant delivers.
Teen Mom and 16 & Pregnant created extremely active social media present. Most of the moms featured have active, verified Twitter accounts. Maci Bookout, who was featured on the first season of 16 & Pregnant and then subsequently on Teen Mom, tweets to over 420,000 followers under the Twitter handle @MaciBookoutMTV. Her account exemplifies the impact of 16 & Pregnant beyond the show. Reuters reported that the two names fast growing names in 2011 were Maci and Bentley, her son’s name (10). While it is unreasonable and illegal for MTV to prevent the young women featured on the show to use social media or sell stories to tabloids, it should at least acknowledge the impact on the show.
Most importantly MTV should be addressing the legal trouble that multiple show participants face. The shocking example of Season 1 mom, Ebony Jackson-Rendon and her husband Josh Rendon is particularly sad. The couple was arrested in September of 2011 for felony charges of maintaining a drug premises and misdemeanor charges of endangering the welfare of a minor (11). The police report states that the conditions of the home were “deplorable” and that the house “was full of maggots, flies and both human and dog feces’ (11). This endangerment of a child surely is no fault of MTV, but could have provided a moment to further underline the extreme challenges of parenting as a teen if it was addressed by the show. By providing an update on the couple and using it as a teaching moment, MTV could have controlled some of the backlash it received. By picking and choosing what to feature on the show, MTV does a disservice to the viewers by failing to show the full picture of teen parenting.

Critique 3: The message of Teen Mom is inconsistent with MTV programming
While it is certainly commendable for MTV to get people talking about teen pregnancy, the efficacy is weaken by its presentation on a channel who also produces a show called I Just Want My Pants Back. Other current MTV programming includes The Jersey Shore, which features binge drinking as the sole plot point as well as The Real World, the show that in its infancy was lauded as a fresh look at issues facing young adults, but has quickly devolved into televised bacchanalia (5). This inconsistency in programming sends a mixed message to teenagers, who are susceptible to unrealistic optimism (12). If a teenager watches cast members of The Real World get drunk, have a one night stand and be congratulated, they are more likely to identify with that scenario than the plight of those featured on Teen Mom. The classic “it won’t happen to me” concept is encouraged by featuring multiple shows where young adults act out without any consequence.
MTV has established a partnership with the National Campaign to Prevent Teen and Unplanned Pregnancy as well as creating their own campaign on sexual health, It’s Your Sex Life (13). The website for It’s Your Sex Life has a user friendly design, straightforward facts and plenty of resources for teenagers. It’s unfortunate that these collaborations become diluted when held next to MTV culture as a whole. For example, It’s Your Sex Life features the following section with advice for talking to a partner about sex.
“LOVE YOURSELF by respecting yourself. If your partner refuses to use condoms, be firm. No condom, no sex. If your partner doesn’t want to protect you and his/herself and doesn’t respect your wishes, you might want to ask yourself if you really want to have sex with this person” (13).

The following are quotes from Vinny Guadagnino of The Jersey Shore:
“Seeing Nicole cleaning is like seeing Mike with a f-cking condom. It just doesn't happen.” Episode 12, Ciao Italia (14).

“I thought she was gonna get with Mike, I thought she was gonna get with Deena, I didn't know who this chick was gonna get with, but somehow she ends up on top of me” Episode 3, Twinning (14).

Its problematic that It’s Your Sex Life offers sound public health advice as one paragraph on their website and that The Jersey Shore premiered to 8.8 million viewers this season (15). While its naïve to think that a network would sacrifice massive amounts of advertising money and viewers by foregoing airing shows like The Jersey Shore, it does raise the question that Teen Mom or 16 & Pregnant might not be being presented on the correct platform. It’s understandable for the network to run shows like The Real World or Jersey Shore. They are entertainment fluff at its finest; more importantly, they feature adults. The problem lies in MTV’s reliance on the viewer to determine between escapism and realism.
This critique is not a takedown of MTV programming as a whole, its examining what could be a valuable teaching tool’s power become diluted by its programming block. In 2010, the Kaiser Family Foundation funded the reproduction of the show so that it could be disturbed to schools and nonprofits as a learning tool (16). By presenting the show in a classroom, Teen Mom allows for an honest dialogue with immediate feedback. Teachers or non-profit workers can steer teens towards resources and point out which aspects of the show are less realistic.

Intervention 1: Change the setting
It has been proven that a multi-faceted approach to sexual education works most effectively. The most effective intervention to prevent unwanted pregnancies was a combined educational and contraceptive promotion (17).
In Piaget’s theory of cognitive development, it is theorized that by age 11 or 12, adolescents fully display formal operational reasoning skills. The final stage of Piaget’s model, the formal operational stage is the point at which adolescents are able to reason and assign rational consequences to abstract situations (18). In the case of teenage pregnancy, this would mean an adolescent reconciling the physical act of sex with the lifelong commitment of having a child. Teen Mom and 16 & Pregnant do a good job illustrating this reasoning. Showing the long term effects of pregnancy is an important piece of transferring that theory to a personalized example; however, this alone is not enough to reduce teen pregnancy rates.
An important aspect of a comprehensive sexual education is accurate, straightforward information about contraception and the biology of pregnancy. Some commonly held myths teenagers believe can range from the myth that a woman cannot get pregnant the first time she has sex to something as mistaken as condoms being reusable (19). A basic working knowledge of biology and contraception is essential for any intervention about teenage pregnancy (18).
Teen Mom and 16 & Pregnant could become more effective by presenting the series in a different setting. By incorporating Teen Mom’s capitalization on teen’s operational reasoning skills and couching it in an educational environment, Teen Mom could prevent more pregnancies. Having a sex educator on hand to supplement Teen Mom with facts and to answer questions would improve the intervention. The Kaiser Family Foundation saw this possibility and bought the right to reproduce the series to show in schools and allow nonprofits to use it (16). By presenting Teen Mom and 16 & Pregnant in a classroom, the mixed messages of the media are not removed but they facilitate the conversation. While censorship of television will not and should not be evoked, the ability to have a discussion about what is realistic and what is not would help teenagers make more rational decisions about sex.

Intervention 2: Using positive framing and the Social ecological model
Teen Mom uses it platform as a way to show teenagers the harsh realities of teen pregnancy; however, interventions based out of fear, or framed in a negative way, do not account for the larger social influence. A teenager can watch 16 & Pregnant, identify with the moms featured and believe that they will make different choices about unsafe sex. The lack of education is not the issue. The issue is that when a teen finds themselves in situation that is unsafe, they lack the self-esteem to assert themselves (18).
The Social Ecological Model, popularized by Urie Bronfenbrenner, examines the interaction between the different “spheres” in an individual’s life and how they affect each other and the individual. The model shows the individual at the center of 4 concentric circles of influence; interpersonal, organizational, community and policy (20). This theory can be applied to teenage pregnancy interventions to excel beyond the average educational and contraceptive interventions. Studies have shown that by focus on improving more broad social influences can improve teenage health outcomes. For example, the Gatehouse Project intervention featured a high focus on improving teacher student communication, parent- teacher communication, and problem solving as a route to behavioral change and increased health outcomes, instead of focusing solely on pregnancy reduction or decreased drinking. The study found that the intervention cohort had 25% less marked risky behaviors, which included early initiation of sexual intercourse and substance abuse (21). Studies show that teens with higher self-esteem are more likely to use contraception when they become sexually active. Additionally, those who didn’t not regularly use contraception were found to be “more impulsive and lack an internalized locus of control” (18).
As for Teen Mom, the idea of changing the framing to the positive message of improved self- esteem may be the piece the show lacks. It currently provides education, as well as real life examples, but misses the positive spin. MTV has tried to include their reunion specials as a way to start a dialogue and to allow an expert to weigh in on the issue. This seems like an afterthought and for the teen moms featured surely is too late to intervene; however, if MTV featured a show that was equally relatable, for example in a high school setting, but also focused on showing the positive consequences of making healthy choices a greater impact could be achieved. The show could feature a focus on improving communication between peers and their teachers and administrators. Additionally it could focus on creating an environment where self-esteem is held in as high esteem as the notoriety teenagers gain from going on Teen Mom. While this is a long term intervention strategy that requires the cooperation of a lot of people, it has been shown to have positive effects on the mental and physical health of the teenage population (21). This would not remove the glorification of teens on the show, but it would provide the viewers with the perspective that perhaps that glorification is not what they want.

Intervention 3: Show a more realistic demographic
Another aspect of Teen Mom that limits its efficacy is the unrealistic demographic of teens featured on the show. They are doing a disservice to the program by featuring mostly white, Southern teenage girls (5). By expanding the range of the show to more inclusively feature teenagers of different races, socioeconomic backgrounds and geographic locations, Teen Mom can universalize its appeal. The show’s creators stated that they heavily pursued casting in the South East, but against statistic odds featured mostly white teenagers. By providing a more racially diverse look at pregnancy, Teen Mom could become a more balanced, thus more effective, intervention.
Additionally, Teen Mom should feature fathers just as equally as mothers. Despite the mother’s biological burden, teen fathers need to be held just as responsible in these programs. By sending a message that both teen mothers and fathers are equally responsible for contraception and child rearing broadens the campaigns reach.

Teen Mom and 16 & Pregnant provide a framework for a successful intervention on teenage pregnancy in the United States but fall short in execution. The show features an inaccurate representation of the pregnant teen population, glorifies its participants to star status and confuses the message by lacking a unilateral stance on sexual safety on MTV programming as a whole. Teen Mom and 16 & Pregnant could be a more effective intervention by changing the platform on which the shows are presented, more accurately representing the target population and focusing on programing that takes into account greater social influences to promote healthy choices.

1) "CDC - About Teen Pregnancy - Teen Pregnancy - Reproductive Health." Centers for Disease Control and Prevention. N.p., 21 Apr. 2011. Web. 15 Dec. 2011. .
2) Dolgen, Lauren. "Why I created MTV's '16 and Pregnant' - CNN." Featured Articles from CNN. N.p., 5 Apr. 2011. Web. 15 Dec. 2011. .
3) "Does Reality TV Misrepresent Teen Parenthood?." Conan, Neal . Talk of the Nation. NPR. 16 Aug. 2011. Web. Transcript.
4) Clow, Kenneth E., and Donald Baack. Integrated advertising, promotion, and marketing communications. 3rd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2007. Print.
5) "MTV's 16 and Pregnant (Season 3) | Full Episodes, Photos, Episode Synopsis and Recaps | MTV." New Music Videos, Reality TV Shows, Celebrity News, Top Stories | MTV. N.p., n.d. Web. 15 Dec. 2011. .
6) Sun, Feifei. "What MTV's Teen Mom Doesn't Deliver - TIME." Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - N.p., 14 July 2011. Web. 15 Dec. 2011. .
7) Purvis, Whitney. "Teen Moms: The New Celebrity?." ABC News. ABC. ABC, New York: 3 Mar. 2011. Television.
8) Serpe , Gina . "'Teen Mom' Amber earns $280,000 a year - Entertainment - Reality TV -" Matt Lauer, Ann Curry, Al Roker, Natalie Morales - TODAY show video, news, recipes, health, pets. N.p., 16 Aug. 2011. Web. 15 Dec. 2011. .
9) Ariely, Dan. Predictably irrational: the hidden forces that shape our decisions. New York, NY: Harper, 2008. Print.
10) Marsh, Wendall. " Maci and Bentley soar in baby name game| Reuters." Business & Financial News, Breaking US & International News | N.p., 5 May 2011. Web. 15 Dec. 2011. .
11) "16 & Pregnant™ Couple Arrested, Toddler Taken Into Custody." ABC News. N.p., 23 Sept. 2011. Web. 12 Dec. 2011. .
12) Weinstein, Neil. "Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample." Journal of Behavioral Medicine 10 (1987): n. pag. Springer Link. Web. 11 Dec. 2011.
13) "Test | GYT I It's Your Sex Life." It's Your Sex Life I Where music artists and celebrities meet to spread the word about making smart sexual health decisions. N.p., n.d. Web. 15 Dec. 2011. .
14) "Jersey Shore Quotes - TV Fanatic." TV Fanatic - The latest news, episode guides, and spoilers from your favorite television shows. N.p., n.d. Web. 15 Dec. 2011. .
15) Adalian, Josef . "Jersey Shore Premieres to Huge Ratings [Update] -- Vulture." New York Magazine -- NYC Guide to Restaurants, Fashion, Nightlife, Shopping, Politics, Movies. N.p., 5 Aug. 2011. Web. 15 Dec. 2011. .
16) Bates, Karen. "MTV's 'Teen Mom' Makes For Teaching Moments | WBUR & NPR." WBUR. N.p., 10 Aug. 2010. Web. 15 Dec. 2011. .
17) Oringanje, Chioma. "Interventions for preventing unintended pregnancies among adolescents (Review)." The Cochrane Library 4 (2009): n. pag. The Cochrane Collaboration. Web. 8 Dec. 2011.
18) DeRidder, Lawrence . "Teenage pregnancy: Etiology and educational interventions." Educational Psychology Review 5 (1993): n. pag. Springer Link. Web. 12 Dec. 2011.
19) "Myth vs. Fact | Stay Teen." Stay Teen. N.p., n.d. Web. 15 Dec. 2011. .
20) "CDC - Social Ecological Model - CRCCP." Centers for Disease Control and Prevention. N.p., n.d. Web. 15 Dec. 2011. .
21) Patton, George. "Promoting Social Inclusion in Schools: A Group-Randomized Trial of Effects on Student Health Risk Behavior and Well-Being." American Journal of Public Health 96 (2006): 1582-1587. American Journal of Public Health . Web. 12 Dec. 2011.

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