Monday, December 21, 2015

How MTV's "16 and Pregnant" Reduced Teen Pregnancy

Apparently MTV broadcasts a show called "16 and Pregnant," in which each show tracks a pregnant teen-ager through the final months of pregnancy, and then through birth and the immediate period afterward. Although I fear the show will remain unseen by me, it is apparently watched by enough teenagers that all by itself it put a dent in the US teen birth rate. Melissa S. Kearney and Phillip B. Levine tell the story in "Media Influences on Social Outcomes: The Impact of MTV's 16 and Pregnant on Teen Childbearing," in a recent issue of the American Economic Review (105:12, pp. 3597-3632). (The AER isn't freely available on-line, but many readers will have online access through their library.) Their study is nice example of how modern social science seeks out and builds on a variety of evidence from TV ratings to Twitter accounts.

Kearney and Levine set the stage this way:
In 2012, 29.4 out of every 1,000 girls between the ages of 15 and 19 gave birth in the United States. This rate is considerably higher than that in any other developed country, where typical rates of teen childbearing are more often in the range of 5 to 10 births per 1,000 girls in this age group (Kearney and Levine 2012a). Though still an outlier internationally, the US teen birth rate has declined dramatically over the past 20 years, falling from 61.8 births per 1,000 teen girls in 1991. This decline has occurred in two distinct waves. Between 1991 and 2008, it fell largely continuously from 61.8 to 40.2, representing an annual average rate of decline of 2.5 percent per year. Teen birth rates fell far more rapidly in the next four years, dropping from 40.2 to 29.4, or 7.5 percent per year ...
An obvious question arises here. What factors might have contributed to teen birth rates falling more quickly after about 2008? One possibility is "16 and Pregnant," which started showing in June 2009. Kearney and Levine provide this background on what the show portrays

Among the girls on the show, ambivalence toward teen childbearing is rampant. Only 18 out of 47 report opposition to their pregnancy when they found out, although none report that they were looking to get pregnant. The girls commonly report that they did not think that they would have sex or become pregnant (36 of 47) and that they were ambivalent about getting pregnant (28 of 47). Only 5 of 47 report trying to avoid a pregnancy, but failing. Three-quarters of the girls (36 of 47) report not using any form of contraception at the time they got pregnant.
An important emphasis on most episodes is the relationship between the girl and the father of her child, who is typically her boyfriend. Of all the pregnancies, four led to a marriage prior to the birth and three led to adoption. There were no abortions. Almost all (40 of 47) of the boyfriends stick around through the pregnancy. Many fathers (31 of 44) live with the girl and her child afterwards and most of them (26 of 31) are heavily involved in the child’s life. Only four of the fathers are completely uninvolved. Just over half (24 out of 44) of the relationships between the girl and her boyfriend either collapsed or were very strained by the end of the episode. The show also emphasizes the implications of teen childbearing for the teen mother’s health and well-being. Consistent with national trends, 11 out of the 47 births (23 percent) occurred via C-section; some occurring after up to 26 hours of labor. In addition, in 8 of the 47 pregnancies the mother or her baby experienced a significant health complication. One mother needed to spend a full month in the hospital as a preventative measure. One baby needed to be airlifted to another hospital to receive needed treatment. The show portrays extensive sleep deprivation for the teen mothers. Overall, the realities of the lives of teen mothers are presented in ways that may have been unknown or difficult to imagine for other teens viewing the show.
Levine and Kearney collected data on how many teens watched the show in different viewing areas. Of course, there's a possibility that areas with high teen birthrates might also be more likely to watch the show--but this does not in fact turn out to be true in the data. The authors look at how MTV ratings were correlated with teen pregnancy both before the "16 and Pregnant" show started, and after the show started. They also look for cause-and-effect evidence of what happens right after the show airs. They write:
The results of this analysis imply that the introduction of 16 and Pregnant led teens to noticeably reduce the rate at which they give birth. Our estimates imply that this show led to a 4.3 percent reduction in teen births that would have been conceived between June 2009, when the show began, and the end of 2010. This can explain 24 percent of the total decline in teen births over that period.
Kearney and Levine pushed the analysis another step. They looked at Google Trends to see how common it was to see internet searches on terms like "how to get birth control" or how often Twitter was using terms like "birth control" or "abortion" in tweets. They found that these mentions on social media spiked around the time of episodes of the show. They write: "Large spikes in search activity and tweets about the show are evident exactly at the time a new episode was released. In some specifications, we also see an associated spike in Google searches and twitter messages containing the terms “birth control” and “abortion.” Locations in which the show was more popular experienced greater increases in these types of searches/tweets when the show was on the air."

The fact that a TV show can measurably reduce teen pregnancy is interesting itself, but there is perhaps a broader lesson here. Lots of what passes for teenage health education puts a heavy emphasis on some mixture of dire consequences and preachiness. This television show wasn't part of a public relations campaign--indeed, some critics has expressed concern that it might glamorize teen pregnancy. But as Kearney and Levine write: 
This show produced by MTV was not specifically designed as an anti-teen childbearing campaign, but it seems to have had that effect by showing that being a pregnant teen and a new mother is hard—it strains relationships with friends, parents, and the baby’s father, and means physical discomfort, potential health problems, and sleep deprivation. Apparently those images affected teenage viewers’ motivation to avoid that outcome. This implies that addressing teens’ motivation for avoiding teen parenthood can be an effective tool and, furthermore, that compelling social media can be used as a policy lever to do so.
For those who would like an overview of some previous work by Kearney and Levine on teen pregnancy, here are a couple of earlier posts: