Preventing Teen Pregnancy: The Impact of Dolls, Abstinence, and Sex Education

Alice Langford, National Center for Health Research

The rates of teen pregnancy in the United States are in decline; but even so, 2 out of every 100 teenagers in the U.S. become pregnant.[1]  In 2015, more than 220,000 teens between the ages of 15 and 19 gave birth.[2] Most are adolescents living below the poverty line, minorities, and those in rural communities.[3]  African American and Hispanic teens are twice as likely as white teens to give birth.[4]

Teen pregnancy, childbirth, and childrearing present major social and economic challenges for teenage parents, their children, and society as a whole.  Teen mothers are more likely to have lower educational attainment, a lower income, and a greater dependency on social services. Children of teen parents are more likely to be born prematurely, have more health problems, have a lower educational advancement, to be incarcerated, and to also become teenage parents themselves.[5]  These outcomes make teen pregnancy a part of the “cycle of poverty” that is so difficult to break.[3] There is also a substantial economic cost to society. In 2010, for example, teen pregnancy and subsequent childbirth resulted in nearly $9.4 billion dollars in public costs for prenatal care, labor and delivery, postpartum care, and first year of infant life care.[2]   

Researchers have evaluated the effectiveness of many teen pregnancy prevention programs.  Some have been shown to be effective at reducing teen pregnancy while others have not. Examining the effectiveness of these programs is important because it should influence whether the program receives funding.  Additionally, it has been shown that specific programs work in some communities but not others.[6]

RealCare Baby Dolls

One example of this is the Baby Think It Over infant simulator (now known as the RealCare baby), which was designed in the 1990’s.  Youth would care for the doll on a daily basis to experience the “realities” of being a parent.  In one research study, the researchers concluded that the doll was not an effective way to discourage girls from becoming teen mothers.[7]   

While many girls found that the doll was harder to take care of than they expected, the same group of girls erroneously believed that the doll was more difficult to take care of than an actual baby.  

Despite the discouraging results from that experiment, researchers at a different school found that most teens viewed becoming a teen parent as undesirable after participating in the program.[8]  

Why did these results apparently differ?  Possibly because the programs targeted different communities and carried out each program differently.  Also, it is important to note that the perception of being a teen parent as being undesirable did not necessarily correlate with a lower rate of teen pregnancy.

Abstinence Programs and Sex Education Programs

Some communities advocate for abstinence-only programs.  Abstinence-only programs vary in their design and content, but in general do not discuss the use of contraceptives or condoms as methods to prevent pregnancy and sexually transmitted infections (STIs). Some programs stress continued abstinence until marriage, whereas others focus on abstinence in the short-term future.  In contrast, comprehensive sex education programs discuss both abstinence and safe sex practices to prevent pregnancy and STIs. A subset of comprehensive sex education programs discuss contraception while stressing the importance of abstinence. Others include specific discussions of contraception applications and techniques.

It is important to understand the short-term impact of abstinence only programs. Choosing the Best (CTB) is an abstinence-only program used in Georgia classrooms.  This program has had some short-term success. An evaluation of the program for students in the 9th and 10th grades, found that students who had no prior sexual experience entering the program were 1.5 times more likely to remain committed to abstinence by the end of 9th grade.  However, by the beginning of 10th grade, the students were no longer committed to abstinence. And, among students who were sexually active before participating in the CTB program, the abstinence-only program had no effect on their behavior.[9]

Most curricula are designed for a specific age group.  For example, the older the teenagers, the more likely they are to be sexually active, in which case abstinence-only interventions are less likely to be effective.[9]

Research shows that while comprehensive sex education can be very successful at reducing risky sexual behaviors, the most effective programs combine comprehensive sex education with skills building and youth development.[6],[10]  An example is Love Notes, a curriculum designed for 14-19 year old males and females who have yet to experience teen pregnancy. Love Notes teaches a comprehensive sex education program alongside a larger curriculum focused on forming healthy relationships and preventing intimate partner violence.  Specific topics include life goals, family-of-origin issues in relationships, safety, healthy communication strategies, problem solving, commitment and relationship decision-making, and sexuality in close relationships. Research has shown that the Love Notes program is effective in increasing abstinence, reducing the number of sexual partners, and increasing use of birth control and condoms six months after the completion of the program.[11]   

Which Programs are Best?

There are many types of evidence-based teen pregnancy prevention programs, targeted towards different communities.  When selecting and adapting a program, it is important to ask your educators, community, and yourself questions such as the following:

  • Who is my target audience? (age, gender, socioeconomic status, etc.)
  • What impact do I want my program to have? (fewer pregnancies, decreased sexually transmitted diseases/HIV prevalence)
  • What behavioral changes would I like to see? (increased contraceptive use, increased abstinence)
  • For this group of teens, what are the factors that lead to current behaviors? (such as   contraceptives are not accessible, lack of sexual health education)
  • What interventions will be effective given those issues?
  • Does this intervention make sense to the rest of the community? (Do they understand the intervention and its methods?)
  • Does this intervention take an approach of cultural humility and understanding? Are culture, language, values, and socioeconomic status of the students and community taken into account?[12]   

Trump Administration and Teen Pregnancy

The federal government’s Office of Adolescent Health provides financial support for teen pregnancy prevention programs.  In 2017, the Trump Administration told many Teen Pregnancy Prevention programs that had been promised for funding for the 2015-2019 fiscal years, that they would lose funding in 2018.  However, a federal judge ruled that defunding the programs early is “unlawful,” and the programs will continue to be funded through 2019.[13] A few of the evidence-based programs found on the Office of Adolescent Health’s website (as of August 2018) can be found below. A full list of programs and their descriptions can be found here.

  • Project AIM is a youth development intervention targeted at youth ages 11-14. This program provides participants with the motivation and skills to address barriers to sexual risk prevention such as poverty and hopelessness. The program is delivered both in schools and community based settings.
  • All4You! is a program designed to prevent HIV and other sexually transmitted infections  and unplanned pregnancy by changing attitudes, beliefs and perceived norms that affect  sexual risk taking. This program includes an instructional curriculum and service-learning visits.
  • Becoming a Responsible Teen (BART) is an ethnic pride program focused on HIV prevention for African American adolescents that is delivered in non-school, community-based settings.  Interactive group discussions and role playing are used to cover topics related to HIV/AIDS prevention and teen pregnancy prevention such as correct condom use, assertive communication, refusal techniques, abstinence self-management and problem solving.
  • Draw the Line/Respect the Line is an interactive abstinence program for middle schoolers, focused on the prevention of HIV and other sexually transmitted infections.  Curriculum varies for different grade levels.
  • Families Talking Together is a parent-based program for Latino and African American adolescents focused on preventing and/or reducing sexual risk behavior by building family relationships and communication skills.
  • Teen Outreach Program (TOP) is focused on the positive development of adolescents by using community service learning, mentorship, and a curriculum focused on adolescent health and development, including healthy relationships, communication, influence, goal-setting, decision making, values clarification, community service learning, and adolescent development and sexuality.

The Bottom Line

Although teen pregnancy rates have declined in the U.S., the country continues to have one of the highest rates of teen pregnancy compared to other developed nations.[14]  It is therefore important to continue efforts to reduce the rate of teen pregnancy by funding and implementing programs that have been rigorously evaluated and shown to effectively reduce teenage pregnancy and risky sexual behaviors.  These programs should be modified to make them effective in meeting the needs and cultures of specific communities.


  1. Mathews TJ, Hamilton BE. Declines in births to females aged 10–14 in the United States, 2000–2016. NCHS Data Brief, no 308. Hyattsville, MD: National Center for Health Statistics. 2018.
  2. “Reproductive Health: Teen Pregnancy.” Centers for Disease Control and Prevention, 9 May 2017,
  3. Bridges, Emily. “ Unintended Pregnancy Among Young People in the United States.”, 2011,
  4. “Reproductive Health: Teen Pregnancy.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 26 Oct. 2017,
  5. Cronen, Elizabeth. “Kids Having Kids Unravels the Complex Consequences of Teen Parenthood for Individuals and Society.” Kids Having Kids Unravels the Complex Consequences of Teen Parenthood for Individuals and Society, The Urban Institute, 21 Nov. 2008,
  6. Ball, Victoria, and Kristin A. Moore. “What Works for Adolescents Reproductive Health: Lessons from Experimental Evaluation of Programs and Interventions.” PsycEXTRA Dataset, May 2008, doi:10.1037/e573032010-001.
  7. Krawewski J, Stevens-Simon C.  Does Mothering A Doll Change Teens’ Thought about Pregnancy?.  Pediatrics. 2000, 105(3).
  8. Malinowski A, Stamler L.  Adolescent Girls’ Personal Experience With Baby Think It Over Infant Simulator.  MCN, The American Journal of Maternal/Child Nursing. 2003, 28(3).
  9. Lieberman, Lisa, and Haiyan Su. “Impact of the Choosing the Best Program in Communities Committed to Abstinence Education.” SAGE Open, vol. 2, no. 1, 22 Mar. 2012, doi:10.1177/2158244012442938.
  10. Davis, Laura. “Components of Promising Teen Pregnancy Prevention Programs.”, 1996,
  11. Barbee, Anita P., et al. “Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial.” American Journal of Public Health, vol. 106, no. S1, Sept. 2016, doi:10.2105/ajph.2016.303429.
  12. “Promoting Science-Based Approaches to Teen Pregnancy Prevention Using Getting to Outcomes (PSBA-GTO).” Centers for Disease Control and Prevention, 22 Nov. 2016,
  13. Hellmann, Jessie. Judge Orders Trump Officials to Process Grants for Teen Pregnancy Programs. The Hill, 4 June 2018,
  14. “Teen Pregnancy Rates Declined In Many Countries Between The Mid-1990s and 2011.” Guttmacher Institute, 21 Sept. 2016,