Friday, May 10, 2013

 “Not Now”
A Critique of NYC Human Resources Administration
Anti-Teen Pregnancy Campaign - Claudia Gumina

For this assignment, I have chosen to focus on the NYC Human Resources Administration “Not Now” campaign, whose goal is to discourage teenage girls and boys from engaging in behaviors which are likely to lead to pregnancy. The campaign uses images of children crying and generally looking upset to transmit the message they are trying to convey which is not very clear, but appears to be “Teenage Pregnancy is Bad”. The campaign portrays children along messages depicting the consequences and difficulties that teenage parents face when having to raise a child, but it does not in any way suggest what teenagers should do to avoid these things. It does not provide solutions to the problems faced by teenage mothers, nor does it suggest ways to prevent it.
Through the Health Belief Theory, and based on the assumption that once teenagers understand the consequences of teenage pregnancy they will stop engaging in related behaviors (11), the campaign simply states facts and statistics and delivers them through crying babies in order to inform their audience. It appears that the main goal of the campaign is to scare teenagers into not having children, but it does not address the behaviors that lead to teen pregnancy which should be the focus. With messages like, “Honestly, Mom... Chances are he won’t stay with you. What happens to me?” (13) the campaign aims to discourage girls from getting pregnant by suggesting that they will likely end up raising the child on their own. Based on the Theory of Reasoned Action in which perceived social norms are believed to dictate a behavior, the campaign uses shaming and fears of stigmatization to convey their unclear message. Similarly, the campaign uses language which appears to take control over decisions which girls and boys should make themselves inspiring psychological reactance.  The adds belittle the experiences that teen parents go through when raising a child and narrow them down to children being expensive. In a way it aims to take control over the reproductive rights of teenagers, again, inspiring, reactance. The campaigns tell teens that if they become parents, they are doomed to fail in life, and this may inspire the need to prove them wrong.

Use of The Health Belief Model and Why It Does Not Work
As mentioned before, the campaign focuses mainly on using the Health Belief Theory to change the behavior of their audience. One of their adds reads, “If you finish high school, get a job and get married before having children, you have a 98% chance of not being in poverty.” By increasing the perceived severity of the condition, in this case, teen pregnancy, the campaign aims to make teenagers aware of the seriousness of the issue and hopes that this newly acquired knowledge will stop them from engaging in dangerous behaviors (7). The perceived cost of teen pregnancy, poverty, should be enough to stop teenagers from engaging in irresponsible behavior, according to this theory, but it does not take into consideration the barriers presented to the boys and girls. Many similar campaigns have managed to create an attitude change, but no long term changes (8). One problem with this campaign is that is assumes that people act rationally: “Teen pregnancy will seriously affect my life so I won’t get pregnant.” The message in the campaign seems to imply that pregnancies are things that people can completely control and happen only when you want them to. It tries to discourage teenagers from having children at an early age as if it were something that is commonly premeditated.   It appears to ignore the fact that most teen pregnancies are unplanned and even if a girl has the intention of not becoming pregnant, she is not in control of other factors like birth control failing, or even peer pressure. One of this biggest assumptions that the Health Belief Model makes, in this campaign and others, is that people are engaging in unhealthy behaviors because they are not aware of the consequences. In this case, the belief appears to be that teenagers are not aware of the costs of parenthood and that is why they are not being careful about early pregnancies. By increasing the perceived susceptibility of teenagers and making the perceived benefits of a childless adolescence obvious, the campaign aims to encourage teenagers make better decisions regarding pregnancy, but again does not account for intentionality (1). With strong images and messages, they believe that the campaign will be able to show young adults the risks of teen pregnancy and this will completely change their views about the matter. It is very likely that teenagers are already aware of the consequences of having a baby at an early age and are not actively trying to get pregnant for the most part. It seems as if the creators of the campaign believe that teenagers actually want to be parents, and not that they are somehow forced into parenthood by unplanned situations.

Misuse of The Theory of Reasoned Behavior and Perpetuating Stereotypes
By creating fear of stigmatization and ostracization (6), the “Not Now” campaign aims to change the attitudes of teenagers regarding pregnancy through the theory of reasoned behavior. By making them consider what others would think of them, they aim to instill fear  of becoming social pariahs because of the negative connotations associated with teenage pregnancy. One of their adds reads, “I’m twice as likely not to graduate high school because you had me as a teen.” With phrases like this, they expect to show teens the shame that being a pregnant mother brings to them and possibly their families. Children of teenagers are less likely to graduate high school and therefore will be uneducated and thus less intelligent than the rest of the population. This is what their message implies, but instead of discouraging teenagers from engaging in activities that can result on a pregnancy, all it does is put single and young mothers down. Parenthood comes with moral obligations to take care of our children and provide them with the resources they need to become valuable members of society. If someone is not able to do this, they are considered considered bad parents and viewed negatively. They aim to get teenagers to modify their behavior through perceived social pressures. The theory of reasoned behavior suggests that people presented with ethical and moral dilemmas will fear social rejection and are less likely to engage in a particular behavior (15). This is what the campaign aims, but it does so by belittling the decision-making power of teenagers and creating hostility towards another under-represented group which already deals with discrimination.
Similarly to the health belief model, the theory of reasoned behavior does not account for external factors that may affect a person’s choice when engaging in a situation. Girls may be afraid of becoming single mothers and of the stigma associated with it, but because of one reason or the other, they may become pregnant and have a child and have to deal with the consequences regardless of whether she wanted to or not. Economic and emotional factors are not taken into account here, and neither is intentionality. Again, intention is not necessarily related to a successful behavior and as much as someone may not want to become a teen parent, many factors like medical barriers are out of their control. Vallerand et al explain that “motivation to comply may not be a necessary determinant of subjective norms” and because it is wrongfully assumed that they do, many try to change behaviors by emphasizing social norms (14).

How Not Measuring Psychological Can Hurt a Campaign
Besides intentionality and rationality, one important factor that the creators of the campaign seem to not have measured is psychological reactance. For a campaign to be persuasive, it needs to target its audience in a way that makes them feel identified with the message they are trying to transmit, not put them down for their behaviors. Because the “Not Now” campaign, addresses teenagers with an authoritative tone, it is very unlikely to create feelings of agreement, but the complete opposite. The campaign in question is more likely to create feelings of rebellion or reactance. Bhrehm’s psychological reactance theory states that any message aimed at changing someone’s attitudes or behaviors, can in fact be perceived as a threat to an individual’s or group’s freedoms and thus be rejected by ignoring or derogating the source and even by producing even more of the undesired behaviors (4). In the case of this campaign, it can be seen as a threat to teenager’s reproductive freedoms because the campaign does not only aim to tell teens what to do, but also to tell them what is going to happen to them if they do not behave as they are told. The “Not Now” campaign inspires reactance because it appears to want to take control over the decisions that teens make but it is very vague and this is a main factor that creates feelings of resistance. The adds simply stay facts to scare young individuals away from becoming teen parents, but it does not in any way explain how to prevent a pregnancy. It shows poverty as being a consequence of teen pregnancy and not the other way around, and this lack of explicitness is very detrimental to the way the message is received.
In a similar manner, the campaign’s use of babies as the carriers of their messages does nothing to help them (5). Yes, people care about the future of their children, but hearing babies say that they are not capable of raising them is also bound to create reactance. The babies are telling young adults that they are likely to become just a statistic and that they will not be able to raise a child successfully, taking away their freedom and their chance to make their own decisions.  With the messages they use, they basically tell teenagers that they will not be able to control their future if they have a child and that they are following a path to failure. This creates a need in the target audience of the messages to reestablish the freedom that was threatened by the message.
Sadly, the most appalling aspect of this campaign is not the way they deliver their message, but the message per se. Nowhere in the campaign does it explain how to avoid a pregnancy. There are no talks of birth control or safe sex anywhere. Just don’t get pregnant as a teen. It does not matter how. Instead of finding ways to suggest the use of contraceptives, what the campaign does is use single mother stereotypes to create a sense of fear. It tells teens that they do not want to end up like those mothers; poor, alone and uneducated. Not only is the campaign not effective at achieving their goal, but in the process of transmitting their message they reinforce stereotypes and may make the experiences of those already having a hard time, worse. The “Not Now” campaign is shame based and presents not having a baby as the solution to all their problems. It assumes that teens do not know the consequences of pregnancy and underestimates their decision making abilities. The campaign places all the blame and weight of teen pregnancy mainly on the mother and does little to address the bigger issues like poverty and difficult access to birth control and health facilities among underprivileged communities. It uses messages based on stigma to dissuade teenagers from becoming young parents but it does not provide any knowledge about the tools necessary to avoid doing so. The campaign does send a strong message, but it is not one that is received pleasantly. Many of these teens they are addressing may be the children of women who at one point were teen moms so not only is the campaign aiming to tell teenagers how their lives are going to turn out, it may also be insulting their mothers.
Overall, the “Not Now” campaign is unlikely to get teenagers to listen to their message because it makes a series of assumptions about their audience. First, it assumes that the reason that adolescents become young parents is because they are not aware of the difficulties associated with raising a child. Based on the Health Belief Model, they expect that once teens become aware of the consequences of teen pregnancy, they will stop engaging in activities that will put them at risk for it. Second, they assume that intentionality leads to a change in behavior, but this is not the case; only because a girl does not want to get pregnant, does not mean she will not. Similarly, through the Theory of Reasoned Action, they believe that by stigmatizing teen pregnancy and appealing to people’s need to adhere to social norms, they will be able to persuade teens into not having children at an early age. Sadly, the only thing they achieve with this is perpetuating already existing stereotypes and hurting an ostracized community of women. Using both of these theories negatively affects the campaign, but as mentioned before the factor that likely hurts it’s message the most is psychological reactance. The campaign directors failed to measure the levels of reactance that the messages of the campaign would incite among teenagers and because of its authoritative tone and controlling messages, it threatens adolescent’s freedom. The messages they use belittle their experiences and deems them unfit for other duties, overstepping over teenagers private lives. As said, it is not only the way in which the message of the campaign is presented that is detrimental for their purpose, but the actual message which fails to instruct teenagers on how to avoid pregnancies. It tells them not to become teen mothers, but it does not tell them how.

Re-designed Intervention: Others Do It Too.
To address the problems faced by the “Not Now” campaign, one would have to start by changing the message. The goal, which is decreasing the rates of teen pregnancy, would stay the same, but it would have to be addressed differently. As mentioned before, the way this campaign goes about trying to get teenagers to not get pregnant, is simply by telling them “Don’t get pregnant.” A redesigned campaign would still urge teenagers to avoid becoming young parents, but it would do so by showing them ways in which they can avoid unplanned pregnancies. The previous campaign avoided the topic of sex completely, and since unplanned pregnancies are the result of unprotected sex, a better campaign would start there. Acknowledging the reality that teenagers are having sex can be taboo and criticized by many, but by addressing the root of the problem, better results would be obtained. When targeting teen pregnancy a successful add, would conjointly address the issue of STIs and help teenagers prevent both.
An example of a message displayed in their adds then could be, “Having sex or thinking about it? Others do too. What most aren’t doing is making it safe. There are many ways in which you can prevent an unplanned pregnancy or STIs. For more information, visit, or text ‘makeitsafe’ to xxxxx.” An add like this would belong in a campaign titled, “Others do it too,” which would bring the topic of sex to the front of the add and shows teenagers that they can in fact have sex and avoid unwanted consequences. The messenger for an add like this would be another teenager or young adult; someone that teens can identify with. This campaign is not assuming that teens are uninformed, but it is giving them the option of accessing more information and it is in no way criticizing another group of society. Through this and other techniques, an add like this could be more effective than the “Not Now” adds.

Minimizing Assumptions: Letting Your Audience Decide
In order to solve the issue presented by the “Not Now” campaign when basing its technique on the Health Belief theory, the first step one needs to take is minimizing all the assumptions that the messages in the campaign make about teenagers. First, it is not realistic to think that the reason teenagers are becoming young parents is because they are not aware of the consequences. By phrasing the messages in the campaign as questions, assumptions can be avoided. By asking the question, “Having sex or thinking about it?” teenagers’ attention is drawn to the add without actually putting them on the spot. It does not assume that they are having sex, or that if they are, they are unaware of contraceptive methods, but it gives them the option of acquiring more information if they need it. A campaign like this would make the audience think about the perceived benefits without the use of fear-arousing communications (10).
Similarly, this campaign would not assume that having the intention of doing something, necessarily leads to a behavioral change. Considering this campaign would be based on a comprehensive sexual education, information about Plan B (emergency contraception) would also be available to teenagers who want it. An message related to this, that could be seen in an add could be, “Got caught up in the heat of the moment? Others have too. There are many ways in which you can prevent an unplanned pregnancy or STIs. For more information, visit, or text ‘makeitsafe’ to xxxxx.” Again, this add is not accusing teenagers  of doing anything, but making their situation, if it is in fact something that they are going through, more relatable. The previous campaign if anything, would have lead to unrealistic optimism with teenagers thinking that their health outcomes could be more positive than others’ simply because the real reasons behind teen pregnancy were not addressed in the campaign. (3).

Using The Theory of Reasoned Action to Your Advantage
As opposed to the original campaign, one like this would not be trying to modify a behavior simply by scaring its audience, but by addressing the real source of the problem, which in this case is unprotected sex due to limited access to contraceptive methods, and possibly information about them. With adds like this, we aim to understand a health behavior and fix it at its origin, rather than targeting and shaming teenagers when it is already too late and related to a behavior that most can modify. The theory of reasoned action assumes that an attitude or subjective norm significantly predicts intention, but it does not “accommodate behaviors that are not entirely under an individual's volitional control.” (12). The modified campaign would account for “accidents” and would use perceived social norms to its benefit in a much more subtle way. It would not criticize a population, but make teenagers feel like if they are in need of information regarding STIs and contraceptive methods, it is normal and they are not the first to have questions. It is in no way blaming them for their behavior, but providing help if they need it. Social norms in this case, would be used to make teenagers feel more comfortably with their insecurities. The “Others do too,” is the key component to modifying the campaign in the Theory of Reasoned Action aspect. This campaign would eliminate fear of social norms related to questions like, “What do others think? and how much do I care what they think about me?” and replace it with a sense of empathy and community. One of the goals of the modified campaign would be for teenagers to feel that if they are in fact uninformed about safe sex, they are not the first ones to wonder about sexuality and it is normal: Society won’t look down on you. Society feels your pain.
Studies have shown that that both the personal (attitudinal) and social (or normative) components play an important role in determining behavior (14). Because of this, the Theory of Reasoned Action is only partially effective. By ignoring attitudinal components of behavior , it assumes that evoking social norms is enough to inspire a behavior change. With their adds, they present an image relating teen parenthood to high poverty levels. In this case there is a negative association with the behavior they are portraying and apart from strengthening existing stereotypes, it may offend many and create a defensive attitude in those who can personally relate with the situation. The modified adds would portray a positive association between the behavior (engaging in safe sex) and what society thinks of it (it is good). This would take advantage of the perceived weight of social norms in teenagers, while avoiding portraying anyone in a negative light. Again, related to the health belief model, this campaign would not be making any assumptions and this would make its audience more receptive to its message.

Lost Freedom Vs. Stolen Freedom: Measuring Psychological Reactance
As mentioned in the description of the initial campaign, one of the biggest factors that is detrimental to the transmission of its message is the psychological reactance that it inspires. It has been thought that individuals do not so much want to reestablish their freedom when faced with the idea of losing it, but more when there is someone specific who is threatening it (2). In this case, it is the campaign (and the crying babies along its messages) that threaten the freedom of teenagers and young adults; not so much the idea of losing it. “Don’t become a young mom or you will be forever alone.” seems to be one of the messages read in the adds. This inspires a typical “don’t tell me what to do” response in teenagers and leads to them disregarding the adds as authoritative and controlling. With the new campaign, the message would not be telling teens how to act or behave, but giving them options. IF you are having sex, and IF you need more information, it is available to you. It is not forcing teenagers to read facts about teen pregnancy or poverty, assuming that they are unaware of them, but more likely assuming that they know the consequences.
One very important factor in the delivery of the message for the new campaign, would be the messenger. As mentioned before, the original campaign uses babies along the messages in the adds, that if anything makes teenagers think they are adds for diapers. Teenagers are more likely to listen and think about a message when it is delivered by someone with whom they can identify with and whom they believe has had similar experiences. The role of similarity, then, can be used for our advantage (9). The “Others do it too” campaign would use teenagers ranging from 15-20 as their main messengers. It would portray them in stylish outfits and in casual relatable circumstances. It is relevant to target all ethnicities with the adds, and for this reason teenagers representative from different races would be used, but not in a stereotypical way to avoid creating reactance for other reasons. Overall, it is important to try to get rid of signs of any adult influence in the adds, making it seem as if they are made for teenagers by someone who can related with them, but not in a way that they seem unreliable.
With a complete make-over, the NYC Human Resources Administration Anti-Teen Pregnancy Campaign, could be successful at preventing adolescents from becoming teen parents.  It’s main message would change from “Don’t get pregnant” to “This is what you can do to avoid an unplanned pregnancy.” It would offer guidance related to sexual health to those who need it, and target teenagers in a non-aggressive way. The new campaign would not just tell teenagers not to do something, but it would tell them how to, and it would above all, not assume that they are engaging in a behavior. With the “Others do it too” campaign, the messages and images would not be perpetuating stereotypes of underprivileged populations or aiming to create feelings of shame, but telling teenagers that they are not alone in the way they feel or the questions that they are too embarrassed to ask. By not assuming that they do not understand the consequences of unprotected sex, it does not put them on the spot, but it offers help if they need it. This campaign also would account for irrational behaviors (as mentioned before by providing Plan B information) and would not assume that intentionality leads to a behavioral change. Above all, the new campaign would provide options and suggestions for those who need information and bring in the topic of STIs along with that of pregnancy to be part of a more comprehensive sexual education. The main goal of this campaign, would be to reduce the incidence of teen pregnancy and STIs in teenagers, not by shaming them and accusing them of engaging in a behavior, but by telling them that they are not alone and that their problems are faced by many others that have learned how to manage and prevent unwanted consequences.

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