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A Dollar a Day Not to Get Pregnant

July 9, 2009

A pregnancy prevention program based at the University of North Carolina at Greensboro that pays 12 to 18 year old girls one dollar for every day they are not pregnant has spurred conversation and raised eyebrows as it has made its way through the blogosphere. College Bound Sisters was founded in its most infant stages almost 20 years ago by Hazel Brown, professor of nursing, and Rebecca Saunders, associate dean of the graduate school. But the program made headlines after a Fox News story brought to light its incentive-based system.

Brown emphasized that College Bound Sisters is more than just a monetary transaction. The money -- which gets deposited into a college savings account -- is given to the participants only after they achieve all three goals of the program: not getting pregnant, graduating from high school and enrolling in college. The girls also receive $5 per week for transportation to the program's classes in sexual health and preparation for college. Some students who have stuck with it have received over $2,000 toward a college degree.

The program is specifically set up for girls whose sisters had a baby before the age of 18, which statistically puts them at risk for teen pregnancy as well. Participants are separated into groups of 12-14 and 15-18.

While money might be the initial impetus that gets students involved with the program, they stay with it because of the education and support they receive, Brown said. Weekly meetings give students sexual education, among other things. Educators promote abstinence but discuss the importance of birth control for those who are sexually active. The girls also learn about college, taking trips to different campuses and getting assistance filling out their applications. The fact that the program takes place on the Greensboro campus further serves to put pregnancy prevention within the context of higher education aspirations.

"It's a balance between working for the money and the more they get into studying and talking about colleges, the more they see that's what they want to do," Brown said. "I feel accurate in saying that no one in the program has parents who have been college graduates."

Shanise Thompson joined the program after finishing 7th grade. Her mother, Alice Thompson, had a child at the age of 17, and her older sister got pregnant at 15, so Shanise was what experts would consider to be one of the most statistically at-risk girls for teenage pregnancy. But Alice Thompson says the program helped Shanise to set her sights in the right direction. Now, she plans to go to a community college for two years and then transfer to Winston-Salem State University, in North Carolina, where she wants to study child psychology.

Alice Thompson added that College Bound Sisters also helped to create a more open relationship between her and her daughters -- one in which the topics of sex and pregnancy were discussed freely. She found the incentive piece of the program to be a great idea, but did not know about it until Shanise had signed up. "The generation of today, you have to have some kind of incentive for children to look forward to, to give them something to strive for. It's easy to tell them you want them to complete school and go off to college, but if there is a program to give incentives, it pays off," Alice said.

The money additionally serves to get the girls into the habit of long term goal-setting, which is accompanied by weekly goals that each participant sets for herself. In this way, Brown says that the girls learn to see not getting pregnant at a young age as part of a long-term path to success.

Brown added that by most accounts the program has been successful. Of the 125 participants who have stuck with it for more than six months, about half have made it all the way through and half have dropped out. 5 percent of the students got pregnant, another 5 percent dropped out of high school, and others parted ways with the program for unrelated reasons. The money saved by those who do not make it through the program is divided up among the remaining girls. Most of those who end up going into higher education attend a college in North Carolina, but the money may be used anywhere.

At the same time, Brown and Saunders have set up a control group of girls with similar characteristics to those in the program, and periodically check in with them. The girls who did not go through the program were four times more likely to become pregnant as teenagers and half as likely to enroll in college. Brown and Saunders have presented their curriculum to the state of North Carolina, and other educators within and outside the United States, but no other colleges are known to have started a similar program.

With operating costs at $75,000 per year, most of which goes to pay the program manager, there is very little overhead. Brown noted that this pales in comparison to the expenses of a single teen pregnancy, which can cost taxpayers up to half a million dollars between healthcare and welfare expenses.

Teen pregnancies currently cost taxpayers $9.1 billion annually, according to Bill Alpert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy. While Alpert acknowledged the possibility of uneasiness about the idea of paying to avoid pregnancies, he said that any program that reduces teen birth rates should be considered a success. With teen birth rates up again for the second year in a row after 14 straight years of decline, he stressed that "we are going to need to try new and innovative things."

"I know that this program generates passion among people," he said, "but the critical question is whether it works. Does it help prevent pregnancy? If it works, it seems to me like an incredibly modest investment."

He added that these incentives are no different from parents giving their kids presents for good behavior or the tax code issuing deductibles for giving to charity.

Other pregnancy prevention approaches that Alpert calls innovative include revising classroom sexual education to focus on "relationships, not just body parts." This similarly puts sex in a larger social context, rather than treating it in isolation. Use of technology has also brought sexual education into the digital age through mechanisms like digital messages that remind girls to take their birth control pills and online games with sexual education information.

Yet, Alpert acknowledged that sex educators are slow to respond to the need for new teaching methods, which is one possible reason why teen pregnancies are up. Furthermore, at a time when many school budgets are forcing principals to cut classes like physical education and math, Alpert said that it becomes harder for the school to be the innovator in sex education programs. Prevention experts must put efforts into figuring out what types of education work, Alpert stressed.

"One of the things [the National Campaign does] is isolates interventions that have success. If this program has been shown to prevent pregnancy through careful testing, we would suggest continuing it."

 

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