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Dollar-a-Day scheme prevents teenage pregnancies in US

Aug 31, 2009

The College Bound Sisters programme in the University of North Carolina aims to avert teenage pregnancy with an incentive of a ‘Dollar a Day’. One-third of young women in the US become pregnant in their teens and more than 80% of these pregnancies are unintentional.

Vermont: In 2003, a young woman began talking to Dr Hazel Brown as they prepared to give a press interview at the University of North Carolina (UNC) in Greensboro.

"You know," she said, "my only brother is in prison for life. My only sister had three babies when she was a teenager. In grade school I was a bully; people were afraid of me and I liked that. I failed seventh grade because I never studied. They passed me anyway because I'd done well on a test. I knew they wouldn't do it again, so in high school I started studying. It was the hardest thing in my life but I made good grades – straight A's in my sophomore and junior year. I'm graduating now with a very high grade point average. I want to go to Xavier University in New Orleans."

This spring that same young woman received her doctorate in pharmacology from Xavier.

College Bound Sisters

While being interviewed in 2003, she was a participant in College Bound Sisters, a programme co-founded by Dr Brown with Dr Rebecca Saunders at UNC, Greensboro. Both women were maternity nurses, hold Ph.D. degrees, and taught at UNCG. The programme they started aims to avert teenage pregnancy in a particularly high-risk group: Younger sisters of teen mothers.

College Bound Sisters is designed to help girls achieve three goals – avoiding pregnancy; graduating from high school; and enrolling in college. It focuses on girls in two age groups: 12 to 14 years; and 15 to 18 years. Programme participants are required to have a sister who had a baby before age 18; they must never have been pregnant; should demonstrate a desire to attend college and be committed to attending the weekly meetings.

Each member who attends meetings; is not pregnant; and is still in school has US$ 7.00 placed in her college fund weekly, which is released upon enrolment in college. Members also receive US $5.00 in transportation expenses when they attend meetings.

"I'd seen too many teens having babies," recalls Dr Brown, who had worked from 1990 to 1995 with the county health department to establish a programme for teenage mothers called Dollar a Day, designed to help them avert further pregnancies.

"I began to wonder what we could do to establish a programme for primary pregnancy prevention," she adds. Inspired by research showing that teenage girls with career or college aspirations were less likely to become pregnant, and by the theory that it is difficult to move towards a negative goal (e.g. "Don't get pregnant") than to aim for a positive one, Brown and Saunders successfully applied for grant money from the state Department of Health and Human Resources.

College Bound Sisters was launched in 1997. Other grants followed and, today, the programme is state-funded for a period of four years, renewable annually.

There are currently 24 girls in the two age groups, which meet separately each week with adult leaders. Meetings are held on the campus of the university and feature "food, fun, fellowship, and education. Guest speakers, campus field trips, demonstrations and an assortment of media covering a wide variety of topics help the programme achieve its goals," Dr Brown says.

In addition, there are quarterly meetings held with parents of the members, providing a forum for discussion of issues related to adolescent girls.

Developing life skills

The keystone to this format is a well-developed and copyrighted curriculum with four distinct units. Sexuality and Pregnancy Prevention focuses on topics such as anatomy and physiology, including preventive care; communication (for example how to say no, verbally and non-verbally); self-identity; and values and morals. Promoting Health Lifestyles explores nutrition, exercise, stress management, health relationships, and alcohol/ drug issues.

Developing Life Skills is about goal-setting; career planning; and money management. Preparation for College includes financial planning; grades; admissions; and visiting colleges. After one such visit, which included sitting in on a class, one participant exclaimed, "I can do this! I know what they were talking about. I can go to college!  I could make a good grade!"

Dr Brown likes to stress that "everything we do is interactive," whether it is having participants use play dough to create anatomical parts as they envision them, or having an array of contraceptives available for the girls to handle during discussion. She also points out that there are all kinds of support along the way, including tutoring and individual mentoring, often provided by sorority sisters on the campus at UNC.

The need for this kind of programme, which has won wide recognition and multiple awards from such organisations as Sigma Theta Tau International and Pharmacia-Upjohn, seems clear from the data: According to the United Nations, the US still has the highest rates of teen pregnancy and birth among comparable countries.

Rampant problem

In 2006, the US teen birth rate was 42 births per 1,000 teens aged 15 to 19, one-and-a-half times higher than the teen birth rate in the UK. Approximately one-third of young women in the US become pregnant during their teen years and more than 80% of these pregnancies are unintentional. About 13% of US births involve teen mothers and about 25% of teenage girls who give birth have another baby within two years. Only about one-third of these young mothers manage to complete high school.

In their own research, College Bound Sisters has found that young women in their control group are twice as likely to become pregnant and drop out of school as programme participants.

Participants who graduate from high school are twice as likely to enrol in college as women in the control group, and while programme participants show continued high self-esteem, members of the control group report drops in this indicator. To date, among the 125 participants only six have become pregnant while in the programme.

"The work is demanding," says Hazel Brown, who hopes to replicate the programme around the country. "But seeing them succeed is the icing on the cake. It is a service for me to do this, a calling. This is my way of working to help these people, to change their life trajectory."

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