Saturday, January 7, 2023

Human behavior and common sense interventions don't yield the expected results.

An interesting update reinforcing a common issue.  Commonsense policies frequently don't work as expected.  All policies have to be tested to see if they are delivering the intended outcome.

From The infant simulator fiasco by Emil O. W. Kirkegaard.  The subheading is A promising avenue for fertility programs?  

Teenage pregnancy is bad. At least, that's what most people think, so they are trying to lower the rates. One team of academics got the bright idea of exposure therapy. The idea is that babies are annoying and difficult to deal with, so if we can mimic this with a toy for young girls, this will make them realize how little they want to have a baby, and thus lower the pregnancy rates.

The idea has been around a long time and while I have heard of many programs in many places, I have never seen any rigorous study of the effectiveness of such programs.  My priors are that evolving social value systems have been far more effective at reducing teen pregnancy than have interventions of this sort.  


Background

Infant simulator-based programmes, which aim to prevent teenage pregnancy, are used in high-income as well as low-income and middle-income countries but, despite growing popularity, no published evidence exists of their long-term effect. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) programme, on pregnancy outcomes of birth and induced abortion in Australia.

[snip]

Findings

57 (86%) of 66 eligible schools were enrolled into the trial and randomly assigned 1:1 to the intervention (28 schools) or the control group (29 schools). Then, between Feb 1, 2003, and May 31, 2006, 1267 girls in the intervention schools received the VIP programme while 1567 girls in the control schools received the standard health education curriculum. Compared with girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth (97 [8%] of 1267 in the intervention group vs 67 [4%] of 1567 in the control group) or at least one abortion as the first pregnancy event (113 [9%] vs 101 [6%]). After adjustment for potential confounders, the intervention group had a higher overall pregnancy risk than the control group (relative risk 1·36 [95% CI 1·10–1·67], p=0·003). Similar results were obtained with the use of proportional hazard models (hazard ratio 1·35 [95% CI 1·10–1·67], p=0·016).

Interpretation

The infant simulator-based VIP programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.

Depending on the different variables taken into account, the intervention increased pregnancies 10-70% in the intervention group.  They accomplished exactly the reverse of what they intended despite the intervention being both common sensical and logical.

It does rather suggest just how powerful is basic biology, regardless of imposed policies.  Humans will be human.  

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