Pregnancy prevention trial falls flat

A attempt to replicate a programme credited with cutting the New York teenage pregnancy rate has failed a UK trial.

According to an independent evaluation published in the British Medical Journal, the young women who took part were actually more likely to get pregnant. They were also more likely to play truant and to be excluded from school.

The Young People’s Development Programme was funded to the tune of $8 million by the UK Department of Health. The evaluation by researchers from the Institute of Education and the School of Hygiene and Tropical Medicine compared the outcomes of children in 27 Development Programme locations around England with 27 other sites, matched in terms of region, deprivation and current teenage pregnancy rates.

The successful New York initiative was based on the Carrera Program, developed by the Children’s Aid Society. Health scientist Michael Carrera’s 1980s service design also aims to reduce substance abuse and improve educational attainment.

To reach these goals, it uses a strategy of overall personal development – a familiar mixture of education, life skills training, mentoring and volunteering. These inputs are augmented with health, sex and drugs awareness sessions, as well as art and sports activities.

The UK trial ran from 2004-2007. Around 2,500 children aged 13-15 who were deemed to be at risk of pregnancy, drug abuse or school exclusion were referred to the programme by teachers and other care professionals. The evaluation team collected information from them before the programme began, and after nine and 18 months.

Led by Meg Wiggins from the Institute of Education, the research team believe that the disappointing results vindicate the decision to evaluate the programme in the UK irrespective of its performance in the US. There is always a temptation to roll out a programme that has been proven elsewhere straight away, but in this case it was resisted, Wiggins says.

However, there is as much doubt about the evaluation method as the quality of the programme. Some of the negative or negligible effects may be down to the limited comparisons allowed by a flawed research design imposed, the researchers say, by factors beyond their control.

Wiggins and her colleagues advise that 'any future implementation of targeted youth development in the UK should occur only within the context of a randomized controlled trial.' More robust methodology would enable researchers to make more confident statements about what works, and what is damaging to young people.

As to why the program may have had detrimental effects on the children who took part, they suggest that by putting together groups of children who already had significant problems, it may have exposed them to bad influence. They also allude to previous studies that have shown that labeling children as a problem can itself contribute to poor outcomes.  

Either way, the UK outlook for the Carrera model is not promising.