“How did he get pregnant?”
That’s the reaction of one teen interviewed on Good Morning America when she saw an image from the ad campaign launched by the Chicago Department of Public Health (CDPH) this past May. The CDPH placed the ads in Chicago’s public transit system to command the attention of passersby in hopes of getting them talking about teen pregnancy.
Chicago has one of the highest teen birth rates in the U.S., with 57 births per 1000 females aged 15-19—one and a half times higher than the national rate. The teen birth rate in Chicago is also a source of substantial racial and ethnic disparities. For example, the birth rate among teens aged 15-19 in 2007 was six to seven times higher in Blacks and Hispanics than in Whites. Furthermore, in the same year, over 95% of teen births in Chicago occurred among Black and Hispanic females.
As part of National Teen Pregnancy Prevention Month, observed annually in May, Chicago Commissioner of Public Health Dr. Bechara Chouchair sought a provocative approach to public service announcements, featuring a diverse population, which would catalyze conversation.
Social media has been alight with activity concerning the ads. Twitter has buzzed about the images, with some 25,000 unique tweets. Retweets have numbered in the millions according to Brian Richardson, a CDPH spokesperson. Facebook reactions have been mixed. While some comments have been favorable, others have admonished the campaign. One woman opined, “This poster picture is childen [sic] porn.”
Despite detractors, Mr. Richardson is satisfied with the huge boost in traffic to the CDPH-sponsored website BeYouBeHealthy.org, included in the copy of each ad. The website extends the effort to curb teen pregnancy beyond the one month period of the ad campaign, offering advice on relationships, ways to navigate the issue of sexual consent and how to say no, and birth control, including how to get free condoms.
The “Unexpected?” ads were created to close that gap by generating conversation among teens and parents. Program Director of Adolescent and School Health of the CDPH Suzanne Elder used focus groups to select the images that were eventually displayed in Chicago bus stops and train stations. The controversial images were repurposed from a campaign by the Milwaukee Department of Health that is credited with a 10% decline in teen pregnancies in the city. The images were the same, but the copy read, “It shouldn’t be any less disturbing when it’s a girl.”
That the CDPH campaign has sparked a national conversation can be seen as a positive unintended consequence. According to the National Campaign to Prevent Teen and Unplanned Pregnancy, teen pregnancies dropped 39% from 1988 to 2008 in the U.S. Even with such a marked decline, the U.S. teen birth rate eclipses that of other comparable countries. The U.K. is second where the rate is about a third lower, and Switzerland, with the lowest rate, has less than one teen birth for every nine in the U.S. And while Chicago’s teen birth rate is declining faster than that of the U.S. as a whole, its elevated rate merits local public health action.
Other city health departments have also taken controversial approaches to reducing teen pregnancy. A campaign by the New York City Human Resources Administration/Department of Social Service, for example, launched a series of ads featuring a diverse group of children born to teen parents to reach their mass transit-anchored target audience earlier this year. Each ad communicated a key fact about a range of social and economic teen pregnancy outcomes while appealing to the emotions of the target audience.
Reactions to these campaigns from targeted teens are mixed. Graham Gilliam, a 16 year-old from New Jersey, pointed out that the images from Chicago and Milwaukee were “so out of the ordinary that it’s almost impossible for someone to miss them.” Jackie Pereira, a 19 year-old from New Jersey, appreciated that the New York ads presented real facts and statistics.
The ads in New York City further engaged viewers by directing them to text “NOTNOW” to a dedicated line to learn the “real price” of teen pregnancy. They could then have a simulated text conversation addressing the attendant social complexities.
Although Mr. Gilliam and Ms. Pereira both said they would not have texted to get more information, more than 7,600 people over a two-month period did contact the number in the ads. According to Carmen Boon of New York City’s Human Resources Administration, “The texting component of our teen pregnancy prevention campaign reached its goals of engaging participants with the campaign messaging and with information on city’s services assisting teens.”
Dr. Jennifer Ashton, a women’s health expert and author of The Body Scoop for Girls, imparts straight-talk advice to teens and young women on pregnancy avoidance through delaying sexual intercourse and contraception. She also attributes some of the decline in the number of U.S. teens having sex to media campaigns. Dr. Ashton found the “Unexpected?” images to be extremely effective, “as boys are half the problem in teenage pregnancy.” She emphasized that “any ad that increases the awareness of teenage pregnancy is going to hopefully bring about some positive results and prevention.”
The return on Chicago and New York City campaigns is hard to gauge. In Chicago, the “Unexpected?” ads leave Brian Richardson cautiously optimistic about their true effectiveness, which he defines as a reduction in the teen birth rate. For that measure he’ll have to wait “several years for real success. Hopefully.”
At the population-level, the relevant question is not “How did he get pregnant?” but rather, “How effective will these campaigns be?” More talk and less action, translating into a lower teen pregnancy rate, means public health has scored.
Edited by Dana March