Want to Prevent Teen Pregnancy? Pay Teens Not to Get Pregnant

We use financial incentives in many areas of life for a simple reason: they work. Why not with teen pregnancy?

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New York City officials recently spent $400,000 on billboards featuring omniscient babies who remind potential mothers about deadbeat dads of the future: “Honestly, Mom, chances are, he won’t stay with you. What happens to me?” In another ad, a crying infant says, “I’m twice as likely NOT to graduate high school because you had me as a teen.”

The shame-and-blame campaign almost immediately drew fire from Planned Parenthood and other health care providers who argued that the ads marginalize young women who are in need of services, not scarlet letters. But a spokesperson from Mayor Michael Bloomberg’s office defended the public-service announcements on the grounds that they are but one component of a multifaceted approach that includes school clinics and sex education, noting, “It is well past time when anyone can afford to be value-neutral when it comes to teen pregnancy.”

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Fair enough. But if we want to get serious about values, we might try an approach with a much more successful track record of behavior change: paying teenagers not to get pregnant. For every person who makes it to age 21 without becoming pregnant or impregnating someone else, the government should dip into the funds we’d otherwise spend caring for infants and teen moms and instead pay a significant cash bonus directly to the young person.

Sex and money have always been drivers of human behavior, but health officials rarely exploit this synergy to maximum benefit. Cash payments to teens could be doubly effective, reducing the number of teen pregnancies (which are declining nationwide but are still high relative to those of other developed countries) while producing what researchers call a “secondary outcome” by teaching self-regulation, patience and the ability to plan for the future—all valuable life skills.

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The New York City ads serve a useful function only insofar as they reassure indignant taxpayers that something is being done about wayward teenagers. But it’s wishful thinking to imagine that snarky speculations about a baby’s future are hitting their target audience of sexually active 15- and 16-year-olds. It’s not that negative advertising can’t work. Political campaigns use it all the time. But decades of research show that teens, like most people, respond to public health campaigns that seem personally relevant and offer concrete action steps. This explains why the infamous anti-smoking ads featuring photos of old, diseased lungs didn’t impress teen smokers as much as newer ads that say smoking is not normative in their peer group or connect them to resources to quit.

We already know that people respond to negative financial incentives. Smoking rates went down as cigarette taxes increased (even when other variables were accounted for). But there is also compelling evidence that people will change their behavior when offered positive financial incentives. A large randomized, controlled trial conducted by Kevin Volpp at the University of Pennsylvania and published in the New England Journal of Medicine in 2009 showed that a $750 incentive roughly tripled the success of smoking cessation, from 5% to 15%. In a recent survey of attitudes to cash payments, 73% of respondents said they would try to lose weight if the government paid them. Half said they would try “really hard.” And Harvard professor Roland Freyer has found that sensibly structured cash payments that are tied to specific goals, like reading more books, can yield good results for complex problems like keeping kids in school.

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Giving teens money to forestall pregnancy makes some people uneasy — why should we pay them to do something they “ought” to be able to manage on their own? — but we use financial incentives in all areas of life, from children’s allowances to tax breaks for home ownership, for a simple reason: they work. In a country steeped in practical values and unrestrained capitalism, it is surprising that we haven’t already put this solution to more widespread or better use.

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