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In high schools around the world, teenagers are handed an electronic doll to care for for a day or two, to expose them to the challenges of parenting. The thought is that these so-called infant simulators will reduce the incidence of teen pregnancy. But the first randomized trial on the dolls finds they may do the exact opposite — actually increasing pregnancy rates in schools where they’re used.

The infant simulator is a doll that cries when it needs to be fed, burped, rocked, or changed. It also electronically measures and reports on mishandling, crying time, the number of changes, and general care. These dolls are used in school- and community-based teen pregnancy prevention programs in 89 countries. This includes 67 percent of US school districts, according to Realityworks, which makes and sells the simulators.

But despite that widespread use, few studies have examined the underlying assumption that these programs actually reduce teen pregnancy. Australian researchers thus decided to conduct a randomized controlled trial.


From 2003 to 2006, Australian researchers followed girls ages 13 to 15 at 57 different schools. One group of 1,267 girls participated in the six-day Virtual Infant Parenting (VIP) program, which includes the infant simulator, while another 1,567 girls got the standard health education curriculum without an infant simulator. The researchers linked the school data to data from hospital records and abortion clinics, and followed the girls until they reached the age of 20.

They found that 8 percent of girls who used the dolls had at least one birth, compared to only 4 percent of the girls in the other group. The researchers also found 9 percent of the girls who used the dolls had abortions, compared to 6 percent of the control group. After adjustment for potential confounders, the intervention group was 36 percent more likely to become pregnant than the control group. The study was published Thursday in the Lancet.


The most comprehensive review of the simulators before this point, published in 2011, had found that the programs had no effect on students’ knowledge levels and mixed effects on their attitudes about teen pregnancy. But the studies focused almost exclusively on students’ expressed intent to become a parent rather than their actual pregnancy outcomes.

And as for why the dolls got such enthusiastic uptake in the first place, Julie Quinlivan, professor of obstetrics of University of Notre Dame Australia, writes in an associated editorial that politicians were seduced by a technological solution to a societal problem.

“The cure for teenage pregnancy is more difficult than a magic doll,” she wrote. “We have to address both mothers and fathers. Programmes need to start in infancy. Investment in vulnerable children is needed to entice these adolescents from the path of premature parenthood into brighter futures. We cannot afford the quick fix, especially when it doesn’t work.”

  • How do we know which students are predisposed to teen pregnancy? If this were true, wouldn’t all the students in these courses become teen parents. Certainly not so in my courses. Generally speaking, very few have become parents while in high school; some a couple of years after high school graduation. Who is to say the students did not postpone pregnancy past high school who would have actually had them while in school? We need to also look at the program as a positive force on students completing secondary school BEFORE having children.

  • The study released yesterday by The Lancet is not a representation of our curriculum and simulator learning modality but the researchers’ “adaptation” and is consequently not reflective of our product nor its efficacy. The RealCare Baby® Program is a combination of curriculum and hands-on aids, and if it is being tested and judged for effectiveness, it should be judged in its entirety.

    The “adaptation” used in the study was developed by Australia’s Swan Hills Division of General Practice, the Coastal and Wheatbelt Public Health Unit and the North Metropolitan Population Health Unit. The class time designated for teaching the adaptation was a mere 2.5 hours.

    The RealCare Program is 14 hours of class time, learning activities and a prolonged take-home simulator experience.

    This study is not measuring Realityworks’ program and infant simulator but – as stated in the study – is investigating the effect of Australia’s Virtual Infant Parenting program.

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