Although teen births have declined significantly in the United States, disparities by race, ethnicity, and geography persist, emphasizing the ongoing need for teen pregnancy prevention efforts. According to the CDC, non-Hispanic black youth, Hispanic youth, and socioeconomically disadvantaged youth of any race or ethnicity have the highest rates of teen pregnancy and childbirth. Teen childbearing can have negative health, economic, and social consequences for mothers and their children, with related costs about $9.4 million annually in the US.1 

In 2012, a total of 305,388 babies were born to teenage mothers in US. The teen pregnancy birth rates in the US are substantially higher compared with those of other Western industrialized nations. Teen pregnancy and birth are significant factors for dropping out of high school. Peer pressure and attitudes regarding teen pregnancy can influence students on whether to become sexually active.

In an attempt to reduce teen pregnancies, the Baby Think It Over (BTIO) program was presented to 8th grade students in Long Branch, New Jersey, as a pilot study in 2001. After the first year, the physical education teachers requested that it become part of the students’ curriculum in school. All the 8th grade health classes took part in the program. Students who had a signed consent form from a parent or legal guardian took the baby simulator home on Friday after school and returned it the following Monday morning. They had to provide total care for the baby for the entire weekend (feed, change diapers, burp, etc.). The purpose of this exercise was to educate the students about the realities and responsibilities of pregnancy and infant care.

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With the assistance of a licensed clinical social worker at the school, the BTIO program can be integrated in health class education regarding abstinence, STD prevention, and pregnancy delay. By implementing this educational program in the middle school, we planned to educate the students before they make the decision to become sexually active without protection. This has created a dramatic decrease in pregnancies (from 26 pregnancies in 2001 to 1 in the past 2 years). Providing close to a real experience with infant simulators and having teen moms speak to peers about their day-to-day challenges can bring about life-changing behavior. Making the BTIO real case parenting program an integral part of our health classes has brought about positive results. It breaks the cycle of teenage motherhood by having the students comprehend the consequences of their actions. Teen mom peers in their class give them a shocking reality check. The teen moms share their stories to students about the financial impact of having a child as a teen, along with the resulting immediate and long-term impact on their lifestyle.

The BTIO approach strives to modify teen attitudes toward sexuality and parenting requirements. This interactive curriculum lets them hear their peers’ opinions on sexuality and parenting as a teenager. Our curriculum called for a class in which teen moms from our high school volunteered their experiences of parenting and the issues affecting the delivery of a child at their ages. Teaching becomes more effective when students are presented with the actual consequences of having unprotected sex and when having a baby becomes a startling reality. The program has had a positive impact in delaying sex and giving our students time to mature and make better decisions in a safer way.

Virginia Carreira, DNP, RN, APN, CDE, CCRN, is a family nurse practitioner in Long Branch, NJ.


  1. CDC. Reproductive health: teen pregnancy—communitywide initiatives. US Department of Health and Human Services, CDC. 2015.