Monday, March 18, 2013

Stigma and Shame: A Campaign in New York Sparks Discussion

You might think this post is going to be about giant, sugary drinks and controversies over the (attempted) ban on them in New York City. Well, that is not the only campaign going on that has sparked interesting discussions about the role, and potential limits, of stigma and shame in campaigns to change human behavior.

Here’ the skinny. New York City has had an ad campaign going with “Posters in thousands of bus shelters and subways show tiny tots bewailing the bad news about teen pregnancy.” The quote is from the first piece I happened to read about this, which is an article by Heather MacDonald in the City Journal.

Here are two examples of what the messages on the posters say:

“Because you had me as a teen, I’m twice as likely not to graduate high school.”

“Honestly Mom ... chances are he won’t stay with you. What happens to me?”

I will provide links to several fascinating articles on this campaign (pro and con and mixed/complicated). If you are interested in these themes, you will find these pieces very interesting.

For starters, here is the link to MacDonald’s piece.

One of the interesting points that MacDonald highlights is what she calls the growing stigma about stigma. She points out that, “For millennia, humans relied on social disapproval to reduce behavior that produced disproportionate costs to individuals and the community.” Whatever your beliefs on the effectiveness of stigma, it seems to me obviously true that it is less acceptable these days to discourage some types of behavior by social disapproval—shame and stigma. I say “some types” because it should be equally obvious that it is growing in acceptability to try to discourage other types of behavior by social disapproval. Maybe the use of social disapproval is not changing much at all in aggregate, just what themes those efforts get attached to these days.

The other point MacDonald brings to the forefront is the ongoing debate in social science and policy circles about causality between poverty and disadvantage and responsibility or control over personal behavior. This argument is a big deal.

In one piece about this in the New York Times, Kate Taylor quotes Haydee Morales of Planned Parenthood of New York City as saying the following (link here):

“Hurting and shaming communities is not what’s going to bring teen pregnancy rates down,” she added.
She said that the campaign’s message — that teenage pregnancy leads to poverty — was backward.
“It’s not teen pregnancies that cause poverty, but poverty that causes teen pregnancy,” she said.

Another piece in a New York Times, by Motoko Rich (linked here), also emphasizes the side of the argument that poverty determines behavior. He quotes an economist named Phillip B. Levine as saying, “Teenage childbearing is ‘a symptom, not a cause’ of poverty and economic immobility.” Levine is second author of a recent study (with Melissa S. Kearney) in which they find that poverty plays a complex role in teen pregnancy based on if teens live in areas of high income inequality or lower inequality. They suggest that higher income inequality contributes to greater teen childbearing.

MacDonald is challenging the view that poverty determines teenage pregnancy with little room for the role of personal responsibility. This causality conundrum is fast becoming an age-old argument among thinkers about all sorts of family patterns associated with higher risks for difficulties in life. Why does the argument matter? Because how you come down in your view of such things will determine what levers you think could be pulled of should be pulled to make a difference. Can an individual, despite great disadvantages, make different choices and improve her (or his) odds of good outcomes or is it the case that little can be done by an individual because the only changes that matter are ones that reduce economic disparities?

In another media piece, Keli Goff takes the position that the ad campaign is needed, and raises the issue of why stigmatizing campaigns are considered fine for some things and not for others. Her piece can be found, here. I do not know anything about Keli Goff and her general beliefs, though she appears to me to be a liberal challenging other liberal’s in their criticism of the New York campaign. For example, while Planned Parenthood has come out against the campaign in New York, Goff writes:

“I just wonder if the women of privilege running Planned Parenthood, which has struggled with diversity in the past, realize that children born in poor communities deserve the same opportunities their kids do -- which means not just randomly distributing birth control but actually giving poor women the same information, incentives and life goals that women who grow up in privilege often take for granted. That includes providing accurate information about why when you choose to become a parent matters.”

Now the part I wanted to call the most attention to in Goff’s piece is the part about the influence of TV on behavior, where she wrote:

“Considering that one of the most widely covered reality-TV trainwrecks -- second only to the Kardashians -- was the star of a show called Teen Mom, I would think that Planned Parenthood has more pressing media concerns than stopping an anti-teen-pregnancy campaign, but apparently not. The show Teen Mom and other reality shows, such as 16 and Pregnant, are perfect examples of why this campaign is needed.”

She goes on to voice a strong concern about the impact on teens of shows where teenagers become famous for becoming pregnant. (She makes some interesting observations about the Kardashians, also.) I generally, strongly agree with this position that television shows are not helping on any number of social trends. But what’s fascinating about this Teen Mom show example is that it’s really not clear if the effect would be to inspire other teenagers to become parents or discourage it. That’s a great question (well, to me, anyway).

One scholar I am in regular dialogue with, Sarah Halpern-Meekin, had what I thought was a very important observation on these issues. She noted that reality shows like “Teen Moms” may have a more positive impact than we’d guess because they could impact the awareness of teens about the downside of teenage births. Such shows can depict, pretty graphically, the difficulties that having a child as a teen bring to one’s life. So, while others have criticized shows like “Teen Moms,” Halpern-Meekin adds an important insight to the whole discussion about what messages may be most effective in helping teens. While there is a reasonable concern that such shows may encourage something that places teens at higher risk for difficult lives (and their children), showing some of the difficulties may well have a preventive effect, for some. She is suggesting, whether intentioned or not, such shows could discourage teen pregnancy, and maybe more effectively than the harsher approach taken in the poster campaign in New York.  Further, she noted that there is really very little research on what types of messages—and delivered how and by who—are truly most effective to warn young people of risks in various pathways of life.

This is the type of question I find most interesting in all of this. What's the best type of message delivery if there is an effective message to be delivered? Some of these other questions are important but they represent chronic, deep arguments about individual choices and the context of poverty. There are some people who seem to be arguing that teenage pregnancy and parenting may not even be a big deal. I’m not very interested in that argument because it seems manifestly silly. I also don’t buy the idea that poverty and other types of disadvantage mean there is no role for individual choice and behavior in determining what happens in life. (See my link on the left side about science, selection effects, and determinism if you want a Big Gulp dose of that discussion. Or just click here. Warning: it's a lot to digest.)

I fully believe that poverty greatly limits the choices an individual can make, but to accept the idea that the individual can do nothing goes too far. Some people get dealt a very tough hand in life, and where true, the chances of getting a good outcome are lower. No question. But that does not mean the individual’s behavior does not matter, and some people seem to want to argue exactly this. A little change at a couple of key moments could make a much larger difference in the life of someone with poor options than the same change would make for others.

This whole dust-up about the New York campaign raises many great questions about the complex goo of social challenges. It would be great to see more effective strategies being tried, tested, and fielded for changing the arc of opportunity for those in poverty. But I also want to know all we can know about what strategies might be most effective for educating individuals, like teens, about things that help them play whatever hands they’ve been dealt in a way that improves their own odds in life. And that includes wanting to know, by solid research, what types of messages and delivery systems teens would actually be most responsive to in affecting risk behavior.