Abstract
The World Health Organisation advocates a direct focus on adolescent men in reducing adolescent pregnancy; however, no trials have been conducted. This trial (ISRCTN11632300; NCT02092480) determines whether a novel Relationship and Sexuality Educational intervention, If I Were Jack, is acceptable and feasible to implement in mixed sex UK classrooms. The intervention is a teacher-delivered intervention that emphasises male alongside female responsibility in preventing unintended pregnancies and is designed to prevent unprotected sex. The trial was a parallel-group cluster randomised controlled feasibility trial with embedded process and cost evaluation in eight secondary schools (unit of randomisation) among 831 pupils (mean age 14) in Northern Ireland, alongside a qualitative evaluation of transferability in ten schools in Scotland, Wales and England. The sampling strategy was a maximum variation quota sample designed to capture a range of school management types. Four schools were randomised to each arm and the control arm continued with usual practice. Study duration was 12 months (from November 2014), with follow-up 9 months post-baseline. Results demonstrated that the intervention was acceptable to schools, pupils and teachers, and could be feasibly implemented, cost-effectively, with minor enhancements. The between-group difference in incidence of unprotected sex (primary outcome at pupil level) of 1.3% (95% CI 0.5–2.2) by 9 months demonstrated a potential effect size consistent with those reported to have had meaningful impact on teenage pregnancy. The study responds to global health policy for a paradigm shift towards inclusion of men in the achievement of sexual and reproductive health goals in a practical way by demonstrating that a gender-sensitive as well as a gender transformative intervention targeting males to prevent teenage pregnancy is acceptable to adolescent men and women and implementable in formal education structures. If I Were Jack now merits further effectiveness testing.
Highlights
Why Men?Feminist research has transformed health science in general, such that it is no longer scientifically acceptable to model either the causes or the cures of ill-health without taking sex and, in more progressive research, the gender continuum into account (Connell 2012)
We report the results of a cluster randomised controlled feasibility trial of a schools-based Relationship and Sexuality Educational (RSE) intervention, which especially emphasises the role of teenage men in preventing teenage pregnancy and is delivered to both males and females aged 14–16
The results from the transferability study endorse the overall acceptability of the intervention within schools, with strong appreciation of the uniqueness of focussing on male perspectives and opportunities afforded to explore the emotions associated with teenage pregnancy by both male and female pupils and teachers
Summary
Why Men?Feminist research has transformed health science in general, such that it is no longer scientifically acceptable to model either the causes or the cures of ill-health without taking sex and, in more progressive research, the gender continuum into account (Connell 2012). While teenage men are rarely excluded from these innovations designed to address teenage pregnancy, they are seldom the central focus (for exceptions, see Gruchow and Brown 2011; Herrman et al 2016; Pulerwitz et al 2015) It is acknowledged at the global health policy level that tackling the gendered power relationships in society that relinquish some men from reproductive/contraceptive responsibility (arguably more prevalent in liberal high-income nations) while giving some men power over women’s reproductive bodies, such as their right to access contraceptive and pregnancy termination services (perhaps more prevalent in conservative low-income countries), is a substantial part of the problem in addressing teenage pregnancy world-wide (United Nations 2015; WHO 2017; WHO 2011)
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