This was written by Jessica Lander, a journalist and teacher living in the Boston area, and Carolyn Smith-Lin, a resident physician at Boston Medical Center in obstetrics and gynecology.
By Jessica Lander and Carolyn Smith-Lin
The Department of Health and Human Services recently slashed $213.6 million in federal grants to 81 organizations across the country working on evidence-based approaches to decrease teen pregnancy rates.
The five-year grants were awarded in 2015 under the federal Teenage Pregnancy Prevention (TPP) Program, created with the aim of understanding what kinds of teen-pregnancy-prevention programs work so that they can be scaled up nationwide.
The abrupt cut was highly unusual, damaging to communities and wasteful for the country.
For 30 years, teen pregnancy and childbirth in the United States has been declining — from an annual teen birthrate of 1 in 16 in 1990, to 1 in 45 today — a historic low. Yet the United States trails all developed countries, including the United Kingdom, Israel, and Spain, based on available data. And there remain sharp geographic disparities: Teen birthrates can be up to 40 times higher in different U.S. counties.
Despite the decline, teen pregnancy and childbearing remain a public health priority. There are increased health risks for teen mothers and their children, including the greater risk of preterm birth, maternal depression and death.
Motherhood remains a leading reason girls cite for dropping out of school. Half of teen moms in the United States live in poverty. This stark reality hurts the young women and their children, but also society at large. Young mothers who lack even a high school diploma, a reported 50 percent of mothers ages 22 or less, are less likely to find enough work to support their new family. Children born into poverty are at greater risk for health complications and educational delays. For communities, delaying pregnancy and childbirth to the age of 20 years would save taxpayers up to $9.4 billion annually.
The TPP initiative has been a poster child for evidence-based policy — that is, programs that have been scientifically demonstrated to be effective, while continuing to test and evaluate different approaches.
Across the country, there is a vast array of sexual health curriculums, programs and approaches. Some are incredibly effective, others are not. The question is: how to identify and scale up the best?
When the Obama administration and Congress created the TPP Program in 2010, HHS commissioned independent experts to scour existing research on teen-pregnancy prevention programs. From a sea of approaches, they found nearly 30 curriculums that have been scientifically tested and shown to reduce teen pregnancy, STIs, young people’s sexual activity, or increase contraception use in at least one community.
TPP set out to build on this knowledge.
Most of the first cohort of grantees, from 2010-2014, tried to replicate approaches with existing evidence. Others used rigorous, randomized control trials to test new innovative programs. The work produced a treasure trove of information.
Ultimately, the first TPP cohort helped the nation better understand where, when and with whom each evidence-based curriculum was most effective.
About 40 percent of studies found positive results. Some curriculums worked in restricted settings — for example, the Teen Outreach Program worked in rural communities. Two were found to be ineffective.
The 81 grantees in the second cohort — those whose funding was just slashed — are similarly working to expand the reach of the effective curriculums and test new ideas. In addition, many had a special focus on finding approaches that work in communities where the teen birthrate is two to three times higher than the national average.
The work and approaches of the grantees is as diverse as the communities they serve.
In North Carolina, the nonprofit SHIFT NC is bringing sex education to children in foster care and juvenile detention centers. In Ohio, the Cuyahoga County District Board of Health has partnered with community organizations with the goal of bringing sex health education to 10,000 students in seven school districts with particularly high teen pregnancy rates.
The Atlanta-based nonprofit Quest for Change partners with schools, churches, health centers and even law enforcement in rural communities in southern Georgia, where teen pregnancy rates are three times the national average.
The Centerstone of Tennessee, which worked with 26 counties in the first cycle, expanded to teach sex education to 60,000 young people in 80 counties across Tennessee, Kentucky and Indiana.
Researchers at the University of New Mexico Health Sciences Center are busy testing new approaches, by working with health clinics and students to create 20-minute intervention for low-income Hispanic and Native American at-risk teens. It uses motivational interviewing, which is an effective technique for other health issues: through conversations, primary care doctors help teens envision precisely how pregnancy could affect their long-term goals and values, and empower teens to make sustained behavioral changes.
For many of the programs, TPP supplies a majority, if not all, of their funding. Without it, roughly 580,000 students will lose access to high-quality evidence-based sexual education.
HHS has provided no real justification for the cuts, offering only a vague claim that there was “weak evidence of the positive impact” of the TPP.
The evidence shows the opposite.
Teen birthrates in the United States have been declining since the 1990s. But the pace of progress in reducing teen birthrates has significantly accelerated since 2010, with rates plummeting by 41 percent. The period coincides with TPP, which observers credit with contributing to the trend.
HHS’s baffling decision came with no input from Congress, which has consistently funded TPP since its inception.
Thirty-seven senators and 148 representatives wrote to Health and Human Services Department Secretary Tom Price, calling the cuts “a blow to bipartisan efforts to prevent unplanned teen pregnancies” that would have a devastating “ripple effect across communities.”
Many speculate that HHS’s real motivation is antipathy to anything connected to comprehensive sex education. Price is a strong proponent of abstinence-only education, and Valerie Huber, the new chief of staff to the department’s assistant secretary for health, was until recently president of a national abstinence education organization.
Yet, TPP focused only on results — promoting curriculums that are scientifically proven to work. A few of its programs are abstinence-based, and most include abstinence as part of a more comprehensive approach. TPP simply provides a library of proven choices from which communities can decide which best meets their needs.
Slashing the TPP programs is foolish. By terminating programs that are already underway, America is pouring its investment down the drain — to the detriment of communities across the country who are desperate for effective solutions.
Don’t we want communities to know what actually works?
(Correction: Because of a dropped word, a previous version mischaracterized the ease with which young mothers without a high school degree can find work. )