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The federal funding was curtailed last month without explanation and without warning: $214 million for teen pregnancy prevention programs across the country.

The city of Baltimore lost $3.5 million, money that Health Commissioner Leana Wen said had supported classes in anatomy and physiology and counseling in social and emotional issues related to sex for 20,000 teens, plus training for 115 teachers. She worries what the loss of funds will mean for local teen pregnancy rates, which already are twice as high as the state's and much higher than the U.S. average.

“This is a central health issue for thousands of vulnerable teens,” she said. “What is going to be the downstream effect on society?”

Wen, a physician, was one of 20 health officials from the nation's largest cities who joined Wednesday to denounce the Trump administration for the cuts and who warned that the consequences could be severe. The teen pregnancy prevention program is among many reproductive health initiatives targeted in recent months. Federal officials have also tried to eliminate funding for Planned Parenthood, family planning clinics abroad and grants for scientific research in the field.

“The scale of this is huge,” said Faiz Shakir, national political director for the American Civil Liberties Union. “We are in a difficult place where Congress is stacked with conservatives and the administration with conservatives who are hostile to women and women’s reproductive rights.”

The $214 million pregnancy prevention program is made up of 81 five-year grants. They now are set to end in June, two years early, under a highly unusual Health and Human Services Department decision outside the normal budget process.

In addition to school and community-based classes like the ones in Baltimore, the program also funds five related research grants at Johns Hopkins University, the University of California at San Francisco and other institutions. The grants' early termination will make the first few years of data invalid because researchers won’t be able to continue some studies.

Wen said she became aware of the situation when she received a grant letter with the termination date changed to two years earlier. She said multiple phone calls and emails to federal grant officials have yielded no answers. She and other health commissioners have sent an official request to HHS Secretary Tom Price calling for the decision to be reversed.

“I believe this is unprecedented that … it is terminated without explanation,” she said.

In separate but related moves, President Trump in May issued an executive order to block U.S. aid to groups abroad that counsel or provide referrals about abortion. His action restricted nearly $8.8 billion in foreign health assistance. Trump's fiscal 2018 budget proposal would bar Planned Parenthood and other abortion providers from receiving federal funds for women's health screenings and other non-abortion services.

In choosing to ax these programs, critics say, the Trump administration is choosing ideology over science.

Though there has been no official statement about why the cuts were made, prominent administration officials have previously talked or written about their opposition to abortion and their views that teaching abstinence is the best policy to help prevent teen pregnancy.

The United States has long struggled with teen pregnancy and has the highest teen birthrate in the industrialized world. That has taken a toll on the nation's economy, contributing to high dropout rates, unemployment, premature babies and foster-care costs. Recent years have seen improvement, however, and the Centers for Disease Control and Prevention reported earlier this year that the teen birthrate had fallen to historic lows, dropping 8 percent since 2014.

Experts have credited better access to contraception and more convenient contraception for teens as well as their increased abstinence. Fewer teens are having sex as a gradual decades-long decline continues, with the latest surveys finding that about 42 percent of girls and about 44 percent of boys ages 15 to 19 report that they have had sex.

Patty Hayes, health commissioner for Seattle & King County in Washington state, signed the letter urging that the prevention grants be restored. Even if you believe in abstinence education, she said Wednesday, science shows that “teaching abstinence alongside birth control has increased abstinence.”

This post has been updated.

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