Alastair Boone is the editor-in-chief of Street Spirit and a former editorial fellow at CityLab.
An Obama-era program to lower the teen birthrate, widely considered a success, is losing its funding, and public health officials demand to know why.
The teen birth rate in the U.S. is at a record low: Since 1991, it’s declined by 67 percent. A large chunk of that drop occurred in the last 6 years, when the Obama Administration’s Teen Pregnancy Prevention Program began.
Now, in its second round of grants, the TPP Program (not to be confused with the trade agreement) is currently funding 84 communities across the country. Between 2010 and 2016, the years during which TPP funds started flowing, the national rate plunged 41 percent.
But that may soon be changing: When these organizations received their annual funding award letters in early June, one crucial number had changed: The date on which their funding would stop coming. Where before their grants had promised five years of funding, from 2015 to 2020*, the letters stated that the money would stop by July of 2018, cutting the program two years short.
“We have seen a decline in teen birth over the past five-plus years, which is amazing, but it’s also not a coincidence,” says Beth Marshall, the associate director of the Johns Hopkins Center for Adolescent Health. “We’ve seen a decline in teen birth because we’ve also seen increases in education and access to contraception.”
Even after the recent rate declines, teen pregnancy in the U.S. remains far more common than in most other developed nations. One in four teenage girls in the U.S. will become pregnant at least once by the age of 20—twice the rate of Canada, for example.
Lawmakers and public health advocates have voiced dismay about the cuts to TPP. A group of Democratic lawmakers—37 senators and 149 representatives—have written to Health and Human Services secretary Tom Price, asking for an explanation. The nonprofit Big Cities Health Coalition—a forum for leaders of America’s largest metropolitan health departments—sent a letter to Price, appealing this decision. The group emphasized a key concern with the early end to the program—the cuts will make it more difficult for researchers to obtain the evidence-based results that measure the effectiveness of individual programs:
Researchers will be unable to analyze data they have spent years collecting, and it will be incredibly difficult to draw any conclusions about what pieces of these programs work best and which are less effective at preventing unwanted teen pregnancy.
In a press call last week, Patty Hayes, the director of public health in Seattle and King County, credited the TPP program with helping her city bring its teen pregnancy numbers down. “When you take a look at the teen birth rate in Seattle and King County, it has fallen by 55 percent since 2008 due to our focused attention on this problem,” she said.
Seattle and King County use FLASH, a comprehensive sexual education program that is taught in every school district in King County, and as well as many other school districts nationwide. But, like many promising programs, FLASH has not yet had the opportunity to be evaluated—to discover how many students are delaying sex, or opting to use contraception, as a result of its programming. “Finally, we’re doing that test,” Hayes says, “and now the money will be yanked from us midstream.”
In Seattle, a total of $2 million will be lost in the new cuts. Nationally, the number is $213.6 million. So far, Trump administration officials has been vague about their reasons behind doing away with the funding. If the hope is to cut costs, the numbers don’t add up. Had it been fully funded, the TPP program would have cost around $500 million between 2015 and 2019—but in 2010 alone, taxpayers spent $9.4 billion on healthcare, child welfare, and incarceration costs associated with teen childbearing nationwide, according to the National Campaign to Prevent Teen and Unplanned Pregnancy.
Instead, many have speculated that the funding cuts are ideological. Several grantees were told that the decision came from the office of Valerie Huber, the new assistant secretary for health at the Office for Adolescent Health. She has been outspoken in her support of abstinence-only sexual education practices.
The majority of TPP funded organizations teach abstinence before promoting contraception. Many use curricula that start by focusing on building healthy relationships, and offering advice about postponing sex. But they also teach to teens who have already begun having sex. “We have evidence that most abstinence-only programs don’t reduce teen pregnancies” said Hayes. “We also have evidence that teaching abstinence alongside birth control and condoms has actually increased abstinence more than an abstinence only approach.”
While city health departments are vocal in the battle over funding, teen pregnancy isn’t just an urban issue: Although the majority of teen births occur in metros (where the majority of teens live), the health risks in childbearing are proportionally greater for rural teens. So are the number of births: According to a 2016 report from the Centers for Disease Control, the teen birth rate is substantially higher in rural counties, and rural areas have also seen a weaker drop over the past 20 years.
Overall, poverty is highly linked with teen pregnancy across all racial and geographic boundaries. Black and Hispanic teens are at the greatest risk of teen parenthood, with 32 and 35 births for every 1,000 girls across the country—compared to 16 in 1,000 for white teens. And in 2013, the teen birth rate was 43.3 in rural counties, compared to 32.7 in metropolitan counties.
TPP advocates emphasize that the program’s 84 grants are designed to accommodate many different kinds of communities and students of varied age and background. “There isn’t a one-size-fits-all solution,” says Andrea Kane, Vice President of the National Campaign to Prevent Teen and Unplanned Pregnancy. “The model you might use for 11- and 12-year-olds is going to be quite different from the model that would be appropriate for late high-school-age youth, or youth who have been in foster care.”
Many of the TPP’s grantees are using multiple models to account for cultural differences, she says. “I think one thing that’s often missed when talking about this is that a number of these grantees are using more than one model,” Kane says. “What the grantees are really trying to do, in concert with their community advisory groups, is figure out who in their community are they trying to serve, and which available models are the best fit.”
Understanding such nuances is crucially important: As the New York Times highlighted in their reporting on the cuts, one TPP-funded program proved to be effective in Houston but had a troubling result in rural South Carolina. During the studied period, sexually inexperienced seventh graders who underwent the training became more likely to have sex by late ninth grade.
A different South Carolina program called Connect, also funded by TPP, appears to have found success using different models for a diverse group of teens. The nonprofit, which operates under the Mary Black Foundation, partners with a number of local organizations that engage with teens all over Spartanburg County. Some work with youth in high-risk ZIP codes, while others focus on vulnerable youth in foster care, or juvenile detention centers across the county. Since Spartanburg County started receiving Office of Adolescent Health funding in 2010, the teen birth rate has declined by 47 percent—marking the first time the county’s teen birth rate was below that of the state.
With its new grant, Connect hoped to reduce the rate of teen birth an additional 20 percent by 2020. With these funding cuts, however, they will lose two years of their $5.3 million grant, and like many, they will also not be able to aggregate their research.
“One key principle for our work in public health is that we act on science” says Hayes. “We need the evidence that a new system or rule or intervention is necessary and that it’s effective. And we have the evidence that we need quality sexual health education in this country.”
*CORRECTION: A previous version of this article misstated the funding period.
This article is part of our project, “The Diagnosis,” which is supported by a grant from the Robert Wood Johnson Foundation.