Sara Gardner, MPH
As the nation focuses on the debate raging around the repeal of the Affordable Care Act and the current health bill being debated in the Senate, little attention is being paid to the fate of the very successful, national Teen Pregnancy Prevention program. Administered through the Office of Adolescent Health, the program has contributed to an unprecedented decline in teen pregnancy rates—from 34 births per 1,000 girls in 2010 to 22 per 1,000 in 2015. That’s a 35 percent decrease over five years. Despite this progress, President Trump’s FY17 budget proposes a 50 percent cut to the program. It’s pretty hard to fathom such a decision, especially when the United States still has one of the highest unwanted teenage pregnancy rates among developed countries, including Canada and the United Kingdom.
Established in 2010 by the Obama administration, the Teen Pregnancy Prevention (TPP) program is a national, evidence-based program that funds organizations across the United States working to prevent unplanned teen pregnancy among youth ages 10 to 19. The program provides $100 million annually to diverse organizations willing to replicate prevention approaches which have been rigorously evaluated by an independent group and then reviewed by the US Department of Health and Human Services. Grantees are required to use one of 44 different models based on their specific needs. It’s comprehensive, adaptable, and it works.
The irony behind the proposed cut is that teen pregnancy prevention is actually one of the few issues that Democrats and Republicans seem to agree on. According to the National Campaign to Prevent Teen and Unplanned Pregnancy, the issue has wide bipartisan support. A January 2017 survey shows that 85 percent of adults, (89% of Democrats and 75% of Republicans) favor maintaining federal funding for the Teen Pregnancy Prevention Program. In addition, the survey showed that 79 percent of adults (81% of Democrats and 73% of Republicans) believe teens should receive more information about both abstinence and birth control as well as sexually transmitted infection protection.
But widespread scientific and public support of comprehensive sexual and reproductive health education may not be enough to prevent the proposed cuts. It is likely that much of the funding from TPP will flow to abstinence-only programs which, despite research showing their ineffectiveness as a stand alone approach, have received over $2 billion dollars in funding over the last 25 years. Adolescents who take virginity pledges, a hallmark of many abstinence-only programs, are less likely to use contraception once they commence sexual activity, and they are just as likely to get sexually transmitted infections. They are also less likely to seek STI testing and treatment. Put plainly, these programs aren’t effective.
Instead, New York City uses a massive multi-pronged public health effort which includes government, community-based organizations, foundations, schools, parents, and youth themselves. This approach has supported the steady decline in teen pregnancy rates—down 53 percent since 2000. Though the credit for this decline is shared by numerous organizations and various private and public funding streams, the role of TPP, the very program President Trump has decided to cut, has been significant.
At the Fund for Public Health in New York City we have collaborated with the NYC Department of Health to implement programs such as Bronx Teens Connection and the current TPP-funded initiative called NYC Teens Connection which expands important work piloted in the Bronx to Brooklyn and Staten Island. Bronx Teens Connection was designed to address the high rates of teen pregnancy in the borough by improving student access to sexual and reproductive health education and services. The program, which began in 2010, supported partnerships among 40 schools, clinics, and youth services organizations working together to connect young, at-risk students to school-based health centers and community clinics.
After five years, more than 6,000 South Bronx teens had received sexual and reproductive health education in over 20 high schools, and the number of 12- to 19-year-olds receiving contraception increased by over 40 percent. The latter stat is particularly important because experts argue that contraception has been a major factor in the decrease in unplanned teen pregnancies.
The TPP-funded NYC Teens Connection builds on this work and has enabled students, teachers, and health practitioners throughout the city to combat high teen pregnancy rates by ensuring adolescents have access to accurate and up-to-date information about their sexual and reproductive health.
While parenting has its challenges at any age, we know that it can be particularly tough for adolescent parents. We have more than enough data to prove it. Teen girls who have babies are less likely to finish high school and they are more likely to need public assistance. They are also more likely to have children who have poorer educational, behavioral, and health outcomes over the course of their lives. It goes beyond the teen and child; the societal impact is huge.
Of all the public health issues we face as a nation, this is one challenge where the numbers are going in the right direction. Unfortunately, the Trump administration’s efforts to decrease this funding undermines the significant progress we have made over time.
It’s a wonder this is still up for debate.