Teen pregnancy prevention programs face funding cliff

By Rose Hoban, N.C. Health News / August 11, 2017

When Rick Brown received the annual letter and check from the U.S. Department of Health and Human Services earlier this month confirming the coming year’s funding for his program, he did a quick skim of the contents and put it in his file.

Then he got a phone call asking if his funding had been cut. He went back to the letter.

“Sorta buried down in a little block toward the bottom of the first page was a remarks section,” said Brown, who is the youth education director for the Children’s Home Society of North Carolina. He manages an annual $586,000 award to present a teen pregnancy prevention program to high school-aged boys in Iredell County. The grant also pays to evaluate how effective the program is at changing attitudes and behaviors among the students.

Brown’s grant was supposed to run through mid-2020, but at the bottom of the letter, “there was just one sentence that said the award would be shortened, to be ending on June 30, 2018.”

A number of teen pregnancy prevention programs around the state have been working to lower the chance that girls become pregnant before they’re old enough. The programs that had their federal funds eliminated were testing new and different ways to address the problem.

In more than 20 years of receiving and administering federal grants, Brown had never seen anything like it: halfway through a grant cycle, without warning, federal officials will cut off his funding.

“We’ve had situations where funding has had to be shortened or cut before, but typically, there’s advanced communication and there’s a process,” said Brown, who noted he has not heard another word from the federal DHHS’ Office of Adolescent Health. “This was just a done deal before anyone ever knew about it.”

Across the country, more than 80 teen pregnancy programs got the same notice in their annual letters that come 2018; $88.5 million in funds will dry up. Many program managers are unsure what will happen after next June.

“We’re trying to figure out what it’ll do to us,” said Elizabeth Finley, spokeswoman for SHIFT NC, which was once known as the Adolescent Pregnancy Prevention Campaign of North Carolina.
“The Obama administration had really concentrated a lot of the efforts around teen pregnancy prevention in the Office of Adolescent Health and at this point, we’re not even sure the Office of Adolescent Health will continue to exist.”

Dropping numbers

Since the turn of the century, pregnancy rates among teens in North Carolina have taken a sharp downturn. In 2001, 69 of every 1,000 girls between 15 and 19 got pregnant, by 2015, that number was reduced by more than half. Now, only 30 of every 1,000 girls get pregnant.

With that drop in pregnancies, the abortion rate for teens has gone from 14.5 per 1,000 teens down to 6.2 per 1,000 teens.

Over more than a decade, teen pregnancy rates have dropped, with steeper declines occurring after 2008.

Experts say there’s a number of reasons for the drop in pregnancy rates, including better long-acting contraception. But one of those reasons is better education and better information for both girls and their male partners.

Which is where the teen pregnancy prevention programs come in?

“We have seen great declines both nationally and in North Carolina in terms of rates of teen pregnancies,” said Michelle Hughes, who leads the advocacy group NC Child. “That’s in large part because of these evidence-based strategies that this federal funding has supported.”

Finley said she’s been bracing for cuts since President Donald Trump named abstinence-only champion Valerie Huber to a high-ranking position in the office of the assistant secretary of the Department of Health and Human Services.

“She has been a really strong opponent of any education around sexual health for adolescents that includes anything beyond abstinence until marriage,” Finley said. “So we kind of felt like the writing might be on the wall when she was named to her position.”

Comprehensive

In an email to N.C. Health News, spokeswoman Diane Gianelli from the office of the assistant secretary wrote, “The teenage pregnancy rate has declined significantly over recent years, but it does not appear this program has been a major driver in that reduction.”

But experts take issue with that statement.

The programs cut were not only teaching kids how to prevent pregnancy, Hughes said. They are comprehensive, teaching kids to prevent sexually transmitted infections along with pregnancy, discussing healthy relationships and stressing the importance of commitment.

Preventing STIs is important, Hughes noted, because currently, one-in-five new HIV diagnoses in the U.S. is a young person between the ages of 13 and 24.

The pregnancy prevention programs being cut have gone beyond the abstinence-only education that was widely funded before the Obama administration when almost no federal dollars funded comprehensive sex education programs. But while abstinence-only programs still exist and still get some federal funds, they’ve fallen short on proof that they work.

“Although a small number of abstinence-only programs have shown limited effectiveness, the weight of scientific research indicates that strategies that solely promote abstinence outside of marriage while withholding information about contraceptives do not stop or even delay sex,” concluded a review by the Guttmacher Institute, an organization which does extensive research on reproductive health issues.

And a review undertaken jointly by the centrist Brookings Institution and the conservative American Enterprise Institute found that comprehensive sex education programs – which include both information about pregnancy prevention along with encouraging kids to wait for sex – do a better job at preventing teen pregnancy.

“Studies give us solid evidence that programs that provide counseling, offer a range of birth control measures including long-acting forms, and provide the services free can substantially reduce pregnancy rates among sexually active couples, including teenage and low-income couples, and enable them to avoid or plan childbearing,” the study authors wrote.

Not just girls

The program Rick Brown was working on, Wise Guys, was developed by the Children’s Home Society 26 years ago. It was one of the only programs specifically for boys in the cohort of grants.
“Because we are a program for boys, we also really look at concepts of masculinity and how the boys in the program understand what it means to be a man, and what it means to be masculine especially in the context of relationships and the decisions they make in their relationships,” Brown said.

He said kids are constantly bombarded with images of hyper-sexualized role models in the media, music, the movies and online.

“The message these teenaged guys get is… that when it comes to sexuality you prove you’re a man by being sexually active, if you father a child that’s another notch in your belt and another proof of your manhood,” Brown explained. He said the program helps young men come up with other ways of being strong.

“You can just tell when you have these discussions with groups of guys that it’s the first time they’ve ever really stopped and thought about those stereotypes,” he said.

Brown said their funding was also testing Wise Guys with new and different populations, to see if the drops in sexual activity they’ve noted among prior graduates were consistent across the groups. If validated, the program could be included in a list of evidence-based programs shown to produce results that school administrators can consult when deliberating how to proceed with educating youth about sex and responsibility.

“It was just a new evaluation study to make sure that we were current and passing muster in terms of being a program that science showed is effective,” he said.
But with the termination of funding, Brown won’t have enough data to validate his program.

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Rose Hoban is the founder and editor of North Carolina Health News, as well as being the state government reporter.