A new $110 million appropriation for teen pregnancy prevention and the Obama administration’s elimination of funds for abstinence-only education has revived what seems like a never-ending debate about how best to spend federal dollars to protect the sexual health and development of young people.
Because the new funding is expected – but not certain – to benefit organizations that run sex education programs that are more comprehensive and rigorously evaluated, abstinence-only proponents, much in favor under the George W. Bush administration, are on the defensive.
So what did Congress do recently to hearten some and disappoint others in the teen pregnancy prevention debate?
First, a recap. For years, there have been two pots of money for abstinence education: one mandatory annual account of $50 million (Section 510 State Abstinence Education) that began in the mid-1990s; and another discretionary program for community-based abstinence education that depends on yearly congressional funding and in fiscal 2009 received nearly $100 million.
Under a Democratic Congress and White House, the mandatory program was allowed to expire in June and no abstinence money was provided for the current, 2010 fiscal year.
Congress instead created a new $110 million Teen Pregnancy Prevention Initiative (TPPI), which passed as part of the 2010 Consolidated Appropriations Act, signed by President Barack Obama in mid-December. The proposal closely follows Obama’s budget request, which called for a shift throughout his budget to programs that have been shown to be effective. Most studies have found little evidence to support the effectiveness of abstinence-only programs.
But Obama’s director of the Domestic Policy Council, Melody Barnes, has said he "is open to innovation, and that could include abstinence-only if there is some indication it would work."
Lawmakers said $100 million of this amount should be spent on competitive grants to a range of public and private entities for evidence-based teen pregnancy prevention that is “medically accurate and age appropriate.” They then divided the grant money into two separate pots – $75 million for replicating rigorously evaluated programs with strong evidence of success and $25 million for innovative strategies that may not yet have a strong evaluation.
But since few know exactly how the U.S. Department of Health and Human Services (HHS) will roll out the new funds, each side wants to see the Obama administration’s interpretation of Congress’ directions before passing judgment.
Setting aside the mandatory state program money that may be gone for the foreseeable future, HHS program rules for allocating the new dollars will be telling because they may determine whether any of the existing community-based abstinence education grantees can reapply for a share of the $100 million when their current funds expire.
Ardent opponents of abstinence are satisfied – albeit not entirely happy – with the president’s plan.
“We would have liked [the president] to have actually allocated [the $110 million] to comprehensive sex education, but teen pregnancy prevention as it has been described … [is] pretty close,” said Marcela Howell, vice president for policy and communications with Advocates for Youth.
If funding goes to schools, education and health departments and community-based organizations for evidence-based teen pregnancy programs at the school level, “we would be satisfied that those funds have moved out of the realm of ineffective abstinence-only and into the realm of at least effective programs,” Howell said.
Federal funding for abstinence-only education began in the early 1980s and expanded as part of welfare reform in the Clinton administration, when the eight-point federal definition of abstinence-only education was created. The law required programs to have as their “exclusive purpose, teaching the social, psychological and health gains to be realized by abstaining from sexual activity” – essentially prohibiting funded programs from discussing contraceptives.
Later, under President George W. Bush, the programs themselves were given more resources, but grantees’ flexibility to operate within the eight-point definition was reduced. Funded programs had to give equal weight to each of the eight points, including the notion that sex outside of marriage is likely to have harmful psychological and physical effects.
As federal funding for abstinence-only education grew, critics who favored a more comprehensive approach – combining abstinence education with lessons about condom use if youths become sexually active – grew louder. By the latter part of the 2000s, numerous states began to reject their portions of federal abstinence money, even though nonprofits still applied for and won federal community-based abstinence education awards.
Each side uses data to bolster the case for its respective approach, and political considerations – with Republicans largely backing abstinence and Democrats largely backing comprehensive sex education – are rarely far below the surface.
“We need to put aside the ideology that has spun out of control in this debate and seems to be at an all-time fever pitch,” said Valerie Huber, executive director of the National Abstinence Education Association (NAEA). She called the zeroing out of the abstinence funding “inexcusable.”
Bill Albert, chief program officer for the National Campaign to Prevent Teen and Unplanned Pregnancy, instead said the new approach will favor what works over ideology. “To me,” he said, “the big headline here is: for the very first time, we have a real serious federal commitment to preventing teen pregnancy by committing money to programs that have evidence of success.”
Still, Albert said, “this is all more complicated than anyone would like,” in part because Congress created a new Office of Adolescent Health to run the program. Lawmakers set aside about $10 million from the $110 million to create the office and to fund technical assistance, training and evaluation.
The agency is establishing the office now, said Luis Rosero, an HHS spokesman, by e-mail, which will support “evidence-based models … and expand teen pregnancy prevention efforts while also addressing a broader range of adolescent health issues.” The statement added that “preventing unintended teen pregnancy is a priority for this administration.”
Huber, of the abstinence education group, agreed that “no one knows what the teen pregnancy prevention RFP [request for proposals] is really going to look like” until HHS shows its hand, because there are many ways to interpret the legislation. She said she is “very concerned,” however, that “there is no priority” in the program for primary prevention – on teaching youths to avoid sex.
The Struggle to Survive Health Care Reform
Abstinence-only proponents like Huber are now working to get the money put back using the health care reform bill being negotiated by the House and Senate as one vehicle, and turning their attention to the fiscal 2011 appropriations fight, which will start in the spring.
Two competing proposals related to teen sexual health were included in the Senate health care bill, which passed Dec. 24. One would restore the abstinence-only mandatory funds and the other would provide mandatory money for teen pregnancy prevention that is more comprehensive. Funding would last about four years as each plan is currently written.
The House health care bill, now being reconciled with the Senate’s, would authorize a $50 million “Healthy Teen Initiative” whose funding would be subject to annual appropriations. It would support grants to states and territories for “medically accurate and age-appropriate” teen pregnancy reduction and sexually transmitted disease-prevention programs.
Huber said her organization supports the provision, sponsored by Sen. Orrin Hatch (R-Utah), to add back the $50 million for Section 510 that expired last summer. It divvies up funds among state agencies that agree to support abstinence-only programs that follow the strict eight-point definition.
A different provision included in the health care bill by Sen. Max Baucus (D-Mont.) and supported by Albert’s pregnancy prevention group would create a new $75 million mandatory account to provide formula funds and other types of grants for evidence-based teen pregnancy prevention and services for high-risk youth.
The fate of these proposals could determine if federal abstinence policies live on or wither – at least while Democrats remain in control of Congress. Lawmakers could also decide to split the difference by including both pots of money in the health care bill, or kill the mandatory funding entirely.
Howell, of Advocates for Youth, said senators should see that keeping both programs is a “contradiction.”
“What we don’t know yet,” Albert added, “is whether we will continue in the U.S. to see a substantive investment in abstinence programs or not. That’s still an open question.”