The Trump administration recommended a $100-million-per-year federal grant program with the purpose of preventing teen pregnancy be defunded after it showed lackluster results. Media outlets are not taking it very well.
Congress set up the program in 2010 to analyze and fund teen pregnancy programs that don’t focus primarily on avoiding sexual risk, which had been a policy priority in previous decades. Instead they could focus primarily on other things, such as teaching contraceptive use or encouraging implantation of long-acting contraception. The program was sold as something that would be evidence-based. Grants were subject to rigorous evaluations and a report, available on the Office of Adolescent Health web site, was released a few months ago.
What the report shows is not a lot of bang for a tremendous number of bucks. In some cases, the grant programs for reducing pregnancy actually showed increases in reported pregnancy and the likelihood of becoming pregnant. Even for some programs that showed short-term positive results, the improvements usually disappeared within a few months.
In response to the weak evidence of positive effects, much less positive sustained impact, Health and Human Services recommended defunding the program after June 30, 2018. A non-profit news site called Reveal News wrote a highly critical piece on the funding change, without mentioning the ineffectiveness of the programs. Many other media outlets followed suit, publishing one-sided stories that treated good intentions as sufficient proof of good-enough results for hundreds of millions of dollars in taxpayer funding. Some media outlets falsely stated that the funded teen pregnancy programs have been shown to be effective.
“Trump’s hires at HHS were notably hostile to teen pregnancy programs that worked. Now they’ve killed them,” claimed one fact-challenged columnist at the Los Angeles Times. No media outlet mentioned the ineffectiveness of the programs, whether it was NPR, the St. Louis Post-Dispatch, Politico, Business Insider, The Independent, Forbes, Teen Vogue, or Bustle, even though effectiveness reports are right there on the agency’s web site.
Take this story from Oregon Public Broadcasting. While it adopted the talking points of critics of funding cuts, it didn’t mention that a $4 million grant to Planned Parenthood of the Northwest resulted in youth who were just as likely as other youth to report having sex without birth control. And teen girls in the program actually reported higher rates of pregnancy than girls in a control group. Stories about teen pregnancy programs in Florida and Georgia completely adopted the talking points of recipients of federal funds and didn’t mention any evidence for or against their effectiveness.
The Results Of Federally Funded Teen Pregnancy Programs
The Teen Pregnancy Program was sold to taxpayers as grounded in evidence, and required reporting on effectiveness as compared to control groups. Two types of grants were awarded and evaluated: replications of existing programs and research on new programs. Only four of the more than 75 replications were found effective, and even then they were not found effective over time. Only eight of the 27 programs trying new approaches had even mildly positive results. Many of the programs weren’t even evaluated, with only 41 of the 102 grantees reporting results on effectiveness.
Last year, HHS highlighted how many youth were taught in the programs, how many new facilitators were trained, and how many grantees published journal articles or made presentations. But on the actual metrics that teen pregnancy programs should be decided, such as whether teen pregnancy and the behaviors that lead to same are reduced, what was shown was marked ineffectiveness, and in some cases increases in sexually risky behavior. A synthesis of the evaluations can be read here.
Here are summaries of the results:
- Children’s Home and Aid Society of Illinois: Carrera Program
Youth who completed the program had sex and unsafe sex at similar rates as youth in an unrelated after-school program.
- Morehouse School of Medicine: Carrera Program
In the first year, students in the program were less likely to report having had sex. By the second and third year, they reported similar rates of sex and sex without a condom.
- Community Action Partnership Network of San Luis Obispo County, Inc/La Alianza Hispana, Inc./Touchstone Behavioral Health: Cuidate
High school students in this program had similar rates of sexual activity and other related sexual risk behaviors as other students. But a couple of subgroups showed increases in sexually risky behavior after completing the program. Youth who had previously been sexually active were “significantly more likely” after this program to report having had recent sexual intercourse. White students in the program were significantly more likely to report having had oral sex and sex without a condom than those in a control group.
- South Carolina Campaign to Prevent Teen Pregnancy: It’s Your Game: Keep it Real
Students in the program had similar rates of sexual initiation, recent sex, and sex without birth control. By ninth grade, a higher proportion of youth in this program had initiated sex than youth in a standard educational program.
- The University of Texas Health Science Center at Houston: It’s Your Game: Keep it Real
There were no differences for students in this program relative to a standard school health curriculum in rates of vaginal or oral sex initiation rates.
- Program Reach, Inc: PHAT! – AbstinenceOnly Intervention
Students in this program had similar reported rates of sexual initiation relative to students who received general health education.
- Better Family Life/San Diego Youth Services/Youth and Family Alliance (LifeWorks): Reducing the Risk
High school students in this program had similar rates of sexual activity and sex without a condom. A group at one of the sites in this program reported less sex.
- Knox County Health Department/County of Hennepin/Planned Parenthood of Greater Idaho: Safer Sex
Nine months after the program, adult females reported similar rates of sexual activity and sex without a condom as a control group. Youth in the program were less likely than youth in a control group to have had sex without a condom.
- Carnegie Mellon University: Seventeen Days
Adolescent girls reported similar rates of safe sex behavior relative to a group offered a video on safe driving. In addition, the study also found similar rates of pregnancy and sexually transmitted infection.
- Florida Department of Health: Teen Outreach Program
Immediately after the nine-month program, teens were less likely to report a range of sexual activity. Ten months later, there were no longer any differences.
- Hennepin County: Teen Outreach Program/It’s Your Future
Teens did not change their sexual behavior on sexual activity, sex without a condom, or initiation of sexual activity.
- Louisiana Office of Public Health: Teen Outreach Program
Youth in the program reported similar rates of sexual activity, sexual activity without effective birth control, and pregnancy rates as youth offered no programming, both immediately following the program, and a year later.
- Planned Parenthood of the Great Northwest: Teen Outreach Program
Youth in the program were as likely as youth offered an unrelated program to report causing a pregnancy or becoming pregnant, having sexual intercourse, or having recent sexual intercourse without an effective method of birth control both immediately after and a year later. Boys reported lower rates of causing pregnancy but females in the program reported becoming pregnant at a higher rate than others.
- Chicago Public Schools: Teen Outreach Program/Chicago Teenage Pregnancy Prevention Initiative
Youth were just as likely as youth who received the standard health curriculum to have sex and to have sex without a condom.
- City of Rochester: Teen Outreach Program/T.H.R.I.V.E. (Teens Helping to Reinvent Integrity, Values and Empowerment)
The study found no significant differences on rates of ever having sex, intentions about having sex, or intentions to use condoms or birth control relative to a work readiness program.
- The Women’s Clinic of Kansas City: Teen Outreach Program
At the one-year follow-up, teens were equally likely as youth receiving the standard school curriculum to report ever having sexual intercourse or having recent sex without using an effective method of birth control.
- Louisiana Public Health Institute: 4 Real Health
Teens did not change their inconsistent condom use during any sex or frequency of sex relative to a general health program.
- Arlington Independent School District: The Crossroads Program
The study found 17- to 19- year olds in the program were less likely to have sex without a condom six months after the intervention, but had similar rates of condom use 3 and 12 months after the intervention. Youth in the program had similar rates of condom use during anal intercourse and oral intercourse at 3, 6, or 12 months after the intervention and of pregnancy 12 months after the program.
- Black Ministerial Alliance of Greater Boston: Healthy Futures
Youth had similar rates of sexual activity and sex without a condom as youth offered the general health program immediately after, three months after, and one year after the program.
- Boston Medical Center: Haitian-American Responsible Teen
Teens reported similar rates of ever having sex, having recent sex, having recent sex without a condom, and having recent sex without using effective birth control as other youth.
- Chicago Public Schools: Health Teacher
(funded by a separate federal contract with Planned Parenthood of America)
Students in the treatment schools were just as likely as those in the control schools to report engaging in sexual intercourse and oral sex, and they did not demonstrate any sustained gains in protective skills, attitudes or intentions 12 months after the program.
- Children’s Hospital Los Angeles: AIM for Teen Moms
Moms in the program had reduced rates of sexual activity without condoms, compared with a control group. However, the interim report found no differences on other key interim outcomes—namely, school or work engagement, education aspirations, attitudes toward birth control, or pregnancy intentions—between the two groups. The report found no evidence that the program increased the use of highly effective contraceptive methods.
- Denver Health and Hospital Authority: Youth All Engaged
Teens had similar proportions of sex with condoms and reports of pregnancies immediately after the program ended. However; Hispanic youth in the program had fewer pregnancies than other Hispanic youth.
- Engender Health: Gender Matters
There were no reduced rates of sexual activity or sex without condoms six months after study enrollment, or in changes in other mediating factors (such as attitudes toward pregnancy and intentions toward sexual risk behaviors). There was also no evidence of changes in gender role beliefs, a key focus of the program.
- National Indian Youth Leadership Project: Web of Life
Students who finished the program reported sex at a similar rate as youth offered the standard school curricula.
- Ohio Health: Teen Options To Prevent Pregnancy
The program increased pregnant and parenting teens’ use of long-acting contraception and reduced the incidence of sexual intercourse without a condom after the first six months of the program. But then, participants assigned to the treatment group reported similar rates of sex, sex without a condom and numbers of sexual partners as other teens.
- Princeton Center for Leadership Training: Teen Prevention Education Program
The study found no evidence that the program led to decreases in the incidence of sexual activity or sex without condoms after the program concluded.
- San Bernardino County Schools: Positive Prevention Plus
Students were less likely to report having had sex and less likely to have had sex without birth control compared with the standard health, science, or physical education curricula, but there were no differences between the groups on becoming pregnant.
- Alaska Department of Health and Human Services: AK PHAT
Six months after the program, teens had similar rates of recent sexual intercourse and condom use during recent sexual intercourse compared with other youth.
- The George Washington University: Be Yourself/Sé Tú Mismo
Latino teens offered the program after school had similar rates of sexual debut, contraceptive use at last sex encounter, and contraceptive use in the past three months relative to youth offered a fitness and nutrition program both immediately after and six months after the program ended.
- The University of Texas Health Science Center at San Antonio: Need To Know
Youth had similar rates of initiation of sex and engagement in risky sexual behavior compared to youth offered the standard health curriculum.
- Tulane University: Be yoU, Talented, Informed, Fearless, Uncompromised, and Loved (BUtiful)
Women offered four weeks of access to BUtiful reported similar rates of reliable contraceptive use, pregnancy, and chlamydia or gonorrhea infection as women offered a nutrition and wellness program.
- University of Colorado-Denver: Multimedia Circle of Life
Youth had similar rates of ever having sex, compared with teens in an after-school science program.
- University of Hawaii: Pono Choices
Teens did not change their sexual behavior relative to youth receiving a standard school curriculum. They had similar rates of initiation of sexual activity and engagement in high-risk sexual behavior one year after the program started.
- University of Louisville Research Foundation: Adaptation of Love Notes and Reducing the Risk
Teens in the Love Notes program had less sexually risky behavior at the six-month follow-up. However, there were no differences between the two groups at the 12-month follow-up. Teens in Reducing the Risk had less sexually risky behavior reported at the three-month follow-up. But there were no differences between the groups at the 12-month follow-up.
- Volunteers of America of Los Angeles: Will Power/Won’t Power
Immediately after, six months after, and one year after the program, there were no differences on sexual activity onset, pregnancy, perceptions of barriers to sexual health, intentions to engage in sexual intercourse, or intentions to use birth control for girls in the program, compared with girls offered a financial literacy program.
Despite the lack of evidence that these programs have reduced teen pregnancy rates, NPR ran a story where a recipient of taxpayer funds suggested these programs should be credited with declines in teen pregnancy rates:
AUDIE CORNISH: Now, the overall teen birthrate is down dramatically, something like 40 percent since its high in the ’60s. And some of that is the decline that we saw in the last eight years during the recession. Do we still need this kind of program?…
TEXAS A&M PROFESSOR KELLY WILSON: We have seen the declines, which is great. But we can also attribute these declines to the evidence-based teen pregnancy prevention programs. And there is still room for improvement to make sure that young people are experiencing pregnancies when they are ready to and that they have access to health care options to make sure that they don’t become pregnant in the first place.
If the media are going to accept claims that these teen pregnancy programs are evidence-based, they should ask for evidence that they work.