The $114.5 million teen pregnancy prevention initiative signed into law by President Obama in December 2009 marks a major turning point in U.S. sex education policy, according to a new analysis published in the Winter 2010 issue of the Guttmacher Policy Review. The initiative replaces many of the most rigid and ineffective abstinence-only programs, which by law were required to have nonmarital abstinence promotion as their “exclusive purpose” and were prohibited from discussing the benefits of contraception.

However, this welcome course correction is tempered somewhat by the late-breaking news that congressional leaders appear to have agreed—per a provision in the final version of the health care reform legislation moving through Congress—to resuscitate the Title V abstinence-only program for five years (see below for more information on this program).

In sharp contrast to the failed abstinence-only policies of the past, the new approach championed by the White House will focus on programs that have demonstrated their effectiveness, and all funded programs will be required to be age-appropriate and medically accurate.

“The administration’s teen pregnancy prevention initiative is an important victory for evidence-based policy-making,” says Heather Boonstra, author of the new analysis. “The next step is critical—finalizing implementation details and regulations that determine which specific programs get funded.”

The initiative will be administered by a newly created Office of Adolescent Health within the Department of Health and Human Services (DHHS), working in cooperation with the Administration for Children and Families, the Centers for Disease Control and Prevention and other relevant DHHS agencies. According to Boonstra, officials will need to determine which programs meet the following funding criteria laid out in the legislation:

  • Effective or promising: A large body of evidence shows that more-comprehensive approaches—those that encourage abstinence, but also contraceptive use for young people who are having sex—can be effective. But rigid, moralistic abstinence-only programs of the type promoted under previous federal policy have not been found to be effective (which is not to say that no intervention focusing only on abstinence can ever work for any population under any circumstances).
  • Age-appropriate: Because adolescence is a time of rapid change, sex education interventions must adapt as young people change. Emphasizing only abstinence may be appropriate for lower grade levels, when very few students are having sex; however, once a significant proportion of students are sexually active, programs should progressively include more information about contraceptives and less about abstinence.
  • Medically accurate: Strict requirements for medical accuracy should apply to any programs funded under the initiative. The withholding of relevant information should be considered, per se, inaccurate—and denigration of condoms or contraceptives, directly or indirectly, preemptively prohibited.

“While it is deeply disappointing that it appears likely that the Title V abstinence-only program will survive in some form, we nevertheless have entered a new era in U.S. sex education policy—and not a moment too soon,” says Boonstra. “For the first time in more than a decade, the nation’s teen pregnancy rate rose in 2006, by 3%—and the increase coincided with the major funding boosts for abstinence-only programs under the Bush administration. Rigid abstinence-only programs truly are a failed experiment and Congress needs to stop funding them altogether.”

Following a steep decline in the 1990s and a flattening out in the early 2000s, teen pregnancy rates increased among all ethnic and racial groups between 2005 and 2006. Earlier research had documented that the significant drop in teen pregnancy rates in the 1990s overwhelmingly had been the result of more and better use of contraceptives among sexually active teens. However, this decline started to stall out in the early 2000s, at the same time that abstinence-only programs became more widespread, teens were receiving less information about contraception in schools and their use of contraceptives was declining.

About the Title V program

The Title V abstinence-only program, which appears to have been have resuscitated in the final version of the health care reform legislation moving through Congress, would offer $50 million in grants to the states annually for five years. Programs funded under Title V must conform to a highly restrictive, eight-point definition—a policy that flies in the face of strong evidence that such rigid, moralistic programs do not work. By the time the Title V abstinence-only program expired in June 2009, roughly half the states had declined to apply for funding under the program, in large part because these programs have proven ineffective.

At the same time, health care reform—if enacted—would not only fund Title V, but would also provide $75 million per year over five years for a new “personal responsibility education program,” most of which would go toward programs that educate adolescents about both abstinence and contraception, and are evidence-based, medically accurate and age-appropriate. Going forward, this means that a total of about $190 million in federal funding would be made available for evidence-based programs ($114.5 million from the new teen pregnancy prevention initiative and $75 million from health care reform), while $50 million would be offered for rigid abstinence-only programs.

Click here for “Key Questions for Consideration as a New Federal Teen Pregnancy Prevention Initiative Is Implemented,” by Heather D. Boonstra, in the Winter 2010 issue of the Guttmacher Policy Review.

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The increase in the teen pregnancy rate in 2006

Facts on American teens’ sexual and reproductive health