On February 11, the Trump administration issued funding opportunity announcements for the Teen Pregnancy Prevention Program (TPPP) that indicate a step away from abstinence-only-until-marriage approaches that the administration has been pushing for years.

The newest announcements make no mention of abstinence-only education (or the administration’s preferred pseudonym, “sexual risk avoidance”), and rely heavily on a report by the National Academies of Sciences, Engineering, and Medicine that was commissioned by the agency that administers TPPP.  Both the report and announcements highlight the importance of holistic, “optimal health” for adolescents, and the announcements emphasize the importance of access to high-quality and teen-friendly health care, health equity and the role of multiple sectors of society in preventing pregnancy during adolescence. This broadened perspective is undoubtedly a positive step for TPPP, but its impact will rest largely on who receives the new grants and how they are used.

This new direction is surprising, as the Trump administration has spent three years advocating for harmful and ineffective abstinence-only programs. These efforts ignore the fact that contraception is driving declines in adolescent pregnancy and fail to serve young people’s broader sexual health needs. State and federal sex education advocates should continue to resist abstinence-only approaches to sex education, while simultaneously arguing for more expansive forms of sex education.

 

Undermining TPPP

This most recent move from the Trump administration is a respite from a years-long campaign to disrupt TPPP and fundamentally change it by emphasizing abstinence-only approaches. In 2010, Congress established the program to support both evidence-based and innovative adolescent pregnancy prevention approaches. The curricula it funds serve as models for educators around the country, and an evidence-based program that receives TPPP funding is essentially receiving the federal government’s stamp of approval.

Abstinence-only programs, by contrast, are fundamentally unethical and ineffective.  Specifically, these programs:

They fail to meet the needs of sexually active young people and equip all young people with information about sex and relationships that will serve them throughout their adult lives.

For these reasons, it was concerning to sex education advocates when the Trump administration launched a multipronged, years-long effort to disrupt the program and shift its focus toward abstinence-only education. In 2017, the White House issued the first of four annual budget proposals that called for the complete elimination of TPPP. Later that year, the administration attempted to terminate five-year grants in their third year of funding. And in 2018, the administration issued funding announcements that ignored evidence-based strategies developed by past TPPP grantees and coerced applicants into using abstinence-only curricula. Advocates have led the pushback against these attacks. In response to both the termination of grants mid-cycle and the 2018 funding announcements, government non-profit legal and health care organizations filed and won multiple court cases on the grounds that the government’s actions were illegal or violated Congress’s intent for the program.

 

Contraception Drives Pregnancy Declines

Promoting abstinence-only education in TPPP is also counterproductive to the stated goal of the program, as evidence has long demonstrated that declining adolescent pregnancy rates are being driven by improved contraceptive use—not declines in sex (with no evidence that abstinence-only programs actually contribute to such declines).Among the adolescents who wish to avert pregnancy, many are turning to highly effective contraceptive methods; in addition, increases in the use of two or more methods may indicate adolescents’ increased interest in or commitment to pregnancy prevention.

New research shows that Britain has seen similar trends in declining pregnancy rates and improving contraceptive use among girls and women aged 16–19, and offers a model for how to achieve the goals of TPPP without abstinence-only education. Relationship and sex education in Britain does not focus on abstinence; instead, it seeks to enable young people to have sex when they want to and are ready, as well as to improve their knowledge of and access to sexual and reproductive health services. Further, British adolescents have an easier time than their U.S. peers obtaining free contraception and confidential reproductive health care services from both general practitioners and clinics that specifically serve young people. Given these differences, it is not surprising that British adolescents are more likely to use highly effective prescription methods than young people in the United States.  With better contraceptive use, British adolescents have fewer pregnancies than those in the United States—and without abstinence-only education.

 

Expanding the Scope of Sex Education

Policymakers and stakeholders at all levels should continue to hold the Trump administration accountable for its attacks on TPPP while also pushing for more expansive sex education curricula than TPPP has provided, and ones that do not frame all adolescent pregnancy as inherently problematic.

Currently, most sex education is focused on two narrow goals: reducing the risk of unintended pregnancy and helping people avoid STIs. Yet the National Academies of Sciences, Engineering, and Medicine report concludes: “It is…equally important to support healthy sexual development as it is to prevent the negative health outcomes associated with sexual behavior.”

An expansive and inclusive curriculum that supports healthy sexual development would frame sex as a positive and healthy aspect of life, rather than an inherently risky activity. It would give young people skills and information related to contraception, healthy relationships, sexual pleasure, consent (a topic already gaining ground among state lawmakers), and sexual agency and autonomy. Further, the sexual health information provided should be age appropriate as well as responsive to and respectful of a range of cultural backgrounds, sexual orientations and gender identities.

The Real Education for Healthy Youth Act would move U.S. sex education in this direction by redirecting funding for the Title V abstinence-only-until-marriage program (currently funded at $75 million per year) to a federal program for comprehensive sex education programs that include many of the elements discussed above. Sex education has the power to shape the way young people see their own and others’ sexuality for the rest of their lives. We need policies in place that will ensure that young people receive accurate and complete sex education.