Programs That Fight Teenage Pregnancy Are at Risk of Being Cut

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ANDERSON, S.C. — At age 14, Latavia Burton knows something about teenage pregnancy. Her mother gave birth to her at 18 and couldn’t attend college because of it. And Latavia’s former best friend became pregnant at 16.

So a pregnancy prevention program in eighth grade and another in her neighborhood this summer hit home. Latavia hasn’t had sex yet, and said if she were asked to she’d say, “Let’s just wait a little longer.” But to be safe, she plans to get an intrauterine device at a clinic for teenagers the program introduced her to. And since she learned that it would not protect her from sexually transmitted diseases, but that condoms would, she said she would “just go to the teen clinic and get some for free” if a boyfriend claimed he couldn’t afford them.

The pregnancy prevention projects Latavia attended are among hundreds across the country, reaching more than a million youths, that are funded by a program the Trump administration has scheduled for elimination in its proposed budget. If Congress concurs, it will end the Obama-era effort to shift away from decades of reliance on abstinence-only programs, which showed little to no evidence of effectiveness. Most projects begun under the Obama administration’s Teen Pregnancy Prevention Program teach about contraception and sexually transmitted diseases in addition to abstinence.

Even before the budget is voted on, the Health and Human Services Department is curtailing the projects, which it funds through grants of $89 million a year to 81 organizations. As reported last month, officials told all the groups their pregnancy prevention grants would end in June 2018, two years early. But only recently did the department offer a reason for the elimination, attributing it in a statement to “very weak evidence of positive impact of these programs.”

A department spokesman, Mark Vafiades, said officials wanted to ensure “the program provides youth with the information and skills they need to avoid the many risks associated with teen sex.” He did not answer whether the department would revert to abstinence-only programs.

Health commissioners from 20 large cities are protesting, writing to Tom Price, the health and human services secretary, that cutting funding “will not only reverse historic gains made in the U.S. in reducing teen pregnancy rates, but also make it difficult to truly understand what practices are most effective.”

Shortly before the groups receiving grants learned their money would be cut early, a leader of an abstinence education advocacy organization, Valerie Huber, was named chief of staff to the health and human services assistant secretary who oversees adolescent health.

Mr. Vafiades said the funding cut-off was “not a decision made by one individual or based on anyone’s like or dislike of one approach.” Still, Ms. Huber, whom the department declined to make available for an interview, wrote in an opinion piece in March that the best message for young people was “to avoid the risks of teen sex, not merely reduce them.” She described the Obama administration’s approach as one “that has been alternatively named teen pregnancy prevention or so-called comprehensive sex education, but which typically normalizes teen sex.”

President Trump has elevated social conservatives, including Mr. Price, to influential roles. The administration is also seeking to defund Planned Parenthood, dilute the Affordable Care Act’s mandate that contraception be covered by insurance and cut budgets for other reproductive health programs, like Title X.

In what is widely considered a public health success story, teenage pregnancy rates have been declining nationally for 25 years. Factors include sex education in schools, movies and shows about teenage pregnancy, cultural shifts that have made it easier for parents to discuss the issue with their children and greater availability of birth control, especially long-acting contraceptives like implants and intrauterine devices.

But rates are still higher than in other industrialized countries, and there is little rigorous research about which approaches work. The Obama administration sought to gather better evidence by having 41 of the 102 projects funded from 2010 to 2014 independently evaluated. Most of those 41 projects were found to be no better than the sex education or behavior health programs already in place in the schools or communities where the projects were.

Only 12 of the 41 were found to have changed sex-related behavior. Brian Goesling, a senior researcher at Mathematica Policy Research, which evaluated some projects, said the Health and Human Services Department commissioned the research to see what worked and to then replace the projects that did not. One lesson was that projects that were effective in one community might fail elsewhere because of different teachers, different teenagers and “a different context,” he said.

Sometimes, positive effects seen at three or six months evaporated by 12 months. And some projects did not measure pregnancy rates, but “self-reported sexual activity, and it’s not clear if that’s reliable,” said Jon Baron, vice president of evidence-based policy at the Laura and John Arnold Foundation, a nonpartisan foundation that has reviewed the evaluations.

Notably, the most successful program helped teenage mothers in Columbus, Ohio, avoid another pregnancy, partly by directing them toward long-acting contraceptives, Mr. Baron said.

Still, he said, the success rates of the evaluated projects were similar to those of clinical trials in medicine, so cutting funding for pregnancy prevention is like “cutting medical research because the vast majority of approaches, interventions and treatments that are tried are proven not to work.”

Abstinence-only programs have often failed to change teenage sexual behavior. A 2007 study of four such federally funded programs, for example, found “not even a hint of an effect on sexual activity, pregnancy or anything,” Mr. Baron said.

Still, the Obama administration’s menu of “evidence-based programs” includes three abstinence programs.

One of the current federal grants, $6.5 million, goes to the South Carolina Campaign to Prevent Teen Pregnancy, which uses it for programs in schools and group homes, as well as the clinic for teenagers in Anderson that emphasizes long-acting contraception. The organization’s project manager, Beth DeHart, said it also received federal permission to supply condoms in nontraditional places, including a bowling alley, nail salons and barbershops.

Project leaders consider the programs beneficial in South Carolina, where births by teenagers dropped to 3,740 in 2016 from 6,954 in 2010. But they acknowledged not everything has worked.

An urban-focused middle school program of computerized and classroom lessons that seemed promising in Houston mostly made no difference in rural South Carolina, but had one troubling result: Students who were sexually inexperienced before seventh grade were more likely to have had sex by late ninth grade.

“We learned that is not the right curriculum for South Carolina,” said Beth DeSantis, the chief executive of the South Carolina Campaign to Prevent Teen Pregnancy. “Preventing teen pregnancy is very complex. There’s not one silver bullet.”

Ms. DeHart said their organization told schools “please do not use this program anymore with the young people.”

Now, Anderson County’s schools use two other programs. Mr. Baron said each showed some preliminary positive effects, one in Philadelphia and one in Northern California.

Interviewed at United Way of Anderson County, Latavia, who lives in a housing project, said her programs’ instructors discussed saying no to sex, and “We learned how to put a condom on a penis.”

At New Foundations, a group home for youths who come from foster care or the justice system, seven girls attended a recent session on pregnancy prevention. Four were born to teenage mothers, said Katrina Upton, a registered nurse and clinical therapist, and Jo McClain, a clinical therapist. Asked what was the safest behavior, a girl said, “Not doing it,” and was surprised to learn that “abstinence” meant the same thing.

Afterward, Francis, 17, who is at the group home because of a drug-related arrest and asked that only her middle name be used to protect her privacy, said she would talk with her boyfriend about “not having sex so much.” She will also ask him to get tested for sexually transmitted diseases “in case he has been doing stuff, like, behind my back,” she said, and “if we do have sex again.”