The National Strategy to Prevent Out-of-wedlock Teen Pregnancies



I.  Strengthen the National Response to Prevent Out-of Wedlock Teen Pregnancies

Teen pregnancy is a problem that impacts nearly every community. The responsibility to solve this problem lies with all of us, including families, communities, and young people themselves. In calling for a national strategy, Congress has recognized the critical importance of assuring that every community, large or small, urban or rural, is working to find solutions to this problem.

As part of the national strategy, we will use new resources to strengthen, integrate, and support additional teen pregnancy prevention and other youth-related activities in communities across the country. Further, we will work with our partners to identify additional promising efforts and disseminate information about them to other communities.

A. Increase Opportunities Through Welfare Reform

The 1996 welfare law calls for additional efforts to prevent out-of-wedlock teenage pregnancies and to assure that communities engage in local efforts to prevent teenage pregnancy. These additional efforts are a critical component of our national strategy. As President Clinton has said, "Nobody should get pregnant or father a child who isn't prepared to raise the child, love the child, and take responsibility for the child's future." HHS will work with the states to provide guidance, to capture lessons learned from these welfare reform initiatives, to identify successful and innovative strategies, and to disseminate that information to all interested parties. [Additional information about the Welfare Reform law and how it is being implemented can be reviewed at web pages of the Administration for Children and Families on that topic.]

Personal Responsibility for Minor Parents. Under the new welfare law, unmarried minor parents will be required to stay in school and live at home, or in an adult-supervised setting, in order to receive assistance. The law also supports the creation of Second Chance Homes for teen parents and their children who might be at risk of abuse if they remained in their own homes. Second Chance Homes are expected to provide teen parents with the skills they need to become good role models and providers for their children, giving them guidance in parenting, child development, family budgeting, and proper health and nutrition, and in avoiding repeat pregnancies.

Abstinence Education. The new welfare law provides $50 million a year in new funding for state abstinence education activities, beginning in FY 1998. States will be able to target these funds to high-risk groups, such as teenage boys and girls most likely to have children out-of-wedlock. These new funds will be available through the Maternal and Child Health Block Grant.

Incentives for States. Under the new welfare law, HHS will award a bonus to as many as five states in the country that have the largest decrease in out-of-wedlock births while also having abortion rates lower than in 1995. The bonus will equal $20 million per state if five states qualify, and $25 million per state if fewer states qualify.

The Toughest Possible Child Support Enforcement. Through tougher child support enforcement, we will send the strongest possible message to young girls and boys that parenthood brings responsibilities and obligations and that they should not have children until they are ready to provide for them. The 1996 welfare law includes the child support enforcement measures President Clinton proposed in 1994 ­ the most sweeping crackdown on non-paying parents in history. The new measures include: streamlined efforts to name the father in every case; employer reporting of new hires to locate non-paying parents who move from job to job; uniform interstate child support laws; computerized state-wide collections to speed up payments; and tough new penalties, like drivers' license revocation, for parents who fail to pay.

B. Support Promising Approaches

HHS-supported programs that include teen pregnancy prevention are just a part of the myriad and diverse teen pregnancy prevention efforts located in communities across the country. However, HHS plays an important leadership role in sponsoring innovative and promising strategies tailored to the unique needs of individual communities. Excluding HHS-funded programs that reach communities through states (e.g., Medicaid and the Maternal and Child Health Block Grant), HHS-supported programs that include teen pregnancy prevention reach an estimated 30 percent of communities in the United States. This represents about 1,410 communities across the country that receive funding from HHS. (See HHS Activities: Programs, Evaluation and Research for overview of HHS teen pregnancy prevention activities and the methodology used to develop this estimate).

The five principles of promising strategies described above are reflected in the teen pregnancy prevention programs HHS supports, including the key demonstration programs of the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA). Additional funding for these programs in FY 1997 will enable communities across the country to expand their teen pregnancy prevention efforts.

The Community Coalition Partnership Program for the Prevention of Teen Pregnancy is one of HHS's most comprehensive and innovative teen pregnancy prevention programs. The CDC launched the program in 1995 by awarding grants to 13 communities with high rates of teen pregnancy located in 11 states. The funds have been used to strengthen existing community-wide coalitions and to develop community action plans. The next phase begins in FY 1997 when a total of $13.7 million is available to help the 13 community coalition partnerships implement their action plans and evaluate their impact, as well as to support related data collection, evaluation, and dissemination activities.

The Adolescent Family Life Program (AFL), created in 1981, supports demonstration projects, approximately one-third of which currently provide abstinence-focused educational services to prevent early unintended pregnancies, sexually transmitted diseases, and HIV/AIDS. Most projects provide comprehensive and innovative health, education, and social services to pregnant and parenting adolescents, their infants, male partners, and their families, with a major emphasis on preventing repeat pregnancies among adolescents. In FY 1996, the AFL program funded 17 projects in 14 states, which will be continued in FY 1997. An additional $7.6 million in new funding will be used to enable smaller communities to develop and implement about 40 abstinence-based education programs and about 60 larger prevention demonstration projects, following the abstinence education definition in the welfare law.

C. Build Partnerships

Building partnerships among all concerned citizens is essential to preventing teen pregnancy, which President Clinton has described as "our most serious social problem." Tackling this problem will require a comprehensive, focused, and sustained effort from all sectors of society. Therefore, HHS will initiate a broad partnership-building process to implement the national strategy and to solicit nationwide commitment and involvement in the goal of preventing out-of-wedlock teen pregnancies. The feedback from this process will allow us to refine the national strategy as well as to improve our ongoing efforts. By building partnerships among national, state, and local organizations; schools; health and social services; businesses; religious institutions; federal, state and local governments; tribes and tribal organizations; parents; and adolescents, we will be able to unite in our efforts to send a strong message of abstinence and personal responsibility to young people and to provide them with opportunities for the future.

An important partner in this effort will be the National Campaign to Prevent Teen Pregnancy. In his January 1995 State of the Union Address, President Clinton challenged "parents and leaders all across this country to join together in a national campaign against teen pregnancy to make a difference." A group of prominent Americans responded to that challenge, forming the National Campaign to Prevent Teen Pregnancy ("Campaign"). The President has pledged the help of the Executive Branch in this non-partisan, private-sector effort.

The mission of the Campaign is to prevent teen pregnancy by supporting the values and stimulating actions that are consistent with a pregnancy-free adolescence. The Campaign is designed to support the efforts of local communities and to make sure that local community efforts are based on research about what works. The Campaign is helping to build partnerships with the media, the business sector, and others, and HHS looks forward to working with the Campaign in implementing the national strategy.

The strategy will also include a partnership effort with federal, state, and community organizations that work on behalf of teenagers with disabilities. Teens with learning disabilities, mental retardation, mental illness, and physical disabilities present a unique set of challenges in preventing out-of-wedlock pregnancies. Mainstream programs can be highly effective, but the unique characteristics of teenagers with disabilities also must be taken into account in developing and implementing these programs. As part of the national strategy, HHS will work to address the special challenges in preventing out-of-wedlock teen pregnancies among young men and women with disabilities. The strategy will address issues such as program access, the need for targeted materials, and opportunities for education and skills-building to give teens with disabilities a positive future and a better chance of avoiding teen pregnancy.

D. Improve Data Collection, Research, and Evaluation

Data collection, research, and evaluation are all critical for contributing to our understanding of the magnitude, trends, and causes of teen pregnancies and births; for developing targeted teen pregnancy prevention strategies; and for assessing how well these strategies work, whether on a local, state, or national level. As part of the national strategy, HHS will work to strengthen each of these important activities.

Data Collection and Surveillance. National statistics on teen birth patterns, including state-by-state data, are now available nearly a full year earlier than in prior years, a result of a more timely approach to collecting, compiling, and publishing vital statistics data. The new system builds on advances in computer and communications technology as well as the CDC's National Center for Health Statistics' (NCHS) long-standing collaboration with state vital statistics offices. Preliminary teen birth rates from the new system for 1995 were published in October 1996 and future statistics will be reported semiannually. (See Teen Birth Data ). The CDC also provides consultation to states and local areas to enable them to compute estimates of teen pregnancy and other related indicators.

The upcoming release in 1997 of the new National Longitudinal Study of Adolescent Health (Add HEALTH), a comprehensive study of adolescent health funded by HHS' National Institute of Child Health and Human Development (NICHD) and other HHS agencies, will provide an opportunity to increase our knowledge about risky behaviors and resiliency factors in adolescents and about environmental influences, including parents, siblings, peers, schools, neighborhoods, and communities. The National Survey of Adolescent Males, supported by NICHD, OPA, and other HHS agencies, and the 1995 cycle of the National Survey of Family Growth, conducted by NCHS with other HHS support, will also provide relevant information on the behavior of young men and women.

Research and Evaluation. While promising approaches to reduce teenage pregnancy have been identified, a comprehensive review of teen pregnancy programs funded by HHS and conducted by Child Trends, Inc. indicates that most interventions have not been rigorously evaluated to assess their impact or to identify the components that contribute to program success or failure. Using our demonstration programs, we will work with our partners to increase our understanding of what works and what does not. For example, the CDC's Community Coalition Partnership Program for the Prevention of Teen Pregnancy is helping each community to incorporate evaluation into its teen pregnancy prevention strategy. In addition, the National Institutes of Health is sponsoring research on interventions to prevent teen pregnancy.

The Child Trends report also indicates that further research is needed in a number of areas of normal adolescent development, including why certain adolescents engage in high-risk behaviors, why some adolescents are able to negotiate safely to adulthood, and what factors influence adolescent sexual behavior, including media influences and cultural norms. In addition to its own research studies and demonstration projects, HHS will provide information from its new survey data, (e.g., Add HEALTH), to help researchers answer these questions.

E. Disseminate Information on Innovative and Effective Practices

Sharing information about promising and successful approaches is critical to the replication and expansion of teen pregnancy prevention efforts across the country. Policy makers, program administrators, tax payers, media producers, community leaders, parents, and adolescents all need to know about the approaches most likely to be successful in preventing teen pregnancy.

HHS will continue to work with its partners to highlight innovative practices at the federal, state, and local levels and to disseminate new research and evaluation findings. For example, at a White House press conference in June, HHS released "Preventing Teen Pregnancy: Promoting Promising Strategies: A Guide for Communities" highlighting five teen pregnancy programs that evaluation shows to be promising. (See Examples of Promising Program Strategies). Ongoing efforts include outreach to 105 Empowerment Zones and Enterprise Communities to encourage and help them to include teenage pregnancy prevention in their community development strategies. The Department will also disseminate new information on the developmental needs of youth and on the use of broad-based activities to help teenagers avoid risky behaviors leading to teen pregnancy. In addition, HHS currently supports a variety of resource centers, clearinghouses, and toll-free hotlines at both the state and national level that provide information and technical assistance to state and community-based health, social service, and youth-serving agencies. (See Program Contacts and Other Resources).

II.  Support and Encourage Adolescents to Remain Abstinent

To reach adolescent populations at risk for premature sexual activity and pregnancy, we must develop comprehensive efforts specifically tailored to the unique needs, interests, and challenges of each group, including targeted messages that work. Although the national strategy must send the strongest possible message to all teens that postponing sexual activity, staying in school, and preparing to work are the right things to do, the research shows that girls and boys experience some aspects of early adolescence in different ways, because they encounter different social, cultural, physiological and psychological challenges. Therefore, different approaches will be required to meet the unique needs of different adolescent populations, including disabled teens who are at increased risk of pregnancy. As a result, an important component of the national strategy will be to determine the best ways to reach different groups of young boys and girls.

The national strategy will place a special emphasis on encouraging abstinence among 9- to 14-year-old girls. The research tells us that this a critical age for reinforcing self confidence and positive values and attitudes among girls. In 1997, HHS will use its new Girl Power! campaign to address premature sexual activity among girls aged 9-14, promoting a strong abstinence message. The Girl Power! campaign, launched in November, 1996, is a multi-phased, national public education campaign designed to galvanize parents, schools, communities, religious organizations, health care providers, and other caring adults to make regular sustained efforts to reinforce girls' self-confidence, by providing them with positive messages, meaningful opportunities, and accurate information on a variety of key health issues. The Girl Power! abstinence education initiative includes: engaging all HHS teen pregnancy prevention and related youth programs in sustained efforts to promote abstinence among 9- to 14-year-old girls, and developing and implementing a national media campaign to involve parents and caring adults in sending a strong abstinence message across the country.

The national strategy will also focus on boys and young men. Significantly less is known about the decision-making behavior of boys around motivations for abstinence, sexual activity, and fatherhood. Through the national strategy, HHS will increase our understanding of these factors and work to develop effective prevention strategies, particularly those promoting abstinence, for boys. These efforts will include working with the Administration's Fatherhood Initiative to ensure that men, including pre-teen and teenage boys, receive the education and support necessary to postpone fatherhood until they are emotionally and financially capable of supporting children. The strategy will also build on existing Departmental efforts, such as the Title X Family Planning Adolescent Male Initiative and other Title X-funded projects to support male-oriented community-based organizations in promoting responsible behavior among teenage boys.

Finally, the Department will work with national youth-serving organizations to use their networks to promote activities that encourage abstinence among girls and boys. With their important efforts in stimulating parental and community involvement, these programs will help provide the sustained commitment necessary to help prevent teen pregnancy.

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