A vast array of programs have been launched over the past 30 years in an effort to affect one or another of the factors underlying teen pregnancy and thus reduce the problem. These have included educational programs, programs that improve access to contraception, and multi-component programs. Educational programs include those that teach only abstinence and those that teach abstinence plus effective contraceptive practice. Among them are those that include skill development, such as Postponing Sexual Involvement and Reducing the Risk. Programs designed to improve access to contraception include the development of school-based or school-linked clinics and adaptations of family planning services to increase their accessibility and appeal to youth. Multi-component programs may include some combination of job readiness training, academic tutoring, recreation, mentoring, sexuality education, life skills training, and health and mental health care. Most emphasize one aspect of this array. For example, Summer Training and Education Program and Youth Incentive Entitlement Employment Program focus on job training and employment opportunities, and the Teen Outreach Program utilizes mentoring and service learning. A few programs have included a community component-for example, Project ACTION and the School/Community Program for Sexual Risk Reduction. A few programs, among them the Children's Aid Society's Teen Pregnancy Prevention Program, have offered a comprehensive array of services and activities.
Recent reviews of the literature(4) find serious shortcomings in most of the studies of teen pregnancy prevention programs. Many studies lacked sufficient sample size. Few included long-term follow up. Many programs were conducted as demonstration projects, with a maximum of resources and support; very few have been replicated in less ideal circumstances. A number of studies lacked an experimental design or independent evaluators, or they utilized improper statistical analysis. In addition, difficulty measuring behaviors and a publishing bias toward positive outcomes limited what was known. The accumulation of limitations makes conclusions about programs difficult.
However, a few cautions judgments can be mentioned. None of the programs have been shown to have large, sustained effects on adolescent sexual behavior, contraceptive use, pregnancy, and childbearing rates. Only a few have been shown to have moderate effects. Some educational programs have shown modest positive effects on delay of sexual initiation and less effect on contraceptive use or pregnancy rates. State level data indicate that funding for family planning services can reduce adolescent pregnancies; however, it is not clear how the use of clinic services by adolescents is best encouraged or sustained. Among the multi-component programs, some have shown an effect in reducing sexual risk taking, some have not. The most intensive programs were usually the most effective. Effects tended to disappear when programs were stopped.