HHS has continued to ensure that at least 25 percent of communities have teen pregnancy prevention programs in place as mandated by section 905 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.
In FY 1999, at least 35 percent of communities had teen pregnancy prevention programs in place. This is a conservative estimate because it represents only HHS funded programs that flow directly to communities. HHS also supports other teen pregnancy prevention efforts through its various state block grant programs. For example, two of the purposes of Temporary Assistance for Needy Families (TANF; which replaced Aid to Families with Dependent Children, AFDC) are to prevent out-of-wedlock pregnancies and to encourage the formation and maintenance of two-parent families. In support of these goals, states may use TANF funds for a wide variety of teen pregnancy prevention programs, serving both welfare recipients and the general population. In addition, there are numerous activities supported by funding sources outside of HHS.
Abstinence education is funded by the Department through two programs. In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) created a program entitled the Abstinence Education Grant Program, funded under Section 510 of Title V of the Social Security Act. The grants funded under this program must meet specific criteria defined in the legislation. In addition, the Department has been funding abstinence education through its Adolescent Family Life Program (AFL) since 1981.
Abstinence Education Grant Program. The HHS Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB) is responsible for the administration of the Abstinence Education Grant Program (Section 510 of Title V of the Social Security Act). The law provides for a mandatory annual appropriation of $50 million for each fiscal year (FY), 1998 through 2002. Annual submission of a State application and an annual report are required prior to allocation of funds. Fifty-three States and Territories received Abstinence Education Grant funding in Year 1 of the program (FY 1998), and fifty-two States and Territories received funding in Year 2 (FY 1999). (California, subsequently decided to return both FY 1998 and FY 1999 Abstinence Education Grant funding.) Fifty-three States and Territories received FY 2000 Abstinence Education Grant funding. The final annual reports for the FY 1999 Abstinence Education Grants and the Year 4 (FY 2001) applications were to have been submitted to MCHB by mid-July 2000. In April 2000, MCHB completed an annual program summary for FY 1999. Key findings reported by States and Territories are summarized below.
- Most frequently funded activities were: community-based projects (44 States/Territories); program evaluations (40); technical assistance and training (37); program monitoring (37); state media campaigns (31); and advisory councils/steering committees (25).
- Most frequent state contractual awards were: community-based organizations (38 States/Territories); local boards of education, school districts and schools (29); and youth serving organizations (27).
- Most frequently funded local program activities were: social skills instruction, character-based education, and assets building (37 States/Territories); school-based programs (34); adult mentoring, counseling and supervision (33); curriculum development and implementation (31); and parent education groups (31).
- Age groups most frequently served by States and Territories were: 13-14 year olds (47); and 9-12 year olds (46).
- Populations most frequently targeted by States and Territories were: parents (43); at-risk youth populations, such as youth of color, out-of-school youths, and youth in areas with high rates of out-of-wedlock pregnancies (37); teachers and youth serving professionals (26); and males (25).
In addition, a national evaluation of Abstinence Education programs is being funded and managed separately. See "Abstinence-Only Education Programs National Evaluation," in the "Research and Evaluation Activities" chapter of this document.
Adolescent Family Life Program. The Adolescent Family Life (AFL) Program was enacted in 1981 as Title XX of the Public Health Service Act. Its approach to adolescent pregnancy prevention, as required by statute, has always been abstinence-based; promoting the postponement of sexual activity as the most effective way for adolescents to prevent pregnancy and sexually transmitted diseases (STDs), including HIV infection. This intent has been further reinforced by Congressional requirements, beginning in FY 1997, that specified portions of the Title XX appropriation be used to support prevention projects using the abstinence-only definition under PRWORA. In FY 1999, $9.1 million of the total $17.7 million AFL appropriation was spent to support 72 prevention projects in fulfillment of this requirement. An additional $5 million was spent to continue support for 17 prevention, care and combination projects originally funded in FY 1995, as well as $1 million to support research grants.
Title X National Family Planning Program. The Department is a primary provider of subsidized family planning services, serving nearly 4.5 million persons annually. The Title X program has always played an important role in adolescent pregnancy prevention; approximately 30 percent of those receiving services are under 20 years of age. In addition to clinical services, outreach and education including counseling to encourage continued postponement of sexual activity for adolescent clients who are not yet sexually active are also important components of Title X services for adolescents.
The Community Coalitions Partnership Program and Girl Neighborhood Power! are two programs that help communities develop and maintain collaborations for planning, implementing and evaluating prevention strategies among different sectors of the community.
Community Coalition Partnership Program for the Prevention of Teen Pregnancy. Since 1995, the Centers for Disease Control and Prevention (CDC) has supported demonstration projects in 13 communities with high rates of teen pregnancy (Boston, Chicago, Jacksonville, Kansas City, Milwaukee, Oklahoma City, Orlando, Philadelphia, Pittsburgh, Rochester, San Antonio, San Bernardino, and Yakima, WA).
Eleven of these communities are actively working with Latino and other minority youth and neighborhoods, as part of their overall plan to prevent teen pregnancy. Phase II of the demonstration began in 1997 and continues for five years. In this phase, coalitions of local public and private agencies and organizations, leaders, and residents are working to implement their action plans, field test promising interventions, build toward financial and programmatic sustainability of their programs, conduct site-specific evaluations, and participate in cross-site evaluations.
Each of the 13 demonstration communities have continued their efforts to develop and strengthen, neighborhood coalitions. They continue to mobilize and organize community resources in support of comprehensive, effective and sustainable programs for the prevention of initial and repeat teen pregnancies. The communities are pursuing a wide variety of strategies to provide health, education, employment, recreation and other youth development services, programs and opportunities for youth and their families.
Girl Neighborhood Power! Building Bright Futures for Success (GNP). This five-year national demonstration program, forms part of the Department's Girl Power! effort (see "The Girl Power! Campaign" in the "Building Partnerships" chapter of this document). Administered by the Maternal and Child Health Bureau, Health Resources and Services Administration, the program began in October 1997 and is funded through a cooperative agreement among several agencies within the Department. Girl Neighborhood Power! major goals are: (1) promoting the health and well-being of girls between the ages of nine and fourteen years; (2) preventing the onset of health risk behaviors among girls during their adolescence; (3) encouraging connectedness between girls and the communities in which they live and supporting the growth of the girls' citizenship; (4) developing leadership skills in girls; and (5) fostering communities' and neighborhoods' investments in their youth. Four community partners and one national leadership consortium are funded through this initiative: Crispus Attucks Association, York, Pennsylvania; Girls Incorporated, Memphis, Tennessee; the City of Madison, Wisconsin; Youth and Family Services, Incorporated, Rapid City, South Dakota; and the national leadership consortium, housed at Healthy Mothers, Healthy Babies Coalition, Incorporated, Alexandria, Virginia. Community organizations are required to serve a minimum of four low-income neighborhoods, to demonstrate local commitment through a broad-based coalition of community agencies and parents, and to provide creative programming for the positive development of participating girls. Program elements must include: community service; journal-keeping; before and after school activities; career development; health education, and mentoring. Prevention of teen pregnancy and substance abuse are goals for all four projects. Each grantee receives $200,000 in Federal support, and is expected to match this amount by an additional 25 percent each year beginning in Project Year II.
In recent years, recognition has grown of the critical importance of primary and secondary prevention of youth risk behavior, through youth development approaches targeting all youth, and particularly high-risk youth.
Raising Responsible and Resourceful Youth. In early May 2000, the President and First Lady showed their continued commitment to children and youth by hosting the "White House Conference on Teenagers: Raising Responsible and Resourceful Youth." Topics discussed included new scientific research on youth brain development; changing demographics; perceptions and realities about parents' role in their teens' lives; impact of new media on youth and on parenting; challenges and anxieties of today's teenagers and their families; and what parents, communities and young people can do to build a safe and successful path to adulthood. The conference stressed the importance of positive approaches in preventing adolescent risk behaviors. For example, parents and youth spending time together in family activities was highlighted as a foundation for the prevention of adolescent sexual activity, drug use, and other risky behaviors.
Safe Schools/Healthy Students Initiative. In April, more than $41 million in grants to 23 communities were announced to make schools safer, to foster children's healthy development, to prevent aggressive and violent behavior, and to prevent drug and alcohol use among U.S. youth. These 23 new, three-year grants are in addition to 54 grants given last year. This collaborative initiative among the Departments of Education, Justice, and HHS helps urban, rural, suburban and tribal school districts link prevention activities and community-based services and to provide community-wide approaches to violence prevention and healthy child development.
State Youth Development Collaboration Projects. The Family and Youth Services Bureau (FYSB) provides more than $1 million in funding to provide positive youth development. FYSB funds nine states to develop and support innovative youth development strategies: Arizona, Colorado, Connecticut, Iowa, Maryland, Massachusetts, Nebraska, New York, and Oregon. The grants support efforts that focus on all youth, including vulnerable youth in at-risk situations. Youth development programs have been shown to promote youth self-efficacy, build competencies and encourage young people to delay child- bearing. Each state has designed a unique plan for implementing the project on the basis of identified youth needs and prior state activities with regard to youth development.
Programs for Boys and Young Men
Traditionally, adolescent girls have been the focus of most teen pregnancy research and prevention programs. In recent years, adolescent boys and young men have been recognized as deserving a share of that focus. The National Strategy, together with the Administration's Fatherhood Initiative, have continued to work on ways to expand the Department's efforts to target boys and young men. Research has shown that young men recognize unintended pregnancy as a serious problem and its prevention as a joint responsibility; nevertheless, drawing them into family planning/reproductive health information and service programs continues to be difficult. For the past three years, the Office of Population Affairs has funded several research grants aimed at improving our knowledge of what works for males, through the development of new program models.
Title X Male Involvement Grants. The Office of Population Affairs funds 10 research grants to support community based organizations in developing, implementing, and testing approaches for involving young men in family planning education and reproductive health services programs. The 10 research grants, funded through the Title X Family Planning Program, are currently in their third year. An additional 20 grants have been funded as delegate agencies to existing Title X grantees. While the original 10 projects were primarily community-based models that used their existing youth development and adult mentoring programs as incentives to draw young men into reproductive health and family planning education activities, the mix of program types has now become more comprehensive. In addition to the community based models, a number of projects are based on a clinical model that provides comprehensive health care services, including reproductive health and family planning on site, and many are school based (using established curricula such as Wise Guys), on site, and offer referrals for reproductive health and family planning services and specialized counseling.
Promoting Male Involvement in Pregnancy Prevention: Federal, State and Local Strategies. The Department has sponsored several meetings to identify innovative male involvement strategies that might be shared with a larger audience. Specific strategies designed to inform and collaborate with stakeholders and other community based partners include creative use of the media and social marketing, regional and state forums and summits, peer-to-peer networking opportunities, and technical assistance. The goal is to promote and support a view of boys and men as responsible members of families.
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 created the Temporary Assistance for Needy Families (TANF), replacing the former Aid to Families with Dependent Children (AFDC). Two of the primary goals of TANF are preventing out-of-wedlock pregnancies and encouraging the formation and maintenance of two-parent families; consequently, TANF funds may be used to support teen pregnancy prevention efforts. TANF also requires unmarried minor parents to stay in school and live at home, or in an adult-supervised setting in order to receive assistance. The law supports the creation of Second Chance Homes, which provide teen parents with skills to become good role models and providers of their children, giving them guidance in parenting and in avoiding repeat pregnancies. The Administration's FY 2001 budget includes $25 million to Second Chance Homes. In addition, HHS' other programs are working together to look at welfare reform in the context of their programmatic activities.
Bonus to Reward Decrease in Illegitimacy Ratio. Welfare reform included an incentive for states to reduce the incidence of out-of-wedlock childbearing and encourage the development of new approaches to pregnancy prevention. Awards for the first year of the Bonus to Reward Decrease in Illegitimacy Ratio were announced in September 1999. Alabama, the District of Columbia, California, Massachusetts and Michigan all received awards of $20 million each. The decrease in the ratio of out-of-wedlock to total births ranged from 5.7 percent in California to 1.5 percent in Massachusetts. This provision is targeted toward all women, not just teenage mothers; however, in measuring state decreases in out-of-wedlock births, this measure would also include births among unmarried teens. Consistent with the purpose of TANF, the funds can be used to support a wide variety of programs extending beyond needy families.
Guide to States: Helping Families Achieve Self-Sufficiency. The Administration for Children and Families has developed a guide for states entitled Helping Families Achieve Self-Sufficiency. This guide offers suggestions on how best to use TANF funds for services to children and families (including teen pregnancy prevention efforts). The guide can be found at: http://www.acf.dhhs.gov/programs/ofa/funds2.htm
Effects of Welfare Reform on Parenting Teens. In addition, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention is supporting an initiative on teen parents and welfare reform that generates knowledge on the effects of welfare reform on parenting teens, and measures the effects of preventive interventions on teen parents and their children. The four objectives in support of this goal are: (1) prevention or reduction of alcohol, tobacco, and drug use; (2) improvement in academic performance; (3) reduction of subsequent pregnancies; and (4) improvement in life skills and general well-being. SAMHSA awarded cooperative agreements to 10 Study Sites, and one Coordinating Center in September 1998, and these projects have enrolled more than 1,700 pregnant or parenting teens, to date. Baseline data are currently being analyzed, and contain interesting information with regard to teen pregnancy that will be disseminated to the field as soon as analyses are completed.
Repeat Pregnancies. The Adolescent Family Life (AFL) program will make approximately $4 million available during FY 2000 for demonstration projects to provide health and social services to pregnant and parenting adolescents, their infants and their families. An important component of these projects will be prevention of repeat pregnancies, STD/HIV infection, substance abuse and violence using a youth development approach to build on adolescents' sense of self-worth and self-efficacy through cultural understanding, sports and recreation, visual and performing arts, and other activities.