HHS recognizes that the responsibility to solve the problem of teen pregnancy lies with everyone, including families, communities, and young people themselves. It is important that every community-large or small, urban or rural-works to find solutions to this problem.
Community Programs. The Department of Health and Human Services assured that at least 25 percent of communities had teen pregnancy prevention programs in place-as mandated by section 905 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. This was reported in the National Strategy to Prevent Teen Pregnancy, released in January of 1997. In fact, based on data available at that time, HHS estimated that at least 30 percent of communities had HHS-funded teen pregnancy prevention programs in place in FY 1995.
For this first annual report, the Department prepared estimates of the proportion of communities with HHS-funded programs for fiscal years (FY) 1996 and 1997. In FY 1996, at least 30 percent of communities had teen pregnancy prevention programs in place, and in FY 1997, the proportion increased to at least 31 percent of communities (or 1,470 of 4,752 communities) with programs.
The estimate clearly shows that at least 25 percent of communities had teen pregnancy prevention programs in place. It is a conservative number because it represents HHS-funded programs that flow directly to communities. HHS also supports other teen pregnancy prevention efforts through its various state block grant programs. In addition, there are numerous activities supported by funding sources outside of HHS. Many private and other public-sector agencies are supporting a broad range of prevention activities from life-skills education, school-based curricula and clinics, abstinence education, to family planning. (See Appendix II for more detail about the measurements.)
Highlights of HHS Activities. HHS supports promising approaches to preventing teen pregnancy in a variety of ways. One of our most important roles is providing funds to states and localities to support teen pregnancy prevention programs. HHS is committed to using its resources to strengthen, integrate, and support additional teen pregnancy prevention activities, and other youth-related activities in communities across the country. We will work with our partners to identify additional promising efforts and disseminate information about them to other communities.
State Children's Health Insurance Program (CHIP). One of the most significant accomplishments for this year was the passage of the state Children's Health Insurance Program (CHIP). Established by the Balanced Budget Act of 1997 under Title XXI of the Social Security Act, this new $24 billion program enables states to provide health insurance coverage to uninsured, low-income children. The law allows states to expand coverage for children in three ways: through the Medicaid program, through a separate child health insurance program, or through a combination of these programs. States have the opportunity to involve communities as they design and implement their CHIP programs, allowing new programs, including teen pregnancy prevention programs, to serve as additional sources of services and support for adolescents at risk.
Outreach to inform and enroll those eligible for health insurance coverage under CHIP is a priority for the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration. This initiative should result in increased adolescent enrollment in CHIP, thereby assuring enrolled adolescents' eligibility for a variety of covered services related to pregnancy prevention.
State and Community Program Activities. HHS provides funding to states and communities to support specific program activities. The following are highlights of a number of these activities that have occurred this past year.
- Local Coalitions. Coalitions of local public and private agencies and organizations, with support from CDC through the Community Coalition Partnership Program for the Prevention of Teen Pregnancy, have been working together over the last two years in 13 communities with high rates of teen pregnancy. These coalitions develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans. Using models developed to reduce teen pregnancy, the community action plans are designed to incorporate each community's needs, assets, values, and expectations regarding youth.
In FY 1997, funding was made available in these communities to help implement and evaluate their action plans. Six of the thirteen communities have received funds to conduct enhanced evaluations of their programs, either by monitoring specific outcome indicators or assessing the impact of a specific intervention undertaken as part of their community action plan. Since these Federal funds are not used for direct service delivery and will be phased out in five years, the communities are also working on financial sustainability plans.
- Girl Neighborhood Power!-Building Bright Futures for Success (GNP). This program is challenging America's communities to become active partners in assisting 9 to 14-year-old girls to successfully navigate adolescence and achieve their maximum potential. The initiative, administered by the Health Resources and Services Administration, strives to combine several elements, including strong "no-use" messages about tobacco, alcohol, and illicit drugs with an emphasis on promoting physical activity, nutrition, abstinence, mental health, social development, and future careers. The approach is designed to enable young girls to become successful adults by exercising responsible reproductive health; achieving gender-specific empowerment; stressing the importance of family, community and volunteerism; and maturing as skilled navigators, safe passengers, and productive citizens.
GNP, funded at $1 million a year, is implemented nationally by Healthy Mothers, Healthy Babies Coalition (HMHB) and by four community-based partners. The communities with funded projects include: York, PA; Rapid City, SD; Memphis, TN; and Madison, WI. Our community partners match the Federal funds. Each community-based grantee shares similar program elements such as before/after school activities, career development, community service, health education, journal writing, and mentoring. Through a variety of creative approaches, each of these sites strives to prevent teen pregnancy and high-risk behaviors, while developing self-esteem.
- Abstinence Only Education Program. This program enables states to provide abstinence education that focuses on young people most likely to bear children out of wedlock. Passed as part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the program has a mandatory appropriation of $50 million for each Fiscal Year from 1998 through 2002. Funds were awarded to all states in November 1997, based upon the ratio of low-income children in the state to the total number of children in each state and jurisdiction. States are required to match every four dollars they receive in Federal assistance with three dollars in state funds. The program is administered by the Health Resources and Services Administration.
- Adolescent Family Life Program (AFL). This program supports prevention projects that promote abstinence from sexual activity as the most effective way to prevent adolescent pregnancy. The AFL program also has projects to establish comprehensive and integrated approaches to the delivery of services to pregnant adolescents, adolescent parents, and their children. The AFL program, administered by the Office of Population Affairs, was funded at $14.2 million in FY 1997 (reflecting a $4.5 million increase from FY 1996). Nine million dollars of the total appropriation is being used for prevention grants utilizing the abstinence-only definition contained in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. HHS funded sixty-six projects under this requirement. Another $2.8 million continued support for seventeen previously funded prevention and care projects and $0.7 million supported four research projects.
- Family Planning Program. HHS also provides family planning education, counseling, and clinical services to persons who want them, with priority given to low-income persons. The Title X (of the Public Health Service Act) Family Planning Program, administered by the Office of Population Affairs, has always played an important role in adolescent pregnancy prevention. Approximately 30 percent of the nearly five million persons served each year are under 20 years of age. The program includes counseling to encourage continued postponement of sexual activity for adolescent clients.
Within the Family Planning Program, there have been several, special teen pregnancy prevention initiatives sponsored through our Regional Offices. For example, since FY 1996, all ten HHS regional offices have been supporting demonstration projects in family planning clinics with a focus on the male role in pregnancy prevention. These projects are designed to increase male responsibility with respect to reproductive health and family planning, and to enhance young men's futures through training and employment. Selected clinics employ adolescent males, as well as provide training in various aspects of clinic operation, family planning, and reproductive health education.
- Community-Based Organizations Reaching Young Men. We supported community-based organizations in developing, implementing, and testing approaches for involving young men in family planning education and reproductive health service programs. Despite the data and research showing that young men recognize unintended pregnancy as a serious problem and its prevention as a joint responsibility, experience has shown that drawing them into family planning/reproductive health related information and service programs is difficult. In FY 1998, the Office of Population Affairs awarded ten grants totaling nearly $2 million toward the addition of family planning service and education components to programs where young males already receive other health, education, and social services.
The Department of Health and Human Services will continue to look for ways to assist communities to reach their goals for reducing teen pregnancy and promoting positive and healthy youth development. A complete listing of HHS programs that support youth is listed in Appendix III.