AVOIDANCE BEHAVIOR

The Trump administration’s new plan to reduce teen pregnancies has failed before

Buckle up.
Buckle up.
Image: AP Photo/Gail Burton
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The Trump administration wants to turn back the clock on preventing teen pregnancy in the US by funding programs that urge young Americans to avoid sex altogether. It’s an approach that has failed before in a country that has long lagged its peers on the issue.

In 2010, the Obama administration created an evidence-based program aiming to end unwanted teen pregnancy in the US. The program awarded grants to projects, many of which developed within the communities they aimed to serve, that had delivered measurable results reviewed by the Department of Health and Human Services (HHS).

Projects would be financed in the development stage and, if demonstrably effective, would get additional funding. Grantees included organizations such as Planned Parenthood, and programs that focused on education of male teenagers.

The current administration wants to stop paying 81 of these grants, awarded for five-year periods during the Obama administration, a cut equal to more than $200 million. Last week, a court ordered the federal government to continue paying the grants until the end.

The Trump administration will likely appeal, and has in the meantime published new guidelines for its own grant program, which moves away from an evidence-based, innovation approach to prioritize another element: Abstinence education.

Identifying the true risks

Trump administration policies on teen pregnancy now mirror those long promoted by Valerie Huber, a Department of Health and Human Services official who has supported abstinence for teens—or what she likes to call “sexual risk avoidance.” That wording is reflected in the government’s call for grant applications (pdf): Trump’s plan offers a total of $83 million (of the total $101 million appropriated in 2018 for programs to reduce teen pregnancies) to be distributed in up to 345 grants, with first priority to be given to projects built on a “risk avoidance model,” followed by those designed using “risk reduction models.” The latter programs “clearly communicate that teen sex is a risk behavior” while including contraception as well as abstinence.

The call for applications references the federal Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBS), saying the CDC ”considers teen sex to be a risk behavior, together with other risk behaviors, such as drug use, lack of physical activity, and failing to use a seatbelt when riding in a car.” However, the CDC’s decision to include “teen sex” as part of its system—essentially, a survey of teen behavior—doesn’t mean that any sexual activity is considered risk behavior.

The CDC believes some types of teenage sexual behavior are a health risk—and specifically, as clarified in the YRBS overview, “sexual behavior related to unintended pregnancy and sexually transmitted infections, including HIV infection”—just like some types of dietary and physical-activity choices are potentially dangerous.

By conflating all types of teen sex, the call for grant applications stigmatizes young-adult sexuality and risks shaming teens into not seeking help for sex-related issues. But even more concerning is the fact that abstinence education in the US has repeatedly been shown to fail.

The US has a poor record on preventing teen pregnancy

The US fares pretty poorly when it comes to its teen-pregnancy rate. It ranks 66th in the world, behind most rich countries—and twice as high as the European Union.

Since 1960, teen-pregnancy rates have fallen rapidly in the US. However, while other rich countries have more or less reported a steady downward trend, the US has progressed in some stutter-steps: reductions followed by increases followed by reductions.

Although the rate of teen pregnancy is influenced by many factors, it is worth noting that large abstinence-only programs tend to correlate with increases in pregnancies. After a drop in teen pregnancy rates from the 1960s to the early 1980s, the trend reversed. That corresponded to the Ronald Reagan administration’s introduction of dedicated funding for abstinence-only education in 1981. Under his successor George H.W. Bush, funding for abstinence-only education continued to increase—and so did the rate of teen pregnancy.

What has worked in the US

Teen pregnancy in the US only began to drop again under Bill Clinton’s administration, which continued encouraging abstinence-only efforts (in the context of a  push to promote marriage), yet also allocated resources towards other sexual education. Abstinence-only funding then dramatically expanded during George W. Bush, who increased the budget for abstinence-only programs from $97 million in 2002 to over $214 million in 2008. Bush also limited states’ access to federal funding for sex-ed that was not abstinence based. The steady decline in teen pregnancies slowed significantly.

After Barack Obama took office in 2009, things changed yet again. Between 2010 and 2016, the US saw another sizable reduction in teen pregnancies, parallel to the funding of the very programs that Trump has decided to cut short.