Back to abstinence-only education for teens?

In 2008, the United Way of Greater Milwaukee & Waukesha County launched an initiative to lower Milwaukee's high rate of teen childbirths.

That year, more than 5% of Milwaukee teens between 15 and 17 gave birth—double the national average. The campaign involved building communitywide awareness through the Milwaukee Health Department, local businesses, healthcare providers, schools and community groups. The goal was to cut the rate of teen pregnancies in half by 2015.

The centerpiece of the campaign was an eight-hour, evidence-based, sex education curriculum aimed at middle-school youth called “Making Proud Choices! A Safer Sex Approach to STDs, Teen Pregnancy, and HIV.” By increasing teen knowledge, Milwaukee lowered its teen pregnancy rate for six straight years. By 2012, it stood at 2.6%, nearly achieving its goal three years early.

“We know that we have to give young people information to help empower them to make healthier decisions,” said Nicole Angresano, who has led the United Way's teen pregnancy prevention effort for the past nine years. “We think it was a significant contributor to the reduction in rates.”

Proud Choices is one of more than 40 teen pregnancy prevention programs endorsed by HHS' Office of Adolescent Health as part of its Teen Pregnancy Prevention Initiative (TPPI). The Obama administration program provided grants to agencies and organizations to implement programs with demonstrated effectiveness as well as develop new strategies that educate youth on sex-related issues.

Whether those deserve all the credit—some argue the culture is shifting away from early sexual activity among teens—the fact is between 2007 and 2015 the rate of teen births fell 50% in urban counties and 37% in rural counties, according to a recent study from the Centers for Disease Control and Prevention. Indeed, rates of both teen pregnancy and childbirth have fallen every year since 1991, with only a brief two-year rise between 2005 and 2007.

Critics who supported the abstinence-only sex education approach taken by federal policymakers during the 1990s and 2000s argue the Obama administration programs have been ineffective at best and may have even promoted an increase in sexual activity among teens. But public health advocates are convinced evidence-based, medically accurate sex education programs provided teens with the resources needed to make informed decisions when it comes to sex and contributed to lowering the teen pregnancy rate.

A 2015 National Family Growth Survey conducted by the Centers for Disease Control and Prevention showed a 14% decline over the past quarter-century in female teenagers and a 22% drop among male teenagers age 15-19 who reported having sex. The study also found an increase in the number of teen girls who reported using condoms during sex from 94% in 2002 to 97% in 2013.

The Obama administration's sex education policies represented a major break from the abstinence-only approach, which had been federal policy for decades. Abstinence-only programs received $1.5 billion in federal funding over the past quarter- century, according to the Sexuality Information and Education Council of the United States.

The Obama administration initially invested $110 million in a more comprehensive approach, which grew to $180 million this year. “We have moved toward focusing on the results and not the content,” said Andrea Kane, vice president for policy and strategic partnerships with the National Campaign to Prevent Teen and Unwanted Pregnancy.

With the arrival of a Trump administration in January, however, advocates of evidence-based programs fear policy will shift back to the old approach and set back progress in reducing teen pregnancy rates. “The federal investments since 2010 have really moved from being focused on a particular type of sex education that's based on a certain ideology to evidence-based programs,” Kane said.

Even some public health officials in conservative parts of the country are worried about cuts to the programs. “Every little bit we do certainly is cost-effective because lives are forever changed when a woman has a child sooner than they are ready,” said Dr. Bob England, director of the Maricopa County Public Health Department in Arizona, where the state's teen birth rate fell 57% between 2007 and 2015.

Studies have found babies born to teen mothers are more likely to be premature and have low birth weights, which carries a higher risk of infant mortality as well as physical and mental disorders. Only 40% of teen mothers earn a high school diploma, according to the National Conference of State Legislatures, with two-thirds of teen mothers living in poverty and a quarter dependent on public assistance within three years after giving birth.

TPPI program supporters hope the data will convince the new administration to maintain the programs. “We're hoping … we can make the connection that, yes, these evidence-based program initiatives really make a difference,” said Lauren Killelea, director of development and communications with the Massachusetts Alliance on Teen Pregnancy.

Yet many providers are bracing for cuts. They say GOP-led legislatures are likely to shift the focus of teen pregnancy-prevention to abstinence-only sex education. “Certainly when we've had Republicans in the White House and Republican-controlled houses of Congress there's been more support for abstinence-only programs,” said Nicole Cushman, executive director for Answer, a national organization that trains teachers and other professionals to provide sex education for youth.

GOP majorities in the House and Senate routinely proposed funding cuts to programs that provide contraception and screening for HIV and sexually transmitted diseases. Only a threatened veto from President Obama saved the programs. More than 4 million low-income and uninsured individuals received services under the programs during the Obama years.

It is still unclear where the Trump administration will take the issue. According to the New York Times, the president-elect plans to delegate responsibility for reproductive health issues to Vice President-elect Mike Pence, the conservative governor of Indiana.

Last March Pence signed an anti-abortion law in Indiana that makes it a criminal act to seek an abortion based on the fetus being diagnosed with a genetic disorder. Pence has also sought to defund Planned Parenthood, which resulted in the closing of a number of clinics in the state and the loss of preventive health services such as access to contraception for low-income individuals.

“The same lawmakers that tend to support restrictions on reproductive rights and access to abortion also have tended to favor abstinence-only programs and to oppose more comprehensive approaches to sex education,” Cushman said.

Indeed, that's exactly what advocates for abstinence-only education expect from the new administration. “We are hoping that the Trump administration gives the sexual risk-avoidance approach, also known as abstinence education, a stronger acceptance in both the policy and the funding levels than the past administration has offered,” said Mary Anne Mosack, national director of state initiatives for Ascend, formerly known as the National Abstinence Education Association.

Mosack said the launch of Obama's TPPI effectively ended more than two decades of bipartisan support for sexual risk-avoidance education. There were 169 such programs prior to 2010, she said.

Of course, no one knows what impact returning to that approach will have on teen pregnancy rates. England in Arizona believes greater awareness of the unfavorable economics of teen pregnancy and a culture shift away from early childbearing had a greater impact on reducing the rate of teen childbirths than reproductive health education.

“What will happen if these programs get defunded is we will have a large national experiment, and we'll see what the impact was,” England said.