In July, without warning, the U.S. Department of Health and Human Services sent 81 hospitals, universities, churches and other organizations across the nation a letter informing them that the $213.6 million in federal funding they receive annually to research and prevent teen pregnancy would be cut off by the end of June 2018, according to the Center for Investigative Reporting. Many of these programs operate in poorer areas, meaning that young people in underserved communities would be hit hardest if Congress approves the cuts. This proposal, along with Congressional Republicans’ impotent efforts to repeal the Affordable Care Act and cut Medicaid, is just the latest example of the GOP’s efforts to slash programs and services related to sexual and reproductive health.
While some Republicans have questioned the efficacy of teenage pregnancy prevention programs, a recent study published by BMJ Open in May suggests that there are fewer teen pregnancies when states spend more on social and public health services. Doctor Heather Sipsma of Benedictine University, who co-authored the study, and other researchers compared two factors: how much states spent on social services for impoverished residents from 2005 to 2009 and each state’s teen birth rate two years later, from 2007 to 2011. The team controlled for factors like each state’s racial demographics, region, income inequality, wealth level as measured by gross domestic product per capita and how many children live with one parent. Sipsma’s team found that states which spend more on Medicaid, food stamps, public schools, mass transit and other public programs tended to have lower teen birth rates.
Let’s review the numbers. For each person living in poverty, red states like Texas, Mississippi and Arkansas spent about $25,000 on social programs in 2009. Those states had 50 teen births per 1,000 people in 2011. The numbers for liberal states like Connecticut, Massachusetts and Vermont: $75,000 to $100,000 on social programs for each low-income resident, and between 10 and 20 teen births for every 1,000 people.
Cutting Texas’s family planning budget by $73.1 million cost Texas taxpayers about $81 million.
Sipsma’s team suggested that increased spending on social services and public health programs—such as those related to public education, housing, community health care and recreation—could lower teen pregnancy rates. Isaac Maddow-Zimet, who researches teen pregnancy and sexual health for the Guttmacher Institute, which was originally founded in 1968 as an arm of Planned Parenthood but now operates independently, agrees with the study’s findings. “It wouldn’t surprise me that giving adolescents more social support is a great way to prevent unintended pregnancy,” Maddow-Zimet says.
The past 25 years have benefited from a sharp decline in teen pregnancies. According to U.S. Health and Human Service’s Office of Adolescent Health, the overall teen birth rate fell to 24.2 in 2014 for every 1,000 women ages 15 to 19, down from nearly 60 in 1990. “The data we have suggested [that] the declines were driven entirely by contraceptive use, as opposed to changes in sexual activity,” Maddow-Zimet says, referring to a report published last year. "Sexual activity among adolescents did not change at all over that time period.” Regarding Sipsma’s study, he adds, “I do think it’s easy to say it’s a good thing to give adolescents access to services they need.”
But the Trump administration disagrees.
After evaluations of 37 projects funded by the Teen Pregnancy Prevention federal grant program, created in 2010 under President Barack Obama, an HHS spokesperson wrote in an email that 73 percent of programs had no impact or adverse impact on the behavior of teens who took part in them. The programs’ effects dissipated in six to 12 months, the spokesperson added. HHS did not reply when asked for evidence showing the programs’ ineffectiveness and Playboy did not get a response on which programs HHS considered adequate, or if that 27 percent would continue getting grants.
One of the victims of HHS’s cuts is OIC of South Florida, a nonprofit that gets about $1.25 million annually through TPP. With that funding, OIC employs 20 workers who serve 5,300 teens a year in 13 zip codes. OIC’s workers meet with middle- and high school-aged students to show them the consequences of unexpected pregnancy. In one initiative, students strap on a 20-pound belly to give them an idea of the social stigma a pregnant young woman feels.
“Now, you have a young person who may get pregnant at a young age of 15,” says OIC CEO Newton Sanon. "Let’s talk about the social and emotional trauma that young person will go through. Let’s talk about the cost to our tax base for the care of that young person, the likelihood the person born into such a scenario—the likelihood they’ll have a child as well. Let’s talk about the child being in the foster system, the criminal justice system.” To Sanon, the $1.25 million the feds spend on OIC gives society a much bigger return.
Meanwhile, the Trump administration seems to prefer that teens avoid pregnancy by not having sex. Although the administration claims the anti-teen pregnancy programs do not work, the budget it proposed in the spring included $277 million on abstinence-only education. But teaching teens not to sleep with each other does not prevent it, studies have shown. A study by the Society for Adolescent Health and Medicine, published in September, reported that “abstinence from sexual intercourse can be a healthy choice for adolescents, particularly if an adolescent is not ready to engage in sex. However, government programs exclusively promoting abstinence-only-until-marriage are problematic from scientific and ethical viewpoints… [by] inherently provid[ing] incomplete information to sexually active adolescents.” Such programs date back to 1981, when President Ronald Reagan signed the Adolesecent Family Life Act, which funded the country’s first abstinence-only education program.
In June, Trump appointed Valerie Huber, former president of Ascend, an abstinence education advocacy group, to be chief of staff for the HHS’s assistant secretary for health. An HHS spokesperson would not confirm or deny if the order to cut anti-teen pregnancy programs came from Huber.
For a state-level example of how cuts to programs designed to help the poor effectively raise teen birth rates, look at Texas. When the Lone Star State decimated its family planning budget from $111 million to $37.9 million in 2011, 80 clinics that provided abortions, birth control, condoms and other contraceptives were forced to shutter. About 2,200 young women would not have given birth if the clinics stayed open, wrote Analisa Packham, a researcher at Miami University, in a study published last month. Estimating the cost of each teenage birth at $27,000, Packham calculated that cutting the family planning budget by $73.1 million cost Texas taxpayers about $81 million.
“I think that adolescents need more support, not less support,” says Maddow-Zimet, the Guttmacher researcher. “It’s important that we give adolescents the financial resources and the information they need to really decide their own reproductive lives, and I think that government policies can play a role in that.” Whether or not Congress and Trump agree remains to be seen.