Most teenagers feel uncomfortable talking about sex, but not 16-year-old Bryanna Ely.
As a youth leader for the Buffalo, New York-based teen pregnancy prevention program HOPE Buffalo, Ely talks to not only other teens but also adults. She explains how they can help teens when it comes to their emotional, physical and sexual health, abstinence and birth control.
“It’s definitely made me more comfortable around health providers, because I was very nervous and not willing to talk about it, but then once I joined HOPE Buffalo, it’s an easy subject to talk about. Well, not that easy, but it’s easy enough to talk about that I don’t feel so uncomfortable,” said Ely, who will be entering her junior year in high school this month.
While volunteering with HOPE Buffalo at a local community center, Ely said, she remembered meeting another teenage girl, sharing sexual health information with her and feeling like she made a difference.
“She took in all the information, and she said she would not get pregnant until she was 28 or 30,” Ely said. “I joined HOPE Buffalo because I wanted to make a change in my community and make sure that these teenagers who didn’t have a voice had a voice.”
Yet federal funding for such teen pregnancy prevention programs in the United States is now on the chopping block.
Instead, the US Department of Health and Human Services said in a statement that it’s continuing to review best approaches, which it says “will be guided by science and a firm commitment to giving all youth the information and skills they need to improve their prospects for optimal health outcomes.”
Among the leadership within the Department of Health and Human Services, Secretary Tom Price and Valerie Huber, chief of staff to the Office of the Assistant Secretary for Health, have been proponents of abstinence-only education programs.
‘Took me completely by surprise’
Around the Fourth of July, Stan Martin, project director of HOPE Buffalo, received a notice from Health and Human Services’ Office of Adolescent Health that indicated funding would end next June, after just three years, instead of continuing to fund the program for the expected five years.
Other grant recipients of the Teen Pregnancy Prevention program across the country received the same notice.
The Office of Adolescent Health’s Teen Pregnancy Prevention Program currently funds 84 grants to reduce teen pregnancy across clinics, schools and communities, by implementing and evaluating prevention programs and supporting technology- and program-based approaches, according to the office’s website. Their end date is now June 30.
Meanwhile, funding for “capacity-building” assistance providers that help organizations develop and deliver programs was eliminated effective immediately, said Lauren Ranalli, director of the Adolescent Health Initiative at the University of Michigan, which provides assistance to HOPE Buffalo and other teen pregnancy prevention programs across the country.
“This news took me completely by surprise,” Ranalli said.
“My immediate thought was really about all of the incredible work that was in progress with grantees in South Carolina and Oklahoma and Baltimore and Buffalo and Los Angeles and so many other locations,” she said.
Martin said HOPE Buffalo will be turning to local partners for help. The organization already partners with community centers, public schools and faith-based groups.
“The community itself, they’re demanding that adolescents have access to these resources, to this information, regardless of funding,” Martin said.
Moving forward, “our youth leadership team, they’re heavily involved in every decision that we make. They’ll be educating the community in terms of what this program means to them,” he said. “I think it’s our duty as caring adults that we provide a sense of purpose or hope for adolescents.”
Ely hopes HOPE Buffalo continues, she said. “It has changed my life completely.”
Officials spar over teen pregnancy
Health and Human Services said in an emailed statement to CNN that an evaluation of previous first-round teen pregnancy prevention programs, which were active from 2010 to 2014, revealed that those programs were not as effective as thought.
“The very weak evidence of positive impact of these programs stands in stark contrast to the promised results, jeopardizing the youth who were served, while also proving to be a poor use of more than $800 million in taxpayer dollars,” the statement said.
“The poor evaluation results were the reason that the Trump Administration, in its FY 2018 budget proposal, did not recommend continued funding for the TPP program and HHS hit the pause button on it,” the statement said. “This action gives the Department time to continue its review of the program and the evidence, to ensure that should Congress continue it, the program provides positive reinforcement of the healthy decisions being made by a growing majority of teens.”
Many researchers, program directors and city health officials argue against hitting “the pause button.”
“If the justification for cutting short the current grants is the result from the last round of grantees, then it misses two key big points,” said Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy, a grantee of federal funds.
When analyzing the results from the first round of evaluations from a scientific perspective, those previous results were actually impressive, Albert said, “and (the Office of Adolescent Health) learned from the evaluation results and is using that knowledge to strengthen the current projects.”
“Once the first round of evaluation results were published, the Office of Adolescent Health transparently shared results and strongly encouraged grantees to shift to the most effective models. Grantees have done that, which means that the models that current grantees are implementing are very different and stronger than the mix of models used in the first round,” Albert said.
“The way that OAH has learned from results and used them to strengthen the TPP Program is exactly what you’d expect of a high-quality evidence-based initiative,” he said.
In other words, he said, it is important not to confuse the success of the overall learning and development process with individual program models that were evaluated.
Members of the Big Cities Health Coalition, a coalition of health officials from the 28 largest cities in the US, wrote a joint letter to Price last month urging him to reconsider the decision to cut the project period and funds.
The letter indicated that teen birth rates in the US dropped to a record low last year, following a long-term trend, and the letter suggested that reducing funding for teen prevention programs might reverse that trend.
“Cutting TPPP funding and shortening the project period will not only reverse historic gains made in the US in reducing teen pregnancy rates, but also make it difficult to truly understand what practices are most effective in our communities across the nation,” the letter said.
On the other hand, the Health and Human Services statement said that while teen birth rates are at record lows, sexually transmitted disease and infections are at record highs, according to data from the Centers for Disease Control and Prevention.
Still, Albert said that “there are plenty of reasons” not to give up on the existing teen pregnancy programs quite yet.
‘Another attack on women’
“Rates of pregnancy and births among teens in this country far, far outstrip those in other comparable countries. Our rates, for example, are twice as high as in England, about seven times as high as in Japan,” Albert said.
“With all the progress that has been made, there remains great and profound disparities in teen pregnancy and childbearing in this country, by race and ethnicity and by geography,” he added.
For instance, parts of Texas, including Dallas, have higher teen birth rates than the rest of the country, according to an epidemiologic study published in the journal Obstetrics & Gynecology in June.
The study found that a cluster of teenage births in and around Fort Worth, Texas, between 2006 and 2012 represented a teen birth rate 58% higher than the rest of the contiguous country, even after adjusting for poverty differences.
Statewide, Texas was found to have the highest prevalence of repeat teen births in the country in a CDC report from 2013.
“That alone demonstrates that funding is needed,” said Zachary Thompson, director of Dallas County Health and Human Services, who signed the Big Cities Health Coalition letter.
Regarding the cuts in funding, he said, “I think it was short-sighted and really another attack on women as it relates to focusing on women’s health.”
As for other cities, Baltimore is expected to see about 20,000 students lose access to comprehensive teen pregnancy prevention programs and education due to the funding cuts, said Dr. Leana Wen, the city’s health commissioner, who signed the Big Cities letter.
When Wen learned about the cuts, she initially thought it was a mistake, she said, and now she disputes the conclusions that were put forth in the Department of Human and Health Services’ statement.
“This grant allowed us to have comprehensive reproductive health education in middle schools and high schools throughout our city. … In terms of evaluation, we’re only a few months into the implementation. So we don’t know. We don’t have the data yet about the full potential of what we can achieve,” Wen said.
“We see it as being irresponsible to cut this program now, especially because the justification from the older model is wrong, and so we highly contest this statement” from the Department of Health and Human Services, she said.
Patty Hayes, director of public health for Seattle and King County, said she has seen the teen prevention programs have a positive impact in her community.
“We have been so successful in King County with our teen pregnancy rates reducing by 55%” since 2008, said Hayes, who also signed the Big Cities Health Coalition letter.
“If something works, you invest in it,” she said. “We need for our community to respect science, to move forward with this and to make sure that we are not moving backwards. … I’m very wound up about this.”
As for the Department of Human and Health Services’ statement, Hayes said she was shocked by the way the department characterized the program.
“Their comments show they are not even aware of the focus of grantees who are doing research like ours. The point of evaluation is to learn what works, in what contexts and with which populations,” Hayes said.
“Clearly, evidence-based programs play an important role in reducing teen pregnancy,” she said, adding that since the first round of the Teen Pregnancy Prevention grants were awarded in 2010, the teen birth rate has continued to fall.
The nation’s Teen Pregnancy Prevention Program was established in 2010 with a congressional mandate to fund not only youth-focused programs but also independent evaluation studies that contribute to the field’s understanding of where, when and with whom programs are most effective.
Dr. Christine Dehlendorf, a family physician and associate professor at the University of California, San Francisco School of Medicine, has been developing such research and evaluating a teen pregnancy prevention program called Speak Out.
The program includes educating teens about intrauterine devices and other forms of long-acting reversible contraception. A survey published by the Urban Institute last year found that many adult women don’t even know that much about IUDs.
Now, Dehlendorf has to break the news to the teens involved in her research that Speak Out may no longer continue due to funding cuts.
“I really feel like not being able to evaluate and disseminate this intervention is an insult to those young people who have put in their time and their expertise in helping us figure out how to accomplish our goals,” Dehlendorf said, adding that she also will not be able to obtain scientifically valid results from the research.
“Addressing stubborn public health problems requires innovative approaches — and this means that by definition, there will be variation in how successful programs are,” she said. “Science requires taking risks, doing formal evaluations and then applying the results. That is exactly what the TPP Program was designed to do, and it has had success in improving our understanding of how to improve teen’s reproductive health.”
Sarah Verbiest, executive director of the Center for Maternal & Infant Health in the University of North Carolina School of Medicine, pointed out that cutting funding for teen pregnancy prevention programs also could bring along layoffs.
“When you think about it, that’s a lot of people that are trained, that know these communities, that work in these communities and also who are now going to be needing to find work themselves,” Verbiest said.
While Verbiest has no personal connection to the funding cuts, she said that, as the mother of 17-year-old and 20-year-old children, she finds it difficult to see such teen pregnancy prevention programs disappear.
“We talk about how parents should be having these conversations. As a parent of a 17-year-old, I can say that yes, it’s really important I share my values with my children, and we definitely do, but it’s not easy talking about specifics with them,” Verbiest said, adding that this is where programs can play a role.
“It’s important for us all to think comprehensively about this,” she said. “We really have to get to real conversations about how can these programs work for communities.”