Order Code RS20873 Updated October 4, 2004 CRS Report for Congress Received through the CRS Web Reducing Teen Pregnancy: Adolescent Family Life and Abstinence Education Programs Carmen Solomon-Fears Domestic Social Policy Division Summary In 2003, 47% of students in grades 9-12 reported that they had experienced sexual intercourse; about 20% of female teens who have had sexual intercourse become pregnant each year. In recognition of the often negative, long-term consequences associated with teenage pregnancy, Congress has provided funding for the prevention of teenage and out-of-wedlock pregnancies. This report discusses two programs that exclusively attempt to reduce teenage pregnancy. The Adolescent Family Life (AFL) demonstration program was enacted in 1981 as Title XX of the Public Health Service Act, and the Abstinence Education program was enacted in 1996 as part of the welfare reform legislation. This report will be updated as new information becomes available. Introduction Since 1991, teen pregnancy, abortion, and birth rates have all fallen considerably. In 2000 (latest available data), the overall pregnancy rate for teenagers was 83.6 per 1,000 females aged 15-19, down 27% from the 1991 level of 115.3. The 2000 teen pregnancy rate is the lowest recorded since 1973, when this series was initiated.1 However, it still is higher than the teen pregnancy rates of most industrialized nations. According to a recent report on children and youth, in 2003, 33% of ninth graders reported that they had experienced sexual intercourse. The corresponding statistics for older teens were: 44% for tenth graders, 53% for eleventh graders, and 62% for twelfth graders.2 About 20% of female teens who have had sexual intercourse become pregnant each year. For many years, there have been divergent views with regard to sex and young people. Many argue that sexual activity in and of itself is wrong if the persons are not 1 The Alan Guttmacher Institute, U.S. Teenage Pregnancy Statistics: Overall Trends, Trends by Race and Ethnicity and State-by-State Information, Updated Feb. 19, 2004, p.7. 2 Centers for Disease Control and Prevention, MMWR, vol. 53, no. SS-2, Youth Risk Behavior Surveillance:United States, 2003, May 21, 2004, at [http://www.cdc.gov/mmwr/PDF/SS/ SS5302.pdf]. Congressional Research Service ˜ The Library of Congress CRS-2 married. Others agree that it is better for teenagers to abstain from sex but are primarily concerned about the negative consequences of sexual activity, namely unintended pregnancy and sexually transmitted diseases (STDs). These two viewpoints are reflected in two pregnancy prevention approaches. The Adolescent Family Life (AFL) program encompasses both views and provides funding for both prevention programs and programs that provide medical and social services to pregnant or parenting teens. The Abstinence Education program centers on the abstinence-only message and only funds programs that adhere solely to bolstering that message. (For information on Title X, which serves a much broader clientele than teens and pre-teens, see CRS Report 97-1048, The Title X Family Planning Program.) The Adolescent Family Life Program The AFL demonstration program was enacted in 1981 as Title XX of the Public Health Service Act (P.L. 97-35). It is administered by the Office of Adolescent Pregnancy Programs, Department of Health and Human Services (HHS). From 1981 until 1996, the AFL program was the only federal program that focused directly on the issues of adolescent sexuality, pregnancy, and parenting.3 Program Purpose. The AFL program was designed to promote — family involvement in the delivery of services, adolescent premarital sexual abstinence, adoption as an alternative to early parenting, parenting and child development education, and comprehensive health, education, and social services geared to help the mother have a healthy baby and improve subsequent life prospects for both mother and child. Allowable Projects. The AFL program authorizes grants for three types of demonstrations: (1) projects provide “care” services only (i.e., health, education, and social services to pregnant adolescents, adolescent parents, their infant, families, and male partners); (2) projects which provide “prevention” services only (i.e., services to promote abstinence from premarital sexual relations for pre-teens, teens, and their families); and (3) projects which provide a combination of care and prevention services. Any public or private nonprofit organization or agency is eligible to apply for a demonstration grant. AFL projects can be funded for up to five years. Currently, the AFL program is supporting 107 demonstration projects across the country. (Source: [http://opa.osophs.dhhs.gov/titlexx/oapp.html]) AFL care projects are required to provide comprehensive health, education, and social services (including life and career planning, job training, safe housing, decisionmaking and social skills), either directly or through partnerships with other community agencies, and to evaluate new approaches for implementing these services. AFL care projects are based within a variety of settings such as universities, hospitals, schools, public health departments, or community agencies. Many provide home visiting services 3 The predecessor of the AFL program was the Adolescent Pregnancy program, which was enacted in 1978 (P.L. 95-626). The Adolescent Pregnancy program was designed to alleviate the negative consequences of pregnancy for the adolescent parent and her child (i.e., the care component of the AFL program). The Adolescent Pregnancy program was consolidated into the Maternal and Child Health Block Grant when the AFL program was enacted. CRS-3 and all have partnerships with diverse community agencies. Currently, 45 care projects are being funded; eight of the projects started in FY2002. Since 1997, all AFL prevention projects that have been funded have been abstinenceonly projects that were required to conform to the definition of abstinence education as defined in P.L. 104-193. Most of these projects try to reach students between the ages of 9 to 14 in public schools, community settings or family households; all involve significant interaction with parents to strengthen the abstinence message. Currently, 62 abstinenceonly projects are being funded; 38 of the projects started in FY2002, 6 started in FY2003. Evaluations and Research. Each demonstration project is required to include an internal evaluation component designed to test hypotheses specific to that project’s service delivery model. The grantee contracts with an independent evaluator, usually one affiliated with a college or university in the grantee’s state. The AFL program also authorizes funding of research grants dealing with various aspects of adolescent sexuality, pregnancy, and parenting. Research projects have examined factors that influence teenage sexual, contraceptive and fertility behaviors, the nature and effectiveness of care services for pregnant and parenting teens and why adoption is a little-used alternative among pregnant teenagers. Since 1982, the AFL program has funded 68 research projects. Adolescent Family Life Program (appropriations in millions of dollars) Fiscal year Appropriation Fiscal year Appropriation Fiscal year Appropriation 1982 $11.080 1990 $9.421 1998 $16.709 1983 13.518 1991 7.789 1999 17.700 1984 14.918 1992 7.789 2000 19.327 1985 14.716 1993 7.598 2001 24.377 1986 14.689 1994 6.250 2002 28.900 1987 14.000 1995 6.698 2003 30.922 1988 9.626 1996 7.698 2004 30.720 1989 9.529 1997 14.209 Abstinence Education 1996 Welfare Reform. P.L. 104-193, the 1996 welfare reform law, provides $250 million in federal funds specifically for the abstinence education program ($50 million per year for five years, FY1998-FY2002). Funds must be requested by states when they solicit Title V Maternal and Child Health (MCH) block grant funds and must be used exclusively for teaching abstinence. To receive federal funds, a state must match every $4 in federal funds with $3 in state funds.4 This means that funding for abstinence education must total at least $87.5 million annually. Although the Title V abstinence-only education block grant has not yet been reauthorized, several extension bills have continued funding for the grant. The latest extension (H.R. 5149) continues funding for 4 States use a variety of methods to meet the federal matching requirement, such as state funds, private or foundation funds, matching funds from community-based grantees, and in-kind services (e.g., volunteer staffing, public service announcements, etc.). CRS-4 the Title V abstinence-only block grant through March 31, 2005.5 P.L. 105-33, enacted in 1997, included funding for a scientific evaluation of the abstinence education programs; P.L. 106-554 required an interim report. Mathematica Policy Research won the contract for the evaluation. (See The Evaluation of Abstinence Education Programs Funded Under Title V Section 510:Interim Report [http://aspe.hhs.gov/hsp/abstinence02/ index.htm].) The final report is due in 2005. To ensure that the abstinence-only message is not diluted, the law (P.L. 104-193, Section 510 of the Social Security Act) stipulated that the term “abstinence education” means an educational or motivational program that — (1) has as its exclusive purpose, teaching the social, psychological, and health gains of abstaining from sexual activity; (2) teaches abstinence from sexual activity outside of marriage as the expected standard for all school-age children; (3) teaches that abstinence is the only certain way to avoid out-of-wedlock pregnancy, STDs, and associated health problems; (4) teaches that a mutually faithful monogamous relationship within marriage is the expected standard of human sexual activity; (5) teaches that sexual activity outside of marriage is likely to have harmful psychological and physical effects; (6) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society; (7) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and (8) teaches the importance of attaining self-sufficiency before engaging in sex. What Is Abstinence? It is becoming clear that parents, teachers, and teenagers are not in agreement on what constitutes abstinence. Teens are more likely than adults to believe that behaviors that cannot result in pregnancy constitute abstinence. Because pregnancy prevention together with avoidance of STDs are dual goals of the abstinence education program, some observers contend that it is time for programs to explicitly define what constitutes sexual activity. Others contend that specifying behaviors other than sexual intercourse violates a child’s innocence and may provide ideas for experimentation. Source: Lisa Remez, “Oral Sex among Adolescents: Is It Sex or Is It Abstinence?” Family Planning Perspectives (Alan Guttmacher Institute), 32(6), Nov-Dec. 2000, pp. 298-304. In FY2003, every state except California (and several territories) sponsored an abstinence education program. These programs launch media campaigns to influence attitudes and behavior, develop abstinence education curricula, revamp sexual education classes, and implement other activities focused on abstinence education. State funding is based on the proportion of low-income children in the state as compared to the national total. In FY2003, federal abstinence education funding ranged from $69,855 in Vermont to $4,922,091 in Texas. Appropriations for 2001, 2002, 2003, and 2004. P.L. 106-246 appropriated an additional $20 million for FY2001 to HHS under the Special Projects of Regional and National Significance (SPRANS) program (funded by the MCH Block grant) for abstinence education to bolster the abstinence-only message for adolescents aged 12 through 18. P.L. 106-554 also reinforced the abstinence education program by providing 5 H.R. 4, the welfare reform reauthorization bill, which was passed by the House on Feb. 13, 2003 and approved, with amendments, by the Senate Finance Committee on Sept. 10, 2003, would extend funding for the $50 million abstinence-only block grant through FY2008. Although H.R. 4 was debated on the Senate floor during the period Mar. 29-Apr. 1, 2004, consideration of the bill was not completed. CRS-5 an additional $30 million for FY2002 for continued funding for abstinence-only education under the SPRANS program. P.L. 107-116 increased the SPRANS abstinence program funding from $30 million to $40 million for FY2002. P.L. 108-7 increased funding for the SPRANS abstinence program to $55 million for FY2003. P.L. 108-199 increased funding for the SPRANS abstinence education program to $70.0 million for FY2004. Issues Comparable Funding for Abstinence Education. President Bush has indicated his support for abstinence education. As governor of Texas, he stated: “For children to realize their dreams, they must learn the value of abstinence. We must send them the message that of the many decisions they will make in their lives, choosing to avoid early sex is one of the most important. We must stress that abstinence isn’t just about saying no to sex; it’s about saying yes to a happier, healthier future.”6 The proposal he supported during his presidential campaign would provide at least as much funding for abstinence education as is provided for teen contraception services under the Medicaid, family planning (Title X), and AFL programs, namely about $135 million annually.7 Perhaps as many as 27 other federal programs include a teen contraception component, but expenditures solely for this component could not be isolated.8 For FY2004, the funding for abstinence education totals $135 million: $50 million for the abstinence-only education block grant; $10 million for the AFL prevention projects, $70 million for the SPRANS abstinence-only education program, and $4.5 million for its evaluation.9 Abstinence-Only Versus Comprehensive Sexuality Education. According to a 1997 Alan Guttmacher Institute survey, among the 69% of public school districts that have a district-wide policy to teach sex education, 14% have a comprehensive policy that treats abstinence as one option for adolescents in a broader sexuality education program; 51% teach abstinence as the preferred option for teenagers, but also permit discussion about contraception as an effective means of protecting against unintended pregnancy and 6 Campaign literature from georgebush.com, accessed by author on Nov. 22, 2000. 7 Some family planning experts caution that the spending data may be misleading because it includes much more than contraception services. They contend that family planning programs include a vast array of medical services beyond the prescription of a contraceptive method, including pap smears, breast exams, screening for STDs, and one-on-one counseling of teens. 8 The MCH and Title XX social services block grants are among the HHS programs that provide contraceptive services to teens (GAO/HEHS-99-4, Teen Pregnancy: State and Federal Efforts to Implement Prevention Programs and Measure Their Effectiveness, Nov. 1998). In addition, one of the four purposes of the Temporary Assistance for Needy Families (TANF) block grant is to prevent out-of-wedlock pregnancies. Thus, TANF funds can also be used for a variety of programs to achieve this goal/purpose. 9 Funding for abstinence education amounted to $79 million in FY2001, $100 million in FY2002, and $115 million in FY2003. President Bush’s proposed FY2005 budget would double funding for abstinence-only education to $273 million. It includes a continuation of the $50 million block grant, $26.240 million for the AFL program, $186.426 million for the SPRANS abstinence-only education program (including $4.5 million for an evaluation), and $10 million for a national abstinence education campaign. On Sept. 9, 2004, the House passed the Labor, HHS, Education, and Related Agencies Appropriations for FY2005 (H.R. 5006), which included $191 million for abstinence-only education. CRS-6 disease (an abstinence-plus policy); and 35% teach abstinence as the only option outside of marriage, with discussion of contraception prohibited entirely or permitted only to emphasize its shortcomings (abstinence-only policy).10 Advocates of the abstinence education approach argue that teenagers need to hear a single, unambiguous message that sex outside of marriage is wrong and harmful to their physical and emotional health. They contend that youth can and should be empowered to say no to sex. They argue that supporting both abstinence and birth control is hypocritical and undermines the strength of an abstinence-only message. They also mention recent research that indicates that teens who take virginity pledges to refrain from sex until marriage appear to delay having sex longer than those teens who do not make such a commitment. (The study found that teens who publicly promise to postpone sex until marriage refrain from intercourse for about a year and a half longer than teens who didn’t make such a pledge.)11 They argue that abstinence clearly is the most effective means of preventing unwanted pregnancy and sexually transmitted diseases (including HIV/AIDS). Advocates of the more comprehensive approach to sex education argue that today’s youth need information and decision-making skills to make realistic, practical decisions about whether to engage in sexual activities. They contend that such an approach allows young people to make informed decisions regarding abstinence, gives them the information they need to set relationship limits and to resist peer pressure, and also provides them with information on the use of contraceptives and the prevention of sexually transmitted diseases. They note that abstinence-only messages provide no protection against the risks of pregnancy and disease for those who are sexually active. They point out that teens who break their virginity pledges were less likely to use contraception the first time than teens who had never made such a promise. Although there is much research and many evaluations on both abstinence-only programs and comprehensive sexuality education programs, there is no consensus on the effectiveness of these approaches. According to a 1997 report on research findings: At least four factors limit the conclusions that can be drawn from the many studies reviewed. First, the studies conducted to date are simply too few to evaluate each of the different approaches, let alone the various combinations of approaches. Second, many of these studies are limited by methodological problems or constraints. Third, these studies have often produced inconsistent results. And, fourth, there are very few replications of even the most promising programs that assess their impact in other types of communities and with other groups of youths.12 10 David J. Landry, Lisa Kaeser and Cory L. Richards, “Abstinence Promotion and the Provision of Information about Contraception in Public School Districts Sexuality Education Policies,” Family Planning Perspectives (Alan Guttmacher Institute), 31(6), Nov.-Dec. 1999, pp. 280-286. 11 Peter S. Bearman and Hannah Bruckner, “Promising the Future: Virginity Pledges As They Affect the Transition To First Intercourse,” American Journal of Sociology, Jan. 2001. 12 Douglas Kirby, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, May 2001, Commissioned by the National Campaign to Prevent Teen Pregnancy.