Order Code RS22656
May 1, 2007
Scientific Evaluations of Approaches to
Prevent Teen Pregnancy
Carmen Solomon-Fears
Specialist in Social Legislation
Domestic Social Policy Division
Summary
The long-awaited experimentally designed evaluation of abstinence-only education
programs, commissioned by Congress in 1997, indicates that young persons who
participated in the U.S. Department of Health and Human Services’ Title V Abstinence
Education block grant program were no more likely than other young persons to abstain
from sex. The evaluation conducted by Mathematica Policy, Inc. found that program
participants had just as many sexual partners as nonparticipants, had sex at the same
median age as nonparticipants, and were just as likely to use contraception as
participants. For many analysts and researchers, the study confirms that a comprehensive
sex education curriculum with an abstinence message and information about
contraceptives and decision-making skills is a better approach to preventing teen
pregnancy. Others maintain that the evaluation examined only four programs for
elementary and middle school students, and is thereby inconclusive. Separate
experimentally designed evaluations of comprehensive sexual education programs found
that some comprehensive programs, including contraception information, decision-
making skills, and peer pressure strategies, were successful in delaying sexual activity,
improving contraceptive use, and/or preventing teen pregnancy. This report will not be
updated.
Introduction
For many years, there have been divergent views with regard to sex and young
persons. Many argue that sexual activity in and of itself is wrong if the persons are not
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 teen pregnancy prevention approaches. The abstinence-only education approach
centers on the abstinence-only message and exclusively funds programs that adhere solely
to bolstering that message. The Title V Abstinence Education block grant administered
by the Department of Health and Human Services (HHS) supports this approach. The
comprehensive sexual education approach provides funding (through many other federal

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programs) for both prevention programs (that often include an abstinence message) and
programs that provide medical and social services to pregnant or parenting teens.
Background
Since 1991, teen pregnancy, abortion, and birth rates have all fallen considerably.
In 2002 (the latest available data), the overall pregnancy rate for teens aged 15-19 was
75.4 per 1,000 females aged 15-19, down 35% from the 1991 level of 115.3. The 2002
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.
After increasing sharply during the late 1980s, the teen birth rate for females aged
15-19 declined every year from 1991 to 2005.2 The 2005 teenage birth rate of 40.4 per
1,000 women aged 15-19 is the lowest recorded birth rate for U.S. teenagers. In 2005, the
number of births to teens was 421,123 (10.2% of the 4.1 million births in the U.S.), of
which 6,717 births were to girls under age 15.3 Nearly 23% of all nonmarital births were
to teens in 2005. Although birth rates for U.S. teens have dropped in recent years, they
remain higher than the teenage birth rates of most industrialized nations. According to
a recent report on children and youth, in 2005, 34% of ninth graders reported that they had
experienced sexual intercourse. The corresponding statistics for older teens were 43% for
tenth graders, 51% for eleventh graders, and 63% for twelfth graders.4 About 30% of
female teens who have had sexual intercourse become pregnant before they reach age 20.5
An October 2006 study by the National Campaign to Prevent Teen Pregnancy
estimated that, in 2004, adolescent childbearing cost U.S. taxpayers about $9 billion per
year. Research indicates that teens who give birth are less likely to complete high school
and go on to college, thereby reducing their potential for economic self-sufficiency. The
research also indicates that the children of teens are more likely than children of older
parents to experience problems in school and drop out of high school, and as adults are
more likely to repeat the cycle of teenage pregnancy and poverty. The 2006 report
contends that if the teen birth rate had not declined between 1991 and 2004, the annual
costs associated with teen childbearing would have been almost $16 billion (instead of
1 The Alan Guttmacher Institute, U.S. Teenage Pregnancy Statistics: National and State Trends
and Trends by Race and Ethnicity, updated September 2006, p. 5.
2 In 1970, the teen birth rate was 68.3 births per 1,000 women aged 15-19. The birth rate dropped
to 50.2 in 1986 and rose back to 61.8 in 1991. Since 1991, the teen birth rate for women aged
15-19 has decreased each year, declining almost 35% during the 14-year period from 1991 to
2005 (from 61.8 births per 1,000 women aged 15-19 in 1991 to 40.4 births per 1,000 women aged
15-19 in 2005).
3 National Center for Health Statistics, Births: Preliminary Data for 2005, by Brady E. Hamilton,
Joyce A. Martin, and Stephanie J. Ventura, National Vital Statistics Reports, Vol. 55, No. 11.
December 28, 2006.
4 Centers for Disease Control and Prevention, MMWR, vol. 55, no. SS-05, Youth Risk Behavior
Surveillance: United States, 2005, June 9, 2006, available at [http://www.cdc.gov/mmwr/
preview/mmwrhtml/ss5505a1.htm].
5 The National Campaign to Prevent Teen Pregnancy, How is the 34% Statistic Calculated? Fact
Sheet. February 2004.

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$9 billion).6 In recognition of the negative, long-term consequences associated with
teenage pregnancy and births, the prevention of teen pregnancy is a major national goal.
Scientific Evaluation of Teen Pregnancy Prevention Approaches
While a number of different techniques are available to evaluate the impact of policy
changes, there is widespread consensus that well-designed and well-implemented studies
that require random assignment to experimental and control groups provide more reliable,
valid, and objective information than other types of approaches. Random assignment
experimental studies generally assign potential participants to two groups. Individuals
assigned to a control group are subject to current policies or practices (no policy change);
individuals assigned to the experimental or treatment group are subject to a different
policy initiative (i.e., intervention), such as abstinence-only education. Individuals are
randomly assigned to these two groups, and any differences between the experimental and
control group are attributed to the policy initiative being examined.
The random assignment experimental approach attempts to estimate a program’s
impact on an outcome of interest. It measures the average difference between the
experimental group and the control group. For a policy to have an impact, it must be
determined that the impact did not just occur by chance. In other words, the difference
must be determined to be “statistically significant.” Differences between experimental
and control groups that pass statistical significance tests are reported as policy impacts.7
The random assignment experimental approach generally is considered to provide the
most valid estimate of an intervention’s impact, and thereby provides useful information
on whether, and the extent to which, on average, an intervention causes favorable impacts
for a large group of subjects. (For information about some of the problems with the
experimental approach, see CRS Report RL33301, Congress and Program Evaluation:
An Overview of Randomized Controlled Trials (RCTs) and Related Issues.)
Abstinence-Only Education. P.L. 105-33, the Balanced Budget Act of 1997,
included funding for a scientific evaluation of the Title V Abstinence-Only Education
block grant program (Title 510 of the Social Security Act), originally authorized by P.L.
104-193, the 1996 welfare reform law. Mathematica Policy Research, Inc. won the
contract for the evaluation.8
6 The National Campaign to Prevent Teen Pregnancy, By the Numbers: The Public Cost of Teen
Childbearing, by Saul D. Hoffman. October 2006.
7 U.S. House of Representatives. Committee on Ways and Means. 2004 Green Book:
Background Material and Data on the Programs Within the Jurisdiction of the Committee on
Ways and Means. WMCP: 108-6. On p. Appendix L-31. March 2004.
8 The Title V Abstinence Education block grant program to states was originally provided $250
million in federal funds ($50 million per year for five years, from FY1998 to 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. 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, the latest extension, contained in P.L.
109-432 (the Tax Relief and Health Care Act of 2006), continues funding for the block grant
(continued...)

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Two other programs — the
A Title V Abstinence Education program (1) has, as
Community-Based Abstinence
its exclusive purpose, teaching the social, psychological,
Education (CBAE) program
and health gains of abstaining from sexual activity; (2)
funded via HHS appropriations
teaching abstinence from sexual activity outside of
and the “prevention” component
marriage as the expected standard for all school-age
children; (3) teaching that abstinence is the only certain
of the Adolescent Family Life
way to avoid out-of-wedlock pregnancy, STDs, and
(AFL) program — include the
associated health problems; (4) teaching that a mutually
eight statutory elements of the
faithful monogamous relationship within marriage is the
T i t l e V A b s t i n ence-Onl y
expected standard of human sexual activity; (5) teaching
Education block grant program
that sexual activity outside of marriage is likely to have
harmful psychological and physical effects; (6) teaching
(see Text Box at right). For
that bearing children out-of-wedlock is likely to have
FY2007, total abstinence-only
harmful consequences for the child, the child’s parents,
education funding amounted to
and society; (7) teaching young people how to reject
$177 million: $50 million for the
sexual advances and how alcohol and drug use increases
Title V abstinence program; $13
vulnerability to sexual advances; and (8) teaching the
importance of attaining self-sufficiency before engaging
million for the AFL abstinence
in sex.
education projects; $109 million
for the CBAE program (up to $10
Source: Section 510 of the Social Security Act. [Title
million of which may be used for
42 U.S. C. Section 710]
a national abstinence education
campaign); and $4.5 million for an
evaluation of the CBAE program.
Mathematica’s April 2007 report presents the final results from a multi-year,
experimentally based impact study on several abstinence-only block grant programs. The
report focuses on four selected Title V abstinence education programs for elementary and
middle school students: (1) My Choice, My Future!, in Powhatan, Virginia; (2)
ReCapturing the Vision, in Miami, Florida; (3) Families United to Prevent Teen
Pregnancy (FUPTP), in Milwaukee, Wisconsin; and (4) Teens in Control, in Clarksdale,
Mississippi. Based on follow-up data collected from youth (aged 10 to 14) four to six
years after study enrollment, the report, among other things, presents the estimated
program impacts on sexual abstinence and risks of pregnancy and STDs.
According to the report:
Findings indicate that youth in the program group were no more likely than control
group youth to have abstained from sex and, among those who reported having had
sex, they had similar numbers of sexual partners and had initiated sex at the same
mean age. ... Program and control group youth did not differ in their rates of
unprotected sex, either at first intercourse or over the last 12 months. ... Overall, the
programs improved identification of STDs but had no overall impact on knowledge
of unprotected sex risks and the consequences of STDs. Both program and control
group youth had a good understanding of the risks of pregnancy but a less clear
understanding of STDs and their health consequences.9
8 (...continued)
through June 30, 2007. According to Mathematica, more than 700 Title V abstinence programs
have been funded.
9 Mathematica Policy Research, Inc., Impacts of Four Title V, Section 510 Abstinence Education
Programs, by Christopher Trenholm, Barbara Devaney, Ken Fortson, Lisa Quay, Justin Wheeler,
and Melissa Clark. Final Report. April 2007. Contract No.: HHS 100-98-0010. [http://aspe.hhs.

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In response to the report, HHS has stated that the Mathematica study showcased
programs that were among the first
funded by the 1996 welfare reform
Experimentally Designed Studies of Effective
law. It stated that its recent
Comprehensive Sexual Education Pregnancy
directives to states have encouraged
Prevention Programs
states to focus abstinence-only
education programs on youth most
(1) Aban Aya Youth Project — Chicago, Illinois: The
study found that 78% of boys in the program/
likely to bear children outside of
intervention group used condoms compared to 65% of
marriage, i.e., high school students,
boys in the control group. There were no significant
rather than elementary or middle-
findings for the girls.
school students. It also mentioned
(2) Children’s Aid Society (CAS) Carrera Program —
NY, MD, FL, TX, OR, and WA: The study found that
that programs need to extend the
the girls in the program group were 18% less likely to
peer support for abstinence from the
have had sex than girls in the control group; were 55%
pre-teen years through the high
less likely to become pregnant; and were 80% more
school years.10
likely to use dual methods of contraception at last sexual
encounter. There were no significant findings for the
boys.
Comprehensive Sexual
(3) Draw the Line/Respect the Line — Northern
Education. Advocates of a more
California: At the three-year follow-up, 19% of the boys
comprehensive approach to sex
in the program group had engaged in sexual activity
education argue that today’s youth
compared to 27% of boys in the control group. There
were no significant findings for the girls.
need information and decision-
(4) Postponing Sexual Involvement, Human Sexuality,
making skills to make realistic,
and Health Screening Curriculum — Washington, D.C.:
practical choices about whether to
Several months after the intervention, girls in the
engage in sexual activities. They
program were twice as likely as girls in the control group
contend that such an approach
to delay sex; and girls in the program group were three
to seven times more likely than girls in the control group
allows young people to make
to have used contraception at last sexual encounter.
informed decisions regarding
There were no significant findings for the boys.
abstinence, gives them the
(5) Safer Choices — Texas and California: At the 31-
information they need to resist peer
month follow-up, sexually active program participants
pressure and to set relationship
(boys and girls) were 1.5 times more likely than control
group participants to use a condom; and program
limits, and also provides them with
participants were 1.5 times more likely than the control
information on prevention of STDs
group to use a second method of birth control.
and the use of contraceptives.11
Source: The National Campaign to Prevent Teen
Pregnancy. Putting What Works To Work: Curriculum-
Based on a recent report by the
National Campaign to Prevent Teen
Pregnancy, there are five random
assignment experimentally designed studies (published since 2000) of teen pregnancy
prevention programs that have been proven to be effective in delaying sexual activity,
9 (...continued)
gov/hsp/abstinence07/].
10 U.S. Department of Health and Human Services (HHS), Report Released on Four Title V
Abstinence Education Programs. HHS Press Office. April 13, 2007. [http://aspe.hhs.gov/hsp/
abstinence07/factsheet.shtml].
11 Although more than 30 federal programs have authority to provide funding for pregnancy
prevention services, the amount of federal funding actually spent on comprehensive sexual
education programs or services for teenagers cannot be isolated. See a General Accounting
Office (now Government Accountability Office) report, GAO/HEHS-99-4, Teen Pregnancy:
State and Federal Efforts to Implement Prevention Programs and Measure Their Effectiveness,
November 1998.

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improving contraceptive use among sexually active teenagers, and/or preventing teen
pregnancy.12 (See the Text Box above.)
Many analysts and researchers agree that effective pregnancy prevention programs
have many of the following characteristics:
! Convince teens that not having sex or that using contraception
consistently and carefully is the right thing to do.
! Last a sufficient length of time.
! Are operated by leaders who believe in their programs and who are
adequately trained.
! Actively engage participants and personalize the program information.
! address peer pressure.
! Teach communication skills.
! Reflect the age, sexual experience, and culture of young persons in the
programs.
Although there have been numerous evaluations of teen pregnancy prevention
programs, there are many reasons why programs are not considered successful. In some
cases the evaluation studies are limited by methodological problems or constraints
because the approach taken is so multilayered that researchers have had difficulty
disentangling the effects of multiple components of a program. In other cases, the
approach may have worked for boys but not for girls, or vice versa. In some cases the
programs are very small, and thereby it is harder to obtain significant results. In other
cases, different personnel may affect the outcomes of similar programs.
An Abstinence-Only Intervention Versus an Abstinence Message
There is a significant difference between abstinence as a message and abstinence-
only interventions. While the Bush Administration continues to support an abstinence-
only program intervention (with some modifications), others argue that an abstinence
message integrated into a comprehensive sex education program that includes information
on the use of contraceptives and that enhances decision-making skills is a more effective
method to prevent teen pregnancy. A recent nationally representative survey found that
90% of adults and teens agree that young people should get a strong message that they
should not have sex until they are at least out of high school, and that a majority of adults
(73%) and teens (56%) want teens to get more information about both abstinence and
contraception.13 The American public — both adults and teens — supports encouraging
teens to delay sexual activity and providing young people with information about
contraception. (For additional information on teen pregnancy prevention, see CRS Report
RS20301, Teenage Pregnancy Prevention: Statistics and Programs, and CRS Report
RS20873, Reducing Teen Pregnancy: Adolescent Family Life and Abstinence Education
Programs, both by Carmen Solomon-Fears.)
12 The National Campaign to Prevent Teen Pregnancy, Putting What Works To Work:
Curriculum-Based Programs That Prevent Teen Pregnancy. 2007. Note: The report lists 23
effective programs that used either an experimental or quasi-experimental design. The earliest
program listed was based on a 1990 evaluation. See the Text Box above for a list of five
programs with an experimental design that were evaluated in 2000 or later.
13 The National Campaign to Prevent Teen Pregnancy, With One Voice 2007 — America’s Adults
and Teens Sound Off About Teen Pregnancy, by Bill Albert. February 2007, p. 2.
[http://www.teenpregnancy.org/resources/data/pdf/WOV2007_fulltext.pdf].

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