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April 30, 2018
Federal Teen Pregnancy Prevention Programs
Background
Education program, authorized under Title V of the Social
The U.S. teen birth rate—or the number of births per 1,000
Security Act; and (4) the Sexual Risk Avoidance Education
females aged 15 to 19 each year—has steadily declined
program, authorized under appropriations laws. The U.S.
since the early 1990s. The rate decreased by 67% from the
Department of Health and Human Services (HHS)
most recent high of 61.8 (in 1991) to the most recent low of
administers the four programs, which generally target
20.3 (in 2016). Researchers suggest that multiple factors
vulnerable teen populations. Youth receive teen pregnancy
have influenced this decline, and that there is not
prevention education in school and other settings. Grantees
necessarily a definitive single reason for it. Such factors
for the four programs include states and/or other entities.
may include decreasing teen sexual activity, particularly
among younger teens, and increasing use of contraceptives
Multiple HHS agencies established the related Teen
among sexually active teens.
Pregnancy Prevention (TPP) Review pursuant to the
FY2010 omnibus appropriations law (P.L. 111-117). The
Despite the downward trend in births among teenagers,
review uses criteria to determine which education models
Congress continues to be interested in the issue of teen birth
have been shown, through rigorous evaluation, to reduce
because of its high costs. Teen parents tend to have less
teen pregnancy and related outcomes.
education and are more likely to live in poverty than peers
who are not teen parents. Children of teenage mothers are
Teen Pregnancy Prevention (TPP) Program
more likely to have poorer educational and other outcomes
P.L. 111-117 established and initially funded the TPP
than children of mothers who delay childbearing. Teen
program, and subsequent appropriations laws have provided
childbearing can have larger societal impacts, such as costs
funding. The program competitively awards grants to public
related to public sector health care and lost tax revenue. In
and private entities to implement a variety of evidence-
addition, teen pregnancy disproportionately affects certain
based or innovative models that seek to influence
minority communities and selected states and territories.
adolescent sexual behavior. Such models focus on sexual
Figure 1 shows a map with 2016 teen births rates by
abstinence) or information about the use of contraceptives,
quartile for the 50 states, Washington DC, and five of the
among other approaches. HHS has taken steps to
territories. The highest rates were in 12 states, mostly in the
discontinue funding for the current cohort of grantees.
South, and the territories.
Figure 1. Teen Birth Rates by State & Territory, 2016
After funds are set aside for training and technical
assistance, most of the remaining amount (75%) supports
“Tier 1” grants. Generally, these grantees replicate models
identified as part of the TPP Evidence Review. Another
25% of the remaining TPP program funds are used for “Tier
2” research and demonstration grants that are intended to
develop and refine additional strategies for reducing
teenage pregnancy. Currently, TPP supports 58 Tier 1
grantees in 28 states, Washington, DC, and the Marshall
Islands; and 26 Tier 2 grantees in 11 states and Washington,
DC. TPP grantees served 65,788 youth in FY2016.
Evaluations of the first cohort of TPP grantees (FY2010-
FY2014) showed mixed results. Of 41 evaluations, 12
showed a positive impact in at least one teen pregnancy-
related outcome. Another 16 did not have positive impacts
and 13 had inconclusive results.
Source: Congressional Research Service (CRS), based on data from
the Centers for Disease Control and Prevention (CDC).
Personal Responsibility Education Program (PREP)
Notes: Birth rates are per 1,000 females aged 15 to 19.
The Patient Protection and Affordable Care Act (ACA; P.L.
111-148) established PREP under Section 513 (Title V) of
Teen Pregnancy Programs
the Social Security Act. The program is a broad approach to
Given the consequences associated with teen births,
teen pregnancy prevention that seeks to educate adolescents
Congress has authorized programs designed to delay sexual
aged 10 to 20 and pregnant and parenting youth under age
activity and prevent pregnancies among teenagers. Four
21 on both abstinence and/or contraceptives to prevent
federal programs focus exclusively on teen pregnancy
pregnancy and sexually transmitted infections (STIs). PREP
prevention education: (1) the Teen Pregnancy Prevention
includes four types of grants: (1) State PREP grants, (2)
(TPP) program; (2) the Personal Responsibility Education
Competitive PREP grants, (3) Tribal PREP, and (4) PREP–
Program (PREP); (3) the Title V Sexual Risk Avoidance
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Innovative Strategies (PREIS). PREP grantees served
build the evidence base for sexual risk avoidance by
133,696 youth in FY2015.
conducting or supporting research. Further, HHS must
conduct one or more rigorous evaluations of the education
A majority of PREP funding is allocated to states and
(and associated data) funded through the program.
territories via the State PREP grant. The 50 states,
Sexual Risk Avoidance Education Program
Washington, DC, and eight territories are eligible for
The 2016 omnibus appropriations law (P.L. 114-113)
funding. Funds are allocated by formula based on the
established and funded the Sexual Risk Avoidance
proportion of youth aged 10 to 20 in each jurisdiction
Education (SRAE) program (not to be confused with the
relative to other jurisdictions. Funding for jurisdictions that
Title V program of the same name). It received subsequent
declined the formula grant is available to local entities on a
funding in FY2017 and FY2018. The program supports
competitive basis. Unexpended annual state allotments have
projects for implementing sexual risk avoidance education
been competitively awarded as three-year discretionary
that teaches participants how to voluntarily refrain from
grants to 21 entities to carry out PREP programming in 12
non-marital sexual activity and prevent other youth risk
jurisdictions. State and Competitive PREP grantees must
behaviors. The program targets youth populations that are
replicate evidence-based teen pregnancy prevention
at risk for non-marital sexual activity, such as juvenile
programs or substantially incorporate elements of effective
justice-involved youth and youth in or aging out of foster
programs. While grantees are not required to draw on
care. Grantees have served about 21,000 youth annually.
models identified in the TPP Evidence Review, most do.
Multiple entities may apply for SRAE funding, including
Tribal PREP grants are available for tribal entities to
states and other jurisdictions and educational, nonprofit,
support projects that educate American Indian and Alaska
for-profit, and tribal entities. HHS awarded 27 grants in
Native youth on teen pregnancy prevention. Grantees are to
FY2017. SRAE grantees are advised to review evidence-
support culturally and linguistically appropriate teen
based program models that are included as part of the HHS
pregnancy programs, including those that are promising or
TPP Evidence Review, but do not have to use such models.
evidence-based. Eight tribal grantees are currently funded.
PREIS grants are intended to build evidence for promising
Prior appropriations laws have specified funding for similar
teen pregnancy prevention programs for high-risk youth.
abstinence education programs, the Community-Based
The grants are awarded on a competitive basis to public and
Abstinence Education (CBAE) program from FY200 to
private entities to implement and evaluate innovative youth
FY2009 and the Competitive Abstinence Education (CAE)
pregnancy prevention strategies that have not been
program from FY2012 to FY2015. Both programs provided
rigorously evaluated. PREIS currently supports 13 grantees.
competitive grants to public and private entities to develop
and implement youth abstinence-only education programs.
Title V Sexual Risk Avoidance Education Program
The 1996 welfare reform law (P.L. 104-193) established the
Funding
“Separate Program for Abstinence Education” under
Table 1 shows recent funding levels for the four existing
Section 510 in Title V of the Social Security Act. The
programs. The Title V Sexual Risk Avoidance Education
program had long been known as the Title V Abstinence
program and PREP program are mandatory programs
Education Grant program, which was in effect through
supported by pre-appropriated funds. The Sexual Risk
FY2017. The Bipartisan Budget Act of 2018 (P.L. 115-123)
Avoidance Education and TPP programs are discretionary
replaced Section 510, thereby changing the name of the
programs funded through the annual appropriations process.
program to the Sexual Risk Avoidance Education program
and adding new requirements on financial allotments,
Table 1. Final Funding for Teen Pregnancy Prevention
educational elements, research and data, and evaluation.
Programs: FY2013-FY2018, Dollars in Millions
The overall purpose of the revised program remains
essentially the same, which is to provide youth aged 10-19
Title V
with education that focuses on sexual abstinence.
Sexual Risk
Sexual Risk
TPP
PREP
Avoidance
Avoidance
The 50 states, Washington, DC, and the territories are
FY2013
$98.3
$71.2
$47.5
Not funded
eligible to apply for program funds. Funding is available for
eligible entities in jurisdictions that do not apply for
FY2014
$100.8
$69.6
$46.4
Not funded
funding. (Thirty-seven states, Puerto Rico, and the
Federated States of Micronesia had a Title V Abstinence
FY2015
$101.0
$75.0
$50.0
Not funded
Education program in FY2017.) Jurisdictions request Title
FY2016
$101.0
$75.0
$75.0
$10.0
V Sexual Risk Avoidance Education funds as part of their
request for Maternal and Child Health Block Grant funds,
FY2017
$100.8
$69.8
$69.8
$15.0
which support maternal and child health programs. After
FY2018
$101.0
$75.0
$75.0
$25.0
funding is set aside for HHS administrative costs, funds are
allocated to jurisdictions based on their relative shares of
Source: CRS, based on appropriations and authorizing laws.
low-income children. The prior-law Title V Abstinence
Education grantees served 399,000 youth in FY2015.
Adrienne L. Fernandes-Alcantara, Specialist in Social
Policy
Under the revised law, a state/territory or other entity
receiving funding under the Title V Sexual Risk Avoidance
IF10877
Education program may use up to 20% of such allotment to
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Federal Teen Pregnancy Prevention Programs
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