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Updated May 13, 2020
Federal Teen Pregnancy Prevention Programs
Background
Teen Pregnancy Programs
The U.S. teen birth rate—or the number of births per 1,000
Congress has authorized programs that provide educational
females aged 15 to 19 each year—has steadily declined
curricula and social supports aimed at helping youth make
since the early 1990s. The rate decreased by 72% from the
decisions that will ultimately delay early pregnancy and
most recent high of 61.8 (in 1991) to the most recent low of
parenting. Four federal programs focus exclusively on teen
17.4 (in 2018, the most recent data available). Researchers
pregnancy prevention education: (1) the Teen Pregnancy
suggest that multiple factors have influenced this decline,
Prevention (TPP) program; (2) the Personal Responsibility
and that there is not necessarily a definitive single reason
Education Program (PREP); (3) the Title V Sexual Risk
for it. Such factors may include decreasing teen sexual
Avoidance Education program, authorized under Title V of
activity, particularly among younger teens, and increasing
the Social Security Act; and (4) the Sexual Risk Avoidance
use of contraceptives among sexually active teens.
Education program, authorized under appropriations laws.
The U.S. Department of Health and Human Services (HHS)
Despite the downward trend in births among teenagers,
administers the four programs, which generally target
Congress continues to be interested in the issue of teen birth
vulnerable teen populations. Youth receive teen pregnancy
because of its high costs. Teen parents tend to have less
prevention education in school and other settings. Grantees
education and are more likely to live in poverty than peers
for the four programs include states and/or other entities.
who are not teen parents. Children of teenage mothers are
more likely to have poorer educational and other outcomes
Teen Pregnancy Prevention (TPP) Program
than children of mothers who delay childbearing. Teen
P.L. 111-117 established and initially funded the TPP
childbearing can have larger societal impacts, such as costs
program, and subsequent appropriations laws have provided
related to public sector health care and lost tax revenue. In
funding through FY2020. The program competitively
addition, teen pregnancy disproportionately affects certain
awards grants to public and private entities to implement a
racial and ethnic groups and selected states and territories.
variety of evidence-based or innovative models that seek to
Figure 1 shows a map with teen births rates by quartile for
influence adolescent sexual behavior. Such models focus on
the 50 states, Washington, DC, and three of the territories in
sexual abstinence or information about the use of
2018. The highest rates were in 10 states, mostly in the
contraceptives, among other approaches.
South and Appalachia; Guam; and the Northern Marianas.
Figure 1. Teen Birth Rates by State & Territory, 2018
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
determined to be evidence-based through rigorous
evaluation studies. Another 25% of the remaining TPP
program funds are used for Tier 2 research and
demonstration grants that are intended to develop and test
additional strategies for reducing teenage pregnancy.
Currently, TPP supports 76 Tier 1 grantees and 37 Tier 2
grantees. TPP grantees served more than 244,000 youth
from July 2017 through June 2018.
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 due to attrition, failure to
Source: Congressional Research Service (CRS), based on data from
meet HHS’ research standards, or for other reasons.
the Centers for Disease Control and Prevention (CDC).
Notes: Birth rates are per 1,000 females aged 15 to 19.
Personal Responsibility Education Program (PREP)
Multiple HHS agencies established the Teen Pregnancy
The Patient Protection and Affordable Care Act (ACA; P.L.
Prevention Evidence Review pursuant to the FY2010
111-148) established PREP under Section 513 (Title V) of
omnibus appropriations law (P.L. 111-117). The review
the Social Security Act. The program is a broad approach to
was active from 2010 to 2017, and used criteria to
teen pregnancy prevention that seeks to educate adolescents
determine which education models have been shown,
aged 10 to 20 and pregnant and parenting youth under age
through rigorous evaluation, to reduce teen pregnancy and
21 on both abstinence and/or contraceptives to prevent
related outcomes. HHS encouraged or required grantees for
pregnancy and sexually transmitted infections (STIs). PREP
some teen pregnancy prevention programs to use these
includes four types of grants: (1) State PREP grants, (2)
models.
Competitive PREP grants, (3) Tribal PREP, and (4) PREP–
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link to page 2 Federal Teen Pregnancy Prevention Programs
Innovative Strategies (PREIS). PREP grantees served
up to 20% of such allotment to build the evidence base for
approximately 77,000 youth in FY2018.
sexual risk avoidance by conducting or supporting research.
As required under law, HHS is supporting an evaluation
Mandatory funding is provided through November 30,
known as the Sexual Risk Avoidance National Evaluation
2020. A majority of PREP funding is allocated to states and
(SRANE). The evaluation includes both Title V SRAE
territories via the State PREP grant. The 50 states,
grantees and SRAE program grantees.
Washington, DC, and eight territories are eligible for
funding. Funds are allocated by formula based on their
Sexual Risk Avoidance Education Program
relative share of youth aged 10 to 20. Funding for
The 2016 omnibus appropriations law (P.L. 114-113)
jurisdictions that declined the formula grant is available to
established and funded the Sexual Risk Avoidance
local entities on a competitive basis. Unexpended annual
Education program (not to be confused with the Title V
state allotments have been competitively awarded as three-
program of the same name; and sometimes referred to as
year discretionary grants to 21 entities to carry out PREP
the General Department Management SRAE program). It
programming in 12 jurisdictions. State PREP and
has since been funded through FY2020. The program
Competitive PREP grantees must replicate evidence-
supports projects for implementing sexual risk avoidance
based teen pregnancy prevention programs or substantially
education that teaches participants how to voluntarily
incorporate elements of effective programs.
refrain from non-marital sexual activity and prevent other
youth risk behaviors. The program targets youth
Tribal PREP grants are available for tribal entities to
populations that are at risk for non-marital sexual activity,
support projects that educate American Indian and Alaska
such as juvenile justice-involved youth and youth in or
Native youth on teen pregnancy prevention. Grantees are to
aging out of foster care. Grantees served approximately
support culturally and linguistically appropriate teen
54,000 youth in FY2019.
pregnancy programs, including those that are promising or
evidence-based. Eight tribal grantees are currently funded.
Multiple entities may apply for SRAE funding, including
PREIS grants are intended to build evidence for promising
states and other jurisdictions and educational, nonprofit,
teen pregnancy prevention programs for high-risk youth.
for-profit, and tribal entities. HHS awarded 22 SRAE grants
The grants are awarded on a competitive basis to public and
and continued funding for 30 grantees for FY2019. SRAE
private entities to implement and evaluate innovative youth
grantees are advised to review evidence-based program
pregnancy prevention strategies that have not been
models, but do not have to use such models. Prior
rigorously evaluated. PREIS currently supports 13 grantees.
appropriations laws have specified funding for similar
Title V Sexual Risk Avoidance Education Program
abstinence education programs, the Community-Based
Abstinence Education (CBAE) program from FY200 to
The 1996 welfare reform law (P.L. 104-193) established the
“Separate Program for Abstinence Education” under
FY2009 and the Competitive Abstinence Education (CAE)
program from FY2012 to FY2015. Both programs provided
Section 510 in Title V of the Social Security Act. The
competitive grants to public and private entities to develop
program had long been known as the Title V Abstinence
and implement youth abstinence-only education programs.
Education Grant program, which was in effect through
FY2017. The Bipartisan Budget Act of 2018 (P.L. 115-123)
Funding
replaced Section 510, thereby changing the name of the
Table 1 shows recent funding levels for the four existing
program to the Sexual Risk Avoidance Education (SRAE)
programs. The Title V Sexual Risk Avoidance Education
program and adding new requirements on financial
program and PREP program are mandatory programs
allotments, educational elements, research, and data. The
supported by pre-appropriated funds. The Sexual Risk
overall purpose of the revised program remains essentially
Avoidance Education and TPP programs are discretionary
the same, which is to provide youth aged 10-19 with
programs funded through the annual appropriations process.
education that focuses on sexual abstinence.
Table 1. Final Funding for Teen Pregnancy Prevention
As with PREP, mandatory funding for Title V SRAE is
Programs: FY2016-FY2020, Dollars in Millions
provided through November 30, 2020. The 50 states,
Washington, DC, and the territories are eligible to apply for
Title V
Title V State SRAE funds. Forty-four states; Washington,
TPP
PREP
SRAE
SRAE
DC; and six territories had a Title V Abstinence Education
program that received FY2019 State SRAE funds.
FY2016
$101.0
$75.0
$75.0
$10.0
Jurisdictions request funds as part of their request for
FY2017
$100.8
$69.8
$69.8
$15.0
Maternal and Child Health Block Grant funds, which
support maternal and child health programs. After funding
FY2018
$101.0
$75.0
$75.0
$25.0
is set aside for HHS administrative costs, funds are
allocated to jurisdictions based on their relative shares of
FY2019
$101.0
$75.0
$75.0
$35.0
low-income children. Funding is available for eligible
FY2020
$101.0
$75.0
$75.0
$35.0
entities in jurisdictions that do not apply for Title V
Competitive SRAE grants. Approximately 20 such
Source: CRS, based on appropriations and authorizing laws.
grantees received FY2019 funds. HHS estimates that
Adrienne L. Fernandes-Alcantara, Specialist in Social
approximately 379,000 youth were served under Title V
State SRAE and Competitive SRAE in FY2019. A
Policy
state/territory or other entity receiving funding under the
IF10877
Title V Sexual Risk Avoidance Education program may use
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Federal Teen Pregnancy Prevention Programs
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https://crsreports.congress.gov | IF10877 · VERSION 3 · UPDATED