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Updated September 1, 2022
Federal Teen Pregnancy Prevention Programs
Background
reduce teen pregnancy and related outcomes. HHS
The U.S. teen birth rate—or the number of births per 1,000
encouraged or required grantees for some teen pregnancy
females aged 15 to 19 each year—has steadily declined
prevention programs to use these models.
since the early 1990s. The rate decreased by 75% from the
most recent high of 61.8 (in 1991) to the most recent low of
Teen Pregnancy Programs
15.4 (in 2020, the most recent data available). Researchers
Federal law has authorized programs that provide
suggest that multiple factors have influenced this decline,
educational curricula and social supports aimed at helping
and that there is not necessarily a definitive single reason
youth make decisions that will ultimately delay early
for it. Such factors may include decreasing teen sexual
pregnancy and parenting. Four federal programs focus
activity, particularly among younger teens, and increasing
exclusively on teen pregnancy prevention education: (1) the
use of contraceptives among sexually active teens.
Teen Pregnancy Prevention program; (2) the Personal
Responsibility Education Program; (3) the Title V Sexual
Despite the downward trend in births among teenagers,
Risk Avoidance Education program, authorized under Title
Congress continues to be interested in the issue of teen birth
V of the Social Security Act; and (4) the Sexual Risk
because of its high costs. Teen parents tend to have less
Avoidance Education program, authorized under
education and are more likely to live in poverty than peers
appropriations laws. The U.S. Department of Health and
who are not teen parents. Children of teenage mothers are
Human Services (HHS) administers the four programs,
more likely to have poorer educational and other outcomes
which generally target vulnerable teen populations. Youth
than children of mothers who delay childbearing. Teen
receive teen pregnancy prevention education in school and
childbearing can have larger societal impacts, such as costs
other settings. Grantees for the four programs include states
related to public sector health care and lost tax revenue. In
and/or other entities.
addition, teen pregnancy disproportionately affects certain
racial and ethnic groups and selected states and insular
Teen Pregnancy Prevention (TPP) Program
areas. Figure 1 shows a map with teen birth rates by
P.L. 111-117 initially established and funded the TPP
quartile for the 50 states, Washington, DC, and four of the
program, and subsequent appropriations laws have provided
insular areas in 2020. Four states had the highest teen birth
authority and funding through FY2022. The program
rates (25 or higher): Mississippi, Arkansas, Louisiana, and
competitively awards grants to public and private entities to
Oklahoma. The rates for the insular areas ranged from 15.1
implement a variety of evidence-based or innovative
in the U.S. Virgin Islands to 33.0 in Guam.
models that seek to influence adolescent sexual behavior.
Figure 1. Teen Birth Rates by State & Territory, 2020
Such models focus on sexual abstinence or information
about the use of contraceptives, among other approaches.
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 62 Tier 1 grantees and 17 Tier 2
grantees. TPP grantees served 59,244 youth in FY2021.
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-
Source: Congressional Research Service (CRS), based on data from
related outcome. Another 16 did not have positive impacts
the Centers for Disease Control and Prevention (CDC).
and 13 had inconclusive results due to attrition, failure to
Notes: Birth rates are per 1,000 females aged 15 to 19.
meet HHS’ research standards, or for other reasons.
Multiple HHS agencies established the Teen Pregnancy
Personal Responsibility Education Program (PREP)
Prevention Evidence Review pursuant to the FY2010
The Patient Protection and Affordable Care Act (ACA; P.L.
omnibus appropriations law (P.L. 111-117). The review
111-148) established PREP under Section 513 (Title V) of
was active from 2010 to 2019 but is in the process of being
the Social Security Act. The program is a broad approach to
reestablished. It used criteria to determine which education
teen pregnancy prevention that seeks to educate adolescents
models have been shown, through rigorous evaluation, to
aged 10 to 20, and pregnant and parenting youth under age
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link to page 2 Federal Teen Pregnancy Prevention Programs
21, on both abstinence and/or contraceptives to prevent
states and two insular areas received FY2021 funds. Title V
pregnancy and sexually transmitted infections (STIs). PREP
State SRAE and Title V Competitive SRAE grantees served
includes four types of grants: (1) State PREP grants, (2)
127,647 youth in FY2020. A state/territory or other entity
Competitive PREP grants, (3) Tribal PREP, and (4) PREP–
receiving funding under the Title V Sexual Risk Avoidance
Innovative Strategies (PREIS). PREP grantees served
Education program may use up to 20% of such allotment to
97,966 youth in FY2020.
build the evidence base for sexual risk avoidance by
conducting or supporting research. As required under law,
Mandatory funding is provided through FY2023. A
HHS is supporting the Sexual Risk Avoidance National
majority of PREP funding is allocated to states and insular
Evaluation. The evaluation includes both Title V and
areas via the State PREP grant. The 50 states, Washington,
General Departmental Management SRAE program
DC, and eight insular areas are eligible for funding. Funds
grantees (see below).
are allocated by formula based on their relative share of
youth aged 10 to 20. Funding for jurisdictions that declined
General Departmental Sexual Risk Avoidance
the formula grant is available to local entities on a
Education Program (GD SRAE)
competitive basis. Unexpended annual state allotments have
The 2016 omnibus appropriations law (P.L. 114-113)
been competitively awarded as three-year discretionary
established and funded the GD SRAE program. It has since
grants to 27 entities to carry out PREP programming in six
been funded through FY2022. The program supports
jurisdictions. State PREP and Competitive PREP grantees
projects for implementing sexual risk avoidance education
must replicate evidence-based teen pregnancy prevention
that teaches participants how to voluntarily refrain from
programs or substantially incorporate elements of effective
non-marital sexual activity and prevent other youth risk
programs.
behaviors. The program targets youth populations that are
at risk for non-marital sexual activity, such as juvenile
Tribal PREP grants are available for tribal entities to
justice-involved youth and youth in or aging out of foster
support projects that educate American Indian and Alaska
care. HHS estimates that approximately 54,000 youth
Native youth on teen pregnancy prevention. Grantees are to
participated in the Sexual Risk Avoidance Education
support culturally and linguistically appropriate teen
program 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 such as local governments,
teen pregnancy prevention programs for high-risk youth.
educational, nonprofit, for-profit, and tribal entities. HHS
The grants are awarded on a competitive basis to public and
awarded 31 SRAE grants and continued funding for 51
private entities to implement and evaluate innovative youth
grantees for FY2021. SRAE grantees are advised to review
pregnancy prevention strategies that have not been
evidence-based program models, but do not have to use
rigorously evaluated. PREIS currently supports 12 grantees
such models. Prior appropriations laws have specified
in 10 jurisdictions.
funding for similar abstinence education programs, the
Title V Sexual Risk Avoidance Education Program
Community-Based Abstinence Education (CBAE) program
(Title V SRAE)
from FY2001 to FY2009 and the Competitive Abstinence
Education (CAE) program from FY2012 to FY2015. Both
The 1996 welfare reform law (P.L. 104-193) established the
“Separate Program for Abstinence Education” under
programs provided competitive grants to public and private
entities to develop and implement youth abstinence-only
Section 510 in Title V of the Social Security Act. The
education programs.
program had long been known as the Title V Abstinence
Education Grant program, which was in effect through
Funding
FY2017. The Bipartisan Budget Act of 2018 (P.L. 115-123)
Table 1 shows recent funding levels for the four current
replaced Section 510, thereby changing the name of the
programs. The Title V SRAE program and PREP program
program to the “Sexual Risk Avoidance Education”
are supported by mandatory funds. The GD SRAE program
program and adding new requirements on financial
and TPP program are supported by discretionary funds.
allotments, educational elements, research, and data. The
overall purpose of the revised program remains essentially
Table 1. Final Funding for Teen Pregnancy Prevention
the same, which is to provide youth aged 10-19 with
Programs: FY2018-FY2022, Dollars in Millions
education that focuses on sexual abstinence.
Title V
As with PREP, mandatory funding for Title V SRAE is
TPP
PREP
SRAE
GD SRAE
provided through FY2023with the same entities eligible to
apply for Title V State SRAE funds. Thirty-six states and
FY2018
$101.0
$75.0
$75.0
$25.0
two insular areas had a Title V Abstinence Education
FY2019
$101.0
$75.0
$75.0
$35.0
program that received FY2021 State SRAE funds.
Jurisdictions request funds as part of their request for
FY2020
$101.0
$75.0
$75.0
$35.0
Maternal and Child Health Block Grant funds, which
support maternal and child health programs. After funding
FY2021
$101.0
$75.0
$75.0
$35.0
is set aside for HHS administrative costs, funds are
FY2022
$101.0
$70.7
$70.7
$35.0
allocated to jurisdictions based on their relative shares of
low-income children. Title V Competitive SRAE funding is
Source: CRS, based on appropriations and authorizing laws.
available for eligible entities in jurisdictions that do not
Jessica Tollestrup, Specialist in Social Policy
apply for the state funds. Thirty-five such grantees in 13
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Federal Teen Pregnancy Prevention Programs
IF10877
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