Evidence-Based Policies to Prevent Teen Pregnancy
By Kate Blackman | Vol . 24, No. 16 / April 2016
Did you know?
- The federal government has identified more than 30 evidence-based teen pregnancy prevention programs.
- The federal Teen Pregnancy Prevention Program has funded about 200 grants in more than 35 states.
- Teen birth rates declined 29 percent between 2010 and 2014—more than any other four-year period.
Interest in evidence-based policymaking is growing in state legislatures, particularly to address challenging social issues. Evidence-based policymaking involves investing in approaches that have been rigorously evaluated and have demonstrated results. It is increasingly met with bipartisan support by lawmakers who are seeking to invest limited funds wisely. Teen pregnancy is one notable example of a social issue that has seen exceptional success with evidence-based strategies.
Teen pregnancy has far-reaching implications for women, children and families, as well as for states. States often incur medical costs associated with teen births but, more significantly, teen childbearing affects spending in the health care, justice and welfare systems. State coffers also are affected by lower wages earned by teen parents with less education or fewer job prospects. The consequences continue for future generations as well: Children of teen mothers are more likely than their peers to live in poverty, have poor educational or health status, and become teen parents themselves.
Teen pregnancy and birth rates have reached historic lows, which experts attribute in part to the growing number of programs that have demonstrated success in changing teen sexual behavior. The federal government made a significant investment in evidence-based programs to prevent teen pregnancy beginning in 2010, and since then, the teen birth rate has dropped 29 percent—more than twice the decline of any other four-year period.
The Teen Pregnancy Prevention Program (TPP), administered by the U.S. Department of Health and Human Services’ (HHS) Office of Adolescent Health, is among the first examples of federal evidence-based policymaking. Since 2010, TPP has funded about 200 competitive grants to a wide range of organizations across the nation that are working to reduce teen pregnancy. The federal program focuses on rigorous evaluation and high-quality evidence demonstrating that a program is successful—whether the program focuses on delaying sex, avoiding risky behaviors, providing contraception information, or a combination of strategies. In this way, TPP emphasizes the outcomes of a program over the specific program content or lessons.
The Teen Pregnancy Prevention Program has been lauded by experts, advocates and policymakers as a gold standard for evidence-based policymaking because of its focus on evidence at all stages. To begin, the executive branch and Congress defined what constituted evidence, and HHS developed a careful, systematic process to determine which programs meet high standards to qualify as evidence-based using an independent review of hundreds of evaluation studies.
Through Tier 1 grants, TPP funds agencies and organizations to replicate one or more of these proven programs in their communities. Grantees choose the model—from HHS’ list of more than 30 programs—that best meets their needs and populations. The grants include adequate funding and support to implement programs and operate them according to the model, in a way that increases the likelihood of achieving results comparable to the original evaluation.
The Teen Pregnancy Prevention Program also requires Tier 1 grantees to commit to ongoing evaluation to test whether their program’s outcomes are achieved. In addition, TPP funds Tier 2 grants that allow promising new approaches to be developed and tested. Therefore, TPP uses evidence not only as a requirement for funding, but also as a tool to evaluate both proven and emerging programs. Data collection and evaluation, even of proven models, help program leaders and policymakers not only determine what works, for whom and in what settings, but also ensure sound investments of resources.
State agencies, nonprofits and other organizations in 39 states and the District of Columbia reached nearly 500,000 youth through the Teen Pregnancy Prevention Program between 2010 and 2015, and grantees expect to serve a total of 1.7 million by 2019. For example, the Illinois Department of Human Services received $2 million a year to serve high-risk youth outside Chicago. The approach uses more than five different age-appropriate, evidence-based programs in elementary, middle or high schools, as well as in other settings.
Some states have developed similar approaches on their own, emphasizing evidence and outcomes in teen pregnancy prevention. Colorado’s 2013 HB 1031, for instance, established a grant program for public schools and districts to create and implement evidence-based sexuality education programs. The legislation requires programs to have demonstrated results in specific areas such as delaying sexual initiation or increasing contraceptive use. It defines evidence-based programs with criteria such as rigorous research design, effective replication and publication in a peer-reviewed journal.
More than a decade ago, the North Carolina General Assembly directed establishment of the Teen Pregnancy Prevention Initiatives (TPPI) to provide grants for programs in counties with the highest rates of teen pregnancy or greatest need for teen parenting programs. The subsequent rules require grantees to use programs with “documented success” and to have evaluation plans. In the application guidelines, TPPI lists options of multiple evidence-based programs—all of which are on the federal list—as well as some promising programs. The initiative also supports ongoing monitoring and evaluation. TPPI staff conduct site visits, provide consultation and technical assistance, and support program evaluations.
The Maryland General Assembly considered HB 437 in 2015, which would have created a state-based Teen Pregnancy Prevention Grant Program similar to the federal program. Although it was not enacted, the legislation provides an example of state policymakers looking to define evidence and require evaluation.