Teen Pregnancy Prevention

10/11/2018

Introduction

The U.S. teen birth rate is at an all-time low. As of 2016, the teen birth rate (20.3 births per 1,000 girls ages 15-to-19) declined 67 percent since its peak in 1991. This represents a 9 percent drop from 2015. Downward trends span all 50 states and all racial and ethnic groups. 

Yet despite plummeting rates, teen pregnancy and birth rates for teens ages 15-to-19 in the U.S. remain among the highest of industrialized nations. Roughly 1-in-4 girls will be pregnant at least once before age 20. And about 1-in-6 teen births is a repeat birth. In addition, significant disparities in teen birth rates persist across racial and ethnic groups, geographic regions, rural and urban areas, and age groups.     

Adolescent pregnancy and parenthood are associated with social, health and financial costs to teen parents, families and states. A teen birth can disrupt young people’s educational and career goals, affecting earning potential and future family finances. Only about half of teen mothers earn a high school diploma by age 22, compared to 90 percent of women without a teen birth. Teenage mothers are also more likely to live in poverty and depend on public assistance. Children born to teen parents are more likely to have lower school achievement, enter the child welfare and correctional systems, drop out of high school and become teen parents themselves, compared to children born to older parents. 

Teen births also create significant costs to taxpayers and states. The average cost nationally to provide medical and economic support during pregnancy and the first year of infancy is $16,000 per teen birth, according to an analysis conducted by Power to Decide (a nonpartisan organization formerly called the National Campaign to Prevent Teen and Unplanned Pregnancy). The declines in births among teens save $4.4 billion in public spending each year.

Teen Birth Rate Among Girls Aged 15-19, 2016

Birth rate per 1,000 teen girls, aged 15 -19
Less than 11 11 - 20.9 21 - 30.9 31 - 40.9 41 or higher
 

Teen Pregnancy Affects Educational Opportunity

High School Completion

Teen pregnancy and parenting contribute significantly to high school drop-out rates among teen girls. Thirty percent of teenage girls who drop out of high school cite pregnancy or parenthood as a primary reason. This rate is even higher for Hispanic and African-American teens, at nearly 40 percent. Only about half of women ages 20-29 who gave birth as a teen have a high school diploma, compared to 90 percent of women ages 20-29 who did not have a teen birth. And among those who have a baby before age 18, about 40 percent finish high school and fewer than 2 percent finish college by age 30.

Older Teens and Community College

Older teens (ages 18-to-19) are more than four times as likely to become parents than are younger teens (ages 15-to-17). Older teens account for about 70 percent of all teen births. In addition, the older teen birth rate is declining at a slower rate than the younger teen birth rate. Pregnancy among this age group can disrupt young people’s educational and career goals, as older teens are often finishing high school and entering the job market, or pursuing postsecondary education. Sixty-one percent of students who have a child after enrolling in community college fail to complete their degree. This dropout rate is 65 percent higher than for those who do not have children during community college. Nationally, unplanned births (including births to teenage students) result in nearly 1-in-10 dropouts by women from community college.   

Intergenerational Impact

Teen childbearing not only has the potential to affect the mother’s education, but has implications for children as well. Research shows that children of teen mothers often not only start school at a disadvantage, but they also fare worse than those born to older parents throughout their education. Compared to their peers, children born to teens perform worse on many measures of school readiness and are 50 percent more likely to repeat a grade. Children born to teen moms also often have lower school achievement and are more likely to drop out of high school, compared to children born to older parents.   

Economic Wellbeing and the Cycle of Poverty

Teen pregnancy is strongly linked to poverty, with low income level associated with higher teen birth rates. In addition, 63 percent of teen mothers receive public assistance within the first year of a child’s birth. Fifty-two percent of mothers on welfare had their first child in their teens.   

Low educational attainment among teen mothers affects their economic opportunities and earnings in later years. Teen mothers are less likely to complete high school or college, and are therefore less likely to find well-paying jobs. This is evident in the fact that in 2016, college graduates earned 56 percent more, on average, than workers with a high school diploma. The economic consequences of dropping out of school often contribute to the perpetual cycle of economic hardship and poverty that can span generations.

The vast majority of teen mothers are unmarried when giving birth, with about 9 percent marrying and 59 percent co-habiting by their child’s third birthday. Therefore, child support generally represents a vital income source for these single parent families, but most teen mothers do not receive any monetary support from the child’s father. Teen fathers often have limited educational attainment and earning potential, as well.    

Teen Pregnancy Among Youth in Foster Care

Teen pregnancy rates are much higher among teens in foster care than among the general population. Teen girls in foster care are about 2.5 times more likely to be pregnant at least once before they turn 19-years-old, compared to teens not in the system. Teens in foster care are also more likely to have a repeat pregnancy. Young men in foster care report having gotten someone pregnant at higher rates than young men not in the system: Fifty percent of men aging out of foster care at age 21 say that they have gotten someone pregnant, compared to 19 percent of young men not in foster care.      

Pregnancy among adolescents in foster care creates challenges and costs for the system, such as providing health care and housing for teen mothers and their children. Most youth in foster care are eligible for Medicaid, and states provide coverage through several pathways. Many teens “age out” of the system when they reach age 18 or 21, depending on the state. Teen parents transitioning out of foster care face significant challenges: Caring for their children, completing education and finding employment. And the cycle often continues. The children of teen mothers are more likely to be placed in foster care than their peers born to older parents.  

In response to foster youth’s higher risk of teen pregnancy, Power to Decide and the National Council of Juvenile and Family Court Judges developed a toolkit for judges interacting with foster youth. The toolkit includes judicial practice and bench tools to help judges support foster youth empowerment and teen pregnancy prevention efforts.   

State Policy Options

Because of the consequences of teen pregnancy for young women, families and states, helping young people prevent such pregnancies can improve economic opportunity and lead to significant public savings. State leaders may wish to consider the following policy options for preventing teen pregnancy. In addition, many of the strategies states have pursued to prevent unplanned pregnancy may also be of use in state teen pregnancy prevention efforts.   

  • Ensure access to information and services. Lack of relevant knowledge about how to prevent pregnancy, as well as lack of access to effective prevention services, may be barriers to preventing teen and unplanned pregnancy. Mississippi and Arkansas recently enacted innovative policies to address these challenges by requiring community colleges and public universities to develop a plan to address unplanned pregnancy among students on their campuses. The plans must address eight different areas, such as incorporating information on unplanned pregnancy into student orientation and courses, conducting public awareness campaigns and increasing student access to health services. Most of the details of how to address these areas are left up to the individual schools, and content may include information on both abstinence and contraception. Louisiana passed a similar law in 2017.
  • Integrate pregnancy planning and prevention into human services, education, workforce and other initiatives that support youth and youth families. For example, ensure that programs focused on supporting young parents, including home visiting programs, also focus on helping delay or space a subsequent pregnancy. In addition, ensure that young people transitioning out of foster care receive relevant information and health care to help them avoid an unplanned pregnancy. 
  • Examine your state’s sex education policy. All states are somehow involved in sex education for public school children. State policies vary, however, in particular requirements, such as around curriculum and parental involvement. Twenty-four states and the District of Columbia, for example, require public schools teach sex education. Eighteen states and D.C. require information on contraception be provided when sex education is taught, and 37 states mandate the provision of information on abstinence when sex education is taught. State leaders may examine these and other elements of sex education policy with the aim of developing programs to most effectively help students avoid teen pregnancy and sexually transmitted infections.  
  • Invest in evidence-based programs. Since 2010, the federal government has provided grants to support evidence-based teen pregnancy prevention programs through the Teen Pregnancy Prevention Program (TPP) and the Personal Responsibility Education Program (PREP). State leaders may look to the evidence-based policies and program models supported by the two initiatives as examples of effective interventions to address teen pregnancy in their communities. See the section below on Federal Funding for more information on TPP, PREP and additional federal grant funding. In addition, the U.S. Department of Health and Human Services’ Teen Pregnancy Prevention Evidence Review provides a database of programs identified through an independent systematic review as effective in reducing teen pregnancy, sexually transmitted infections and associated sexual risk behaviors.  
  • Focus efforts on groups with the greatest need. State leaders may wish to identify the disparities in teen pregnancy rates in their communities, in order to maximize scarce resources and ensure that efforts address groups most in need of services. For example, states may choose to focus programs or other efforts in rural regions, which often have higher teen birth rates than urban and suburban areas, or where there may be unique health care access challenges. States may also wish to focus on reducing racial and ethnic teen birth disparities. Despite recent declines, the birth rate for black and Hispanic teens is still more than twice the rate for white teens nationally, and more than four times greater in some states. The American Indian and Alaska Native teen birth rate remains about 60 percent higher than the white teen birth rate.      

Federal Funding

In October 2018, President Trump signed H.R. 6157, which includes $101 million for the Teen Pregnancy Prevention (TPP) Program, $6.8 million for evaluations of teen pregnancy prevention approaches, and $286.5 for the Title X Family Planning Program through September 30, 2019,The following outlines several of these federal funding streams, which are available for state leaders and organizations. Likewise, Power to Decide provides an overview of federal funding for preventing teen and unplanned pregnancy.     

Teen Pregnancy Prevention Program

Administered by the Office of Adolescent Health (OAH), the Teen Pregnancy Prevention Program (TPP) provides competitive grants to a wide range of agencies and organizations across the country to support the implementation of evidence-based teen pregnancy prevention programs and the development and evaluation of new and innovative approaches. 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 these strategies. Regardless of the project’s focus, each must have evidence of success and be medically accurate and age appropriate.

The program includes two “tiers.”

  • Tier 1 grants replicate teen pregnancy prevention programs that have been proven effective through rigorous evaluation and systematic review by OAH. Funded entities choose a program model based on community needs. Every program undergoes independent, systemic review to develop additional information on the model.
  • Tier 2 grants develop, replicate and refine new and innovative models to reduce teen pregnancy.

In the first cohort, from 2010-2015, TPP supported 102 grantees in 39 states and the District of Columbia, reaching about half a million youth. In the second round, initially set from 2015-2019, TPP funded 84 grantees. In July 2017, the U.S. Department of Health and Human Services notified grantees that projects would be shortened from five to three years, which would cut approximately $200 million in funding. In September 2017, the U.S. Senate Appropriations Committee passed a fiscal year 2018 appropriations bill in a bipartisan vote that included funding for TPP, among other programs. The bill provided $101 million for TPP, the same level of funding provided during fiscal year 2017.

Read more about TPP in NCSL’s LegisBrief, Evidence-Based Polices to Prevent Teen Pregnancy

Pregnancy Assistance Fund

The Office of Adolescent Health also administers the Pregnancy Assistance Fund, a $25 million competitive grant program that seeks to improve “health, educational, social and economic outcomes of expecting and parenting teens, women, fathers and their families.” Funds may be used to provide support services in settings such as high schools, institutions of higher education and community service centers. Funds may also be used for prevention and intervention services for pregnant women experiencing intimate partner violence. Pregnancy Assistance Fund grantees include states, territories, and tribal entities. Grantees may also establish partnerships with a range of stakeholders to provide these services.

OAH has funded several cohorts of grantees through the Pregnancy Assistance Fund. Currently, 22 states and one tribal entity receive funding through the program. The U.S. Department of Health and Human Services also recently shortened Pregnancy Assistance Fund grants to one year. 

Personal Responsibility Education Program 

Administered by the Administration on Children, Youth, and Families, the Personal Responsibility Education Program (PREP) provides grants to states for evidence-based programs that emphasize both abstinence and contraception to prevent teen pregnancy and sexually transmitted infections. The program supports youth at higher risk of teen pregnancy, including teens experiencing homelessness, living in foster care, or living in rural areas or other geographic areas with high teen birth rates. PREP also supports pregnant and parenting teens. For more information, Power to Decide provides an overview resource on PREP funding, as well as a resource on PREP funding serving youth in foster care.

The Personal Responsibility Education Program is funded at $75 million annually through fiscal year 2019. In addition to evidence-based programming on abstinence and contraception, PREP projects must also address at least three of the following topics: healthy relationships, positive adolescent development, financial literacy or parent-child communication skills. States may choose from 44 evidence-based program models reviewed by the U.S. Department of Health and Human Services.

PREP funds four types of grants, including formula grants to states and territories, or State PREP. All states and territories are eligible to apply for formula PREP grants to provide evidence-based teen pregnancy prevention programs. Forty-four states, the District of Columbia, American Samoa, the Marshall Islands and the Northern Mariana Islands chose to use their formula allotments in 2017. In addition, PREP funds competitive grants to states, territories, tribes and tribal organizations through CPREP and Tribal PREP. Finally, PREP also supports Personal Responsibility Education Innovative Strategies (PREIS) grants, which fund research and demonstration projects evaluating a broad range of strategies and promising new models to prevent teen pregnancy.  

Title V State Abstinence Education Grant Program

The Abstinence Education Grant Program provides funding to states and territories for abstinence education, and promotes abstinence to prevent teen pregnancy. This program provides formula grants to states and was renamed as Sexual Risk Avoidance Education Program. States may use funds for abstinence education, mentoring, counseling or adult-supervised activities to promote abstinence from sexual activity. While states are encouraged to use evidence-based programs and are required to address each point in the eight-point definition of abstinence education, individual states may determine how much emphasis to place on each point. Programs must be medically accurate and focus on youth with a higher risk of teen pregnancy, including homeless teens, teens of certain racial and ethnic backgrounds, those in foster care, or teens living in geographic areas with high teen birth rates.

In Fiscal Year 2016, funding for the Abstinence Education Grant Program was increased from $50 million to $75 million annually. Subsequently, the grant program awarded more than $60 million to 38 states and territories. The program requires that states fund at least 43 percent of abstinence education programs’ costs with non-federal resources. Current grantees include 37 states and two territories. Program funding extends through Fiscal Year 2019.

Sexual Risk Avoidance Education Program

The Sexual Risk Avoidance Education Program, administered through the Family and Youth Services Bureau, funds projects providing abstinence education as well as projects promoting healthy relationships and the prevention of poverty, dating violence, and teen drinking and illicit drug use. This is an existing discretionary funding program that provides competitive grants (distinct from the Abstinence Education Grant Program recently renamed Sexual Risk Avoidance Education Program, above). Grantees use a Positive Youth Development framework to promote risk avoidance among teens and teach how to voluntarily refrain from sexual activity before marriage. In Fiscal Year 2016, the program awarded $8.9 million in grant funds. The program awarded grants in 2017 totaling more than $13.4 million to 27 grantees in 14 states.

In March 2018, the President signed an omnibus spending bill that included funding for Sexual Risk Avoidance Education, among other programs. The bill provided $25 million to the program, a $10 million increase from previous funding levels.