Feature

HHS eliminates funding for teen pregnancy prevention programs


 

The Trump administration’s sudden funding cut to the Teen Pregnancy Prevention Program will not only halt research and programming efforts at more than 80 institutions across the country, but also will likely unravel recent progress made in reducing teen pregnancies, physicians and program advocates say.

In early July, officials at the U.S. Department of Health & Human Services notified program grantees that the administration would be eliminating funding for the Teen Pregnancy Prevention Program (TPP Program) and that 5-year grants awarded under the Obama administration would be ending in June 2018, 2 years earlier than planned.

The TPP Program is a national, evidence-based initiative established in 2010 to fund medically accurate and age-appropriate programs that work to prevent teen pregnancy in the United States.

Dr. Anne-Marie E. Amies Oelschlager of the University of Washington, Seattle

Dr. Anne-Marie E. Amies Oelschlager

The abrupt funding withdrawal leaves many programs in limbo since they will be unable to complete their research without full funding, said Ann-Marie E. Amies Oelschlager, MD, a professor in the department of obstetrics and gynecology at the University of Washington, Seattle, who specializes in pediatric and adolescent gynecology.

“Those programs serve many youth across the country, so of course the individuals in the programs are going to be impacted,” Dr. Oelschlager said in an interview. “It’s demoralizing for the educators, [and] the researchers, who are looking at innovative methods, to have their funding cut in the middle of evaluating whether their programs are effective.”

An HHS spokeswoman confirmed that on July 1, the agency informed TPP Program grantees that funding for the program would be eliminated as detailed in President Trump’s fiscal 2018 budget proposal. The HHS awarded 81 continuations for TPP Program Tier 1 and Tier 2 grant awards for a total of $89 million through June 30, 2018, according to the spokeswoman. The HHS informed the grantees of their June 30, 2018, end date “to give them an opportunity to adjust their programs and plan for an orderly closeout,” she said.

The University of Southern California, Los Angeles, is one of many institutions impacted by the funding cut. The primary objectives of the Keeping it Real Together project are to implement evidence-based sexual health education programs for youth in middle and alternative high schools and provide an education program for parents of middle school–aged youth, said Luanne Rohrbach, PhD, associate professor of clinical preventive medicine at the university’s Institute for Health Promotion & Disease Prevention and principal investigator for the program.

Dr. Luanne Rohrbach of the University of Southern California, Los Angeles

Dr. Luanne Rohrbach

“We have spent the last 2 years providing training and developing structures within schools and wellness centers to facilitate program implementation,” Dr. Rohrbach said in an interview. “Our project plan calls for scaling up program implementation over a 5-year period to reach an increasing number of youth and parents. Obviously, with the cut in funding we will not be in a position to scale up our programs. Unless we are able to secure other resources to support and sustain what we have already started, it is likely that this programming will come to an end.”

Dr. Rohrbach said she anticipated pushback from the new administration as far as receiving the full 5-year funding, but the sudden program elimination was unexpected.

In March, when President Trump announced his budget priorities for fiscal 2016 and 2017, it was clear that the TPP Program was on the chopping block, Dr. Rohrbach said. However, when Congress passed a continuing resolution for the remainder of fiscal 2016 and 2017, the program remained intact. In his budget recommendations for fiscal 2017 and 2018, the President proposed that the TPP Program be eliminated.

“Despite this recommendation, it was our understanding that the program would be debated in Congress as they developed their recommendations for FY 2017-18 funding,” she said. “That is, we expected there would at least be discussion about it in Congressional budget committees. We did not expect that the program would be eliminated by the Office of the Secretary of HHS.”

Haywood L. Brown, MD, president of the American Congress of Obstetricians and Gynecologists (ACOG) called the administration’s decision “highly unusual” and said it is a step backward for ensuring healthy moms and healthy babies.

“This program and others provide vital research and programming that successfully brought our nation to an all-time low rate of teen pregnancies – progress we cannot afford to jeopardize,” Dr. Brown said in a statement.

Federal data show that the teen pregnancy rate has steadily declined over the last decade. In 2015, the birth rate for girls and young women aged 15-19 years fell by nearly 8% from 2014, according to data from the National Center for Health Statistics. Since 1991, the rate has fallen by 64%. The rate for the younger half of the age group, girls aged 15-17 years, was down 9% from 2014.

Researchers attribute the decline to a combination of economic, cultural, and social factors, as well as a lower prevalence of sexual activity among youth, the use of more effective contraception, and the provision of more information about pregnancy prevention, Dr. Rohrbach said.

“The [TPP Program] has been focused on implementation of evidence-based, comprehensive sexual health education,” she said. “Elimination of these efforts endangers the progress that has been made in reducing teen pregnancies.”

Dr. Oelschlager noted that between 2008 and 2015, the teen birth rate in King County, Washington, declined by 55%. She attributed the reduction to multiple drivers, including a program called Flash, that incorporates a sexual health education curriculum in Seattle-area public schools. Some TPP programs in Northwest Seattle are using the FLASH curriculum, she said.

“This is a very comprehensive program, which includes discussion about reproductive health, sexual violence, prevention of teen pregnancy, sexually transmitted infections, [and] harm reduction,” she said. “That’s been a very effective method of educating our teens about these issues.”

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