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Updated May 13, 2020


Federal Teen Pregnancy Prevention Programs


The U.S. teen birth rate-or the number of births per 1,000
females aged 15 to 19 each year-has steadily declined
since the early 1990s. The rate decreased by 72% from the
most recent high of 61.8 (in 1991) to the most recent low of
17.4 (in 2018, the most recent data available). Researchers
suggest that multiple factors have influenced this decline,
and that there is not necessarily a definitive single reason
for it. Such factors may include decreasing teen sexual
activity, particularly among younger teens, and increasing
use of contraceptives among sexually active teens.
Despite the downward trend in births among teenagers,
Congress continues to be interested in the issue of teen birth
because of its high costs. Teen parents tend to have less
education and are more likely to live in poverty than peers
who are not teen parents. Children of teenage mothers are
more likely to have poorer educational and other outcomes
than children of mothers who delay childbearing. Teen
childbearing can have larger societal impacts, such as costs
related to public sector health care and lost tax revenue. In
addition, teen pregnancy disproportionately affects certain
racial and ethnic groups and selected states and territories.
Figure 1 shows a map with teen births rates by quartile for
the 50 states, Washington, DC, and three of the territories in
2018. The highest rates were in 10 states, mostly in the
South and Appalachia; Guam; and the Northern Marianas.

Figure I. Teen Birth Rates by State & Territory, 2018


Source: Congressional Research Service (CRS), based on data from
the Centers for Disease Control and Prevention (CDC).
Notes: Birth rates are per 1,000 females aged 15 to 19.
Multiple HHS agencies established the Teen Pregnancy
Prevention Evidence Review pursuant to the FY2010
omnibus appropriations law (P.L. 111-117). The review
was active from 2010 to 2017, and used criteria to
determine which education models have been shown,
through rigorous evaluation, to reduce teen pregnancy and
related outcomes. HHS encouraged or required grantees for
some teen pregnancy prevention programs to use these
models.


Teen reg  r -c
Congress has authorized programs that provide educational
curricula and social supports aimed at helping youth make
decisions that will ultimately delay early pregnancy and
parenting. Four federal programs focus exclusively on teen
pregnancy prevention education: (1) the Teen Pregnancy
Prevention (TPP) program; (2) the Personal Responsibility
Education Program (PREP); (3) the Title V Sexual Risk
Avoidance Education program, authorized under Title V of
the Social Security Act; and (4) the Sexual Risk Avoidance
Education program, authorized under appropriations laws.
The U.S. Department of Health and Human Services (HHS)
administers the four programs, which generally target
vulnerable teen populations. Youth receive teen pregnancy
prevention education in school and other settings. Grantees
for the four programs include states and/or other entities.

Tee,, Preg,,an,,y Preve, n{io - (TPP) P °-, ,,gra, ,m
P.L. 111-117 established and initially funded the TPP
program, and subsequent appropriations laws have provided
funding through FY2020. The program competitively
awards grants to public and private entities to implement a
variety of evidence-based or innovative models that seek to
influence adolescent sexual behavior. 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 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
meet HHS' research standards, or for other reasons.


The Patient Protection and Affordable Care Act (ACA; P.L.
111-148) established PREP under Section 513 (Title V) of
the Social Security Act. The program is a broad approach to
teen pregnancy prevention that seeks to educate adolescents
aged 10 to 20 and pregnant and parenting youth under age
21 on both abstinence and/or contraceptives to prevent
pregnancy and sexually transmitted infections (STIs). PREP
includes four types of grants: (1) State PREP grants, (2)
Competitive PREP grants, (3) Tribal PREP, and (4) PREP


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