Briefing Book

What Happened to Teen Pregnancy Prevention?

A Trump budget mystery.

By Robert Gordon

Tagged budgetHHSMedicaidoffice of management and budgetSNAPteen pregnancyTrump Administration

Mick Mulvaney is usually proud to make his case for domestic spending cuts, however destructive. So it is strange and perhaps telling that OMB buried its decision to kill the important Teen Pregnancy Prevention program. Although the cut is no rival to the devastation of Medicaid or SNAP, it is striking nonetheless.

Teen Pregnancy Prevention (TPP) was one of several evidence-based programs created in the second Bush and Obama administrations. It addresses a serious social problem with vast costs spanning generations. And it works. The decision to terminate the program was based on ideology rather than evidence. Yet the decision to hide its termination is somewhat of a mystery.

Like other evidence-based initiatives, the Teen Pregnancy Prevention program requires local initiatives to undergo evaluations and funds those with positive impacts. The Department of Health and Human Services (HHS) maintains a helpful website with the evaluation results. Programs typically include both the promotion of abstinence and explanations about contraception, but there is a lot of variation; TPP is designed around getting results, not using any one approach.

During the last budget fight, OMB proposed to cut, not kill, TPP. Instead, Congress ignored that proposal and provided $101 million, roughly the same as previous years. (See here, p. 401, under General Departmental Management.)

The new Trump budget kills TPP, without ever saying it. OMB’s volume entitled “Major Savings and Reforms” describes more than 100 cuts. Far smaller items receive a whole page, including the Susan Harwood training grants at the Occupational Safety and Health Administration (which are being cut by $11 million) and the Woodrow Wilson International Center for Scholars (-$4 million). There is nothing about the $100 million Teen Pregnancy Prevention cut. In OMB’s door-stopping budget appendix, the program just disappears from appropriations language. (See here, p. 468, also under General Departmental Management.) Precisely the same approach carries over into HHS’s “Budget in Brief,” the 104-page document which usually explains decisions of any consequence (here, p. 89).

It’s like the program never existed.

So to find out what happened, you have to dig into the congressional justifications, which are usually read only by Hill staff and lobbyists. Here we learn: “The Budget eliminates the TPP program. The teenage pregnancy rate has declined significantly over recent years, but it does not appear this program has been a major driver in that reduction.” That’s it.

This is an absurd rationale. While teen pregnancy rates have improved greatly, the problem is far from solved. Our teenage pregnancy rate is still 50 percent higher than that of England or Australia. Children of teen parents are two or three times likelier than children of parents at 20 or 21 to go to prison or grow up to be teen moms. TPP funds programs that often prove effective; 12 different models have been shown in evaluations to get results. Many more may well be working, but due to evaluation design, results are inconclusive. As for whether TPP caused teen pregnancy to define nationwide, it would be a very hard question to study seriously, and, to my knowledge, nobody has tried. But as many of us have said repeatedly now, absence of evidence is not evidence of absence.

Yet this small, effective program gets the axe. What really mattered? Look in the budget where Teen Pregnancy Prevention used to be. There, the Trump budget preserves an abstinence-only education program, described as follows:

This program supports an evidence-based approach defined as voluntarily refraining from non-marital sexual activity.

So, rather than maintaining a program that develops and uses actual evidence, the Trump Administration decrees what approach is evidence-based. And that approach, based on the best research available (conducted during the Bush Administration!), mostly does not work to reduce teen pregnancy.

If the decision to kill the TPP program is about ideology, why was the decision buried? Timing may be the answer. OMB’s budget volumes go to print weeks ahead of the budget’s rollout. Congressional justifications are finalized much later on. Probably somebody decided very late in the day that they really had to kill the evidence-based teen pregnancy prevention program.

We may never know for sure exactly what went on behind the scenes when this decision was made. But this much is certain: The Trump Administration is trying to eliminate a program that has helped scores of teens keep their lives on track. And, whatever the case, it is safe to assume, as with many parts of this budget proposal, that it had nothing at all to do with evidence.

Read more about budgetHHSMedicaidoffice of management and budgetSNAPteen pregnancyTrump Administration

Robert Gordon served as acting deputy director at the Office of Management and Budget under President Obama. The views expressed here are his own. Find him at @robertmgordon.

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