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Trump Administration Abruptly Cuts Funding to Teen Pregnancy Prevention Programs

Some of the junior high students in Travis County, Texas, break into nervous laughter at the mere mention of sex. Some shyly ask questions.

But most fall silent when Julie Maciel, a health educator, tells them how terrifying it is to become pregnant as a teenager.

Maciel, of Austin, had her daughter when she was only 17. The unplanned pregnancy was largely due to a lack of sex education in schools, she says — something she's determined to change.

"It's not just about sex ed. It's about making decisions about what they want to do in the future. They keep in mind, should I have a baby now, or will that delay my dreams?" said now 21-year-old Maciel, who works for EngenderHealth, a non-profit that depends on federal funding to reach at-risk teens who wouldn't otherwise have sex ed in school — funding that is now at risk due to deep cuts made by the Trump administration.

Maciel's work is desperately needed in Texas, which has the fifth-highest teen pregnancy rate in the United States along with the nation's highest repeat teen pregnancy rate, according to the CDC.

Image: A teenager has birth control options explained to her by a social worker
A teenager has birth control options explained to her at the Children's Hospital Colorado's Colorado Adolescent Maternity Program. Marc Piscotty / The Washington Post via Getty Images

But the Lone Star state, like the rest of the country, has experienced a marked drop in teen pregnancies. Last year, teenage births hit a record low in the United States; rates plummeted the most for black and Latina teens, the CDC found, although they're still up to three times as likely as their white counterparts to give birth.

Many hail an evidence-based, Obama-era federal grant program as the biggest driver behind the dip. Started in 2010, the Teen Pregnancy Prevention Program gives $89 million a year to 81 organizations across the United States, including EngenderHealth.

It was renewed in 2015 for another five years.

That's why it was so surprising to Maciel and others when, tucked away in a letter from the Department of Health and Human Services dated July 3, bad news arrived: The Trump administration had slashed more than $200 million from the program without warning — meaning funding would now end in June 2018, not in 2020.

The abrupt funding cut to teen pregnancy prevention, at a time when teenage births are at historic lows, has been called "highly unusual" by Senate Health Committee Democrats, especially since Congress hasn't even voted on the 2018 appropriations bill yet. Legislators have until Sept. 30 to figure out the budget, although they could do a short-term continuing resolution and end up voting in December.

Related: Teen Birth Rates Plummet Among Blacks, Latinas: CDC

"I've worked at the Health Department for 10 years, and I've worked in international health for 20 years prior, and I've never seen anything like this," said Rebecca Dineen, Baltimore's Assistant Commissioner for Maternal and Child Health, which benefits from the grants. "It really was just this notification that your funds are ending."

Dineen fears it could be catastrophic for Baltimore, where teen pregnancy rates have dropped by a third but are still double the rest of the state of Maryland's and significantly higher than the national average. The city stands to lose $3.5 million, which Dineen said will affect 100 schools and about 20,000 students.

"What we're doing is evidence-based work. We have made a 44 percent decrease in teen pregnancy in Baltimore city," she said. "For us to be in such a position of success, to be very strategic in our work and then to have something like this happen, is very surprising."

The Department of Health and Human Services said the grants "were subject to a rigorous evaluation" and said there was "very weak evidence of positive impact of these programs" in contrast to "promised results."

It cited "negative or no impact on the behavior" of teens in 73 percent of evaluation results for 37 of the projects.

That's baffling to Bill Albert, spokesman at the National Campaign to Prevent Teen and Unplanned Pregnancy in Washington, D.C., who pointed out that the teenage birth rate has declined 41 percent since 2010.

"It would be fanciful to suggest that this program alone is responsible for that 41 percent decline, but it would be nonsensical to not believe that it hasn't had a profound effect," he said.

Albert said he suspects Trump's new hires at the HHS — Valerie Huber, an outspoken abstinence education advocate who was recently named chief of staff to the assistant secretary for health, plus social conservative HHS Secretary Tom Price — could be behind the cuts.

"Maybe they don't like the content of the program," he said. "They care more about telling kids to say 'no' rather than supporting programs that help teenagers."

The data cited by HHS doesn't tell the whole story, said Susan Zief, a senior researcher at Mathematica Policy Research, which was commissioned to evaluate some of the projects by the government.

"The evidence shows that these programs are showing promising results on a range of outcomes," she said. But, she said, some programs might have only had positive outcomes on at least one of the program goals: for example, knowledge about pregnancy and STDs, or attitudes toward using contraceptives.

While that may not necessarily have an impact now, that type of positive outcome is important "to influencing subsequent sexual behaviors," she added, noting that longer term research is needed.

In the meantime, health commissioners from 20 large cities have written to Price, pleading for a change of heart.

"Cutting TPPP funding and shortening the project period will not only reverse historic gains made in the U.S. in reducing teen pregnancy rates, but also make it difficult to truly understand what practices are most effective in our communities across the nation," the letter, from the Big Cities Health Coalition, read.

Senate Democrats wrote a letter, too, calling the move "short-sighted." They also praised the teen pregnancy prevention program as a "pioneering example of evidence-based policymaking."

"Despite these successes, HHS has apparently elected to eliminate the final two years of TPP Program grants without cause or a rationale for the termination," they wrote.

in the meantime, grantees are scrambling to see if they can make up for the loss of funding. In Baltimore, officials are "looking in all directions" to recoup their losses, said Dineen. And they're hoping that if funds are appropriated back to the program, that they aren't designated for abstinence-only education.

"I think that would be unfortunate," she said. "Abstinence-only funding can be helpful for our elementary school grades, but there's no evidence around abstinence education in middle and high school years."