Tuesday, August 22, 2017

"America First" and teen pregnancy

For once, America is already first, although that's not a matter of pride. Despite having declined over time, the U.S. continues to suffer from the highest teen pregnancy rate in the developed world, close to 80% of those unplanned — and of those, three quarters winding up in abortion, and one quarter in birth.

Unplanned pregnancies, teen pregnancies in particular, exact a high cost both on society and the individual mothers and children. Teen mothers are more likely to never finish high school. Teen mothers are more likely to live in poverty. Children of teen mothers are more likely to under-perform in school and to be incarcerated. The list goes on.

Preventing teen pregnancy: social cost, lives impacted, abortions — a moral issue to "pro-life" advocates, should be a cause we can all unite on. Fully one quarter of all women under 20 become pregnant. But the Trump administration and Health and Human Services under Tom Price are attempting to deliver a death blow to scientifically supported teen sex awareness and pregnancy prevention.

Teen pregnancy prevention program eliminated

The Obama Administration launched its Teen Pregnancy Prevention Initiative in 2010. Per the Guttmacher Institute: "The $114.5 million teen pregnancy prevention initiative signed into law by President Obama in December 2009 marks a major turning point in U.S. sex education policy, according to a new analysis published in the Winter 2010 issue of the Guttmacher Policy Review. The initiative replaces many of the most rigid and ineffective abstinence-only programs, which by law were required to have nonmarital abstinence promotion as their 'exclusive purpose' and were prohibited from discussing the benefits of contraception."

Last month, the Department of Health and Human Services’ Office of Adolescent Health terminated President Obama's teen pregnancy prevention (TPP) program, which had awarded grants to identify scientifically validated ways to assist teenagers in avoiding unwanted pregnancies. The cut eliminated over $200 million which funded programs and research currently in progress at more than 80 organizations, including world-renowned institutions such as Children’s Hospital of Los Angeles and Johns Hopkins University. The cut also immediately terminated a separate $2.9 million multi-institution consortium grant after the first year of its five-year research program. Several terminated grantees were told the decision was made by Valerie Huber, chief of staff of the Office of the Assistant Secretary for Health. Huber is a Trump appointee who promotes abstinence and opposes sex education. The proposed 2018 HHS budget funds only abstinence education. See the "Extend Abstinence Education and Personal Responsibility Education Program" line item, page 34, in the 2018 budget. The abstinence-only-until-marriage ("AOUM") “Sexual Risk Avoidance Education” program was created by Congress in fiscal year 2016, and is defined as “voluntarily refraining from nonmarital sexual activity” and teaching the “benefits associated with self-regulation.”

The notion that abstinence is the only moral and viable solution to preventing teen pregnancy has been proven ineffective over and over again. In fact, teen pregnancy rates go up in states which offer AOUM-only programs. Even if the Trump administration's (reported) intent is to promote abstinence-only programs, victims of this cut include University of Southern California’s workshops for teaching parents how to talk to middle school kids about delaying sexual activity.[1]

Public health is not a political issue

The somewhat good news is that figures from the CDC indicate the rate of teen pregnancies has been in steady decline. Nevertheless, as we noted, we still lead all industrialized nations:

at CDC web site[2]

We quote the CDC's argument for pregnancy prevention:

Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.

  • In 2010, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.
  • Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school.
  • The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.

These effects continue for the teen mother and her child even after adjusting for those factors that increased the teenager’s risk for pregnancy, such as growing up in poverty, having parents with low levels of education, growing up in a single-parent family, and having poor performance in school.[3]

We don't have far to look for factors negatively impacting teen pregnancy. Oklahoma, for one, has among the highest teen pregnancy rates, exceeded only by Louisiana, Arkansas, Mississippi, and New Mexico:

"I think teen pregnancy will always be a issue ... because we do not have a comprehensive health education system," said Paul Patrick, administrative program manager for Maternal and Child Care Services at the {Oklahoma S]tate Health Department.[5]

Regardless of age, informed awareness is the best guarantor of responsible sex practices, whether preventing unwanted pregnancies or the transmission of HIV and other STDs.

Quoting from a position paper by The Society for Adolescent Health and Medicine published in the Journal of Adolescent Health[6], our emphasis:

  • United States government programs promoting abstinence-only-until-marriage are ethically flawed, are not evidence based, and interfere with fundamental human rights to complete and accurate health information. U.S. federal funding for such programs should be eliminated and Title V, Section 510(b) of the Social Security Act, including subsections AeH, should be repealed. Current funding for abstinence-only-until-marriage programs should be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.
  • “Abstinence-only-until-marriage” as a basis for adolescent health policy and programs should be abandoned.

Political dogma and personal belief systems[7] are no substitute for scientific behavioral and statistical research directed toward identifying the most effective means for preventing teen pregnancies, whether promoting awareness and education or supporting and facilitating safe sexual practices — which include but are not limited to abstinence.

Put in simple economic terms: while roughly half of teens abstain from sex, ignoring the other sexually active half is simply sticking our heads in the sand. Spending $200 million to prevent a $10 billion a year problem was a prudent investment. Instead, the Trump administration has cut teen pregnancy prevention research and programs, meanwhile proposing to fund over half a billion dollars of ineffective, harmful, abstinence-only-until-marriage programs through 2027.[8] This is an egregious failure in public health policy on the part of both the administration and Congress.

FAILS Working America

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[1]More details on the cuts and reactions from researchers is available in this Huffington Post article: Trump Administration Suddenly Pulls Plug On Teen Pregnancy Programs, Huffington Post, 14 July 2017.
[2],[3]About Teen Pregnancy, Teen Pregnancy in the United States, CDC. LINK
[5]Oklahoma teen pregnancy still one of highest in nation, The Oklahoman, 6 August 2017. LINK
[6]Abstinence-Only-Until-Marriage Policies and Programs: An Updated Position Paper of the Society for Adolescent Health and Medicine. LINK
[7]Mores are changing, for example, most young Republicans are in favor of birth control. Young Republicans, Birth Control, and Public Policy at The National Campaign to Prevent Teen and Unplanned Pregnancy (2015).
[8]The budget figures are $271 million 2018-2022, and $277 million 2018-2027.

Updated: September, 2017

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