ADVOCATES FOR YOUTH

Executive Summary Trends in Teenage Pregnancy & Childbearing Methodology Estimates of Federal Expenditures Estimates of Federal Investments Conclusion & Recommendations Endnotes Appendix A: Percent Change in Teen Birth Rate Appendix B: Expenditures & Investments Cost Formulas Appendix C: Key Differences Between AFDC & TANF Order Information

Teenage Pregnancy, The Case for Prevention [PDF]

Estimates of Federal Investments

Teen Pregnancy Prevention

Advocates for Youth calculated the total fiscal year 1996 federal investments by adding up the costs of resources allocated to those pregnancy prevention programs that specifically include adolescents as a target audience. Both primary and secondary teenage pregnancy prevention programs were included in the investment calculation. The various programs included in the investment calculation are discussed below.

In fiscal year 1996, the federal government invested over $440 million ($440,140,498) of the total Medicaid appropriations to provide family planning services to women of reproductive age (15 to 44-years-old). Sixteen percent of clients for Medicaid family planning services are young people ages 15 to 20. The federal government, therefore, invested nearly $71.1 million ($71,083,971) to provide family planning services for young people.

Program Description. Title XIX of the Social Security Act (Medicaid) is an entitlement program that pays for medical assistance for vulnerable and needy individuals and families with low incomes and few resources. Medicaid is the largest source of funding for medical and health-related services for the United States' poorest people. In fiscal year 1996, Medicaid provided health care assistance to more than 36 million people.²⁸

The Health Care Financing Administration, established under the U.S. Department of Health and Human Services), administers grants to the states to administer Medicaid benefits. The Medicaid program allows the states considerable flexibility within their Medicaid plans. However, the federal government requires states to provide basic services—such as general health care, prenatal care, vaccines for children, and family planning services and devices—to categorically needy populations. Groups eligible to receive Medicaid coverage include: recipients of Aid to Families and Dependent Children and Supplemental Security Income as well as pregnant women and children under age six whose family income is at or below 133 percent of the federal poverty level. Under the states' Child Health Insurance Program (CHIP), by the year 2002 all children will be covered who are under age 19 in families with incomes at or below the federal poverty level.²⁸

In fiscal year 1996, a portion of the Healthy Schools, Healthy Communities program's total budget of $4.25 million ($4,250,000) was dedicated to providing health education on topics such as communication and decision-making skills as well as pregnancy and STD prevention. Advocates for Youth included only funds dedicated to health education in the investment calculation. The federal government, therefore, invested approximately $1.3 million ($1,300,000), or about 30 percent, of the total Healthy Schools, Healthy Communities budget on teen pregnancy prevention initiatives.

Program Description. In 1994, Congress established Healthy Schools, Healthy Communities (HSHC), the first federal program that specifically mandates the creation of school-based health centers. HSHC is administered federally by the Bureau of Primary Health Care (BPHC), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services. HSHC provides school-based, family-centered, primary care services, including diagnosis and treatment of acute and chronic illnesses, preventive health, and dental and mental health services. In fiscal year 1996, HSHC funded 26 projects in 20 states and serving approximately 23,000 students. Each of the 26 sites was permitted to use as much as $60,000 of its funding to provide health education.³⁸

In fiscal year 1996, the federal government invested over $0.9 million ($921,945) to address Objective 5.1 of Healthy People 2000: to reduce pregnancies among females ages 17 and younger. The Preventive Health and Health Services Block Grant provided $359,479 in funds for Objective 5.1 while the remaining $562,466 in funds came from other sources.

Program Description. The Centers for Disease Control and Prevention (CDC) operates one major program specifically to reduce teen pregnancy, the Preventive Health and Health Services Block Grant (Public Law 102-051). The block grant is given to 61 projects to address the Health Status Objectives in Healthy People 2000, the federal government's blueprint for raising Americans' health status through an organized focus on prevention. Objective 5.1 of Healthy People 2000 specifies reducing pregnancies among 15- to 17-year-old females to no more than 50 per 1,000.³⁹

In fiscal year 1996, the federal government invested $0.2 million ($200,000) in teen pregnancy prevention via the Community Health Center (CHC) Program. Five CHCs participated in the Guidelines for Adolescent Prevention Services (GAPS) program. They provided teen clients at 11 sites with health education and guidance on various issues, including teen pregnancy prevention. Federal funds for evaluation of the Community Health Centers' GAPS program are also included in the investment calculation.

Program Description. The Community Health Center (CHC) Program is a federal grant program funded under Section 330 of the Public Health Service Act to provide for primary and preventive health care services for medically under served people in rural and urban U.S. communities. In fiscal year 1996, the community and migrant health center appropriation was consolidated to include homeless and housing programs. Funding for CHCs was approximately 85 percent of the consolidated appropriations—$758.1 million—in fiscal year 1996. CHCs exist in areas where economic, geographic, or cultural barriers limit access to primary health care for a substantial portion of the population. While services in each CHC are tailored to the needs of the community, most seek to improve access to comprehensive services for migrant and seasonal farm workers, people infected with HIV/AIDS, the elderly, the homeless, and substance abusers.⁴⁰

Under a three-year pilot project, five CHCs implemented Guidelines for Adolescent Preventive Services (GAPS) to increase teens' access to services and to prevent teen pregnancy. GAPS is the American Medical Association's set of recommendations that describes the content and delivery of comprehensive clinical preventive services for people ages 11 to 21, a population which is traditionally hard to reach. GAPS is unique because it emphasizes health guidance, which encompasses health education, health counseling, and anticipatory guidance.⁴¹

In fiscal year 1996, the federal government invested nearly $3.3 million ($3,250,000) in the Community Coalition Partnership Program for the Prevention of Teen Pregnancy. Each of the 13 communities received a grant of approximately $250,000 to organize their resources to support effective and sustainable teen pregnancy prevention programs.

Program Description. The Community Coalition Partnership Program for the Prevention of Teen Pregnancy (CCPPPTP) is a competitive, five-year program federally administered by the Centers for Disease Control and Prevention (CDC). CDC launched the program in 1995 by awarding grants in 11 states to 13 communities with high rates of teen pregnancy. CDC awarded each community about $250,000 per year for the first two years. The funds were used to strengthen existing community-wide coalitions and to develop action plans. The second phase began in fiscal year 1997, with a total of $13.7 million to help the 13 community coalition partnership programs implement their action plans and later evaluate their impact.

In fiscal year 1996, the federal government invested nearly $0.2 billion ($192,592,000) in the National Family Planning Program (Title X). About 30 percent of the population served by Title X family planning clinics were under the age of 20. The federal government, therefore, invested over $57 million ($57,777,600) to provide family planning services for young people.

Program Description. The National Family Planning Program, created in 1970 as Title X of the Public Health Service Act, is a categorical grant program that provides funding for comprehensive family planning services. The program is administered by the Office of Family Planning within the Office of Population Affairs, U.S. Department of Health and Human Services.⁴²

Title X family planning service funds are allocated to 10 regional offices of the Department of Health and Human Services which solicit applications, manage a competitive review process, award grants, and monitor program performance. Grantees include states, family planning councils, and Planned Parenthood affiliates, among others. Nearly two-thirds of Title X service funds are awarded to state health departments.⁴²

In fiscal year 1996, the federal government invested slightly over $1.0 million ($1,012,500) via the Maternal and Child Health Services Block Grant to support teen pregnancy prevention initiatives.

Program Description. The Title V of the Social Security Act establishes the Maternal and Child Health Services Block Grant, the basic authorizing legislation for the Maternal and Child Health Bureau (MCHB). Title V is a federal/state partnership that supports and develops community-based programs to improve the health of mothers and children, ensure quality health care for families, and create safe and healthy communities.³² The fiscal year 1996 appropriation for the Maternal and Child Health Block Grant was over $678 million ($678,204,000).

Eighty-five percent of the block grant passes directly to the states and 15 percent is reserved for the Maternal and Child Health Bureau to operate federal projects, such as Special Projects of Regional and National Significance (SPRANS), Community Integrated Service System (CISS), and Healthy Tomorrows Partnership for Children Program. MCHB jointly funded 147 demonstration projects with the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration, under the Pregnant and Postpartum Women and their Infants initiative.

Special Projects of Regional and National Significance (SPRANS) is a set-aside federal program to which approximately 15 percent of the Title V funds are allocated. Five categories of projects: (1) applied research; (2) training; (3) genetic disease testing, counseling, and information dissemination; (4) hemophilia diagnostic and treatment centers; and (5) maternal and child health improvement projects (MCHIPs). MCHIPs cover a range of activities and support the demonstration of innovative services and new techniques for the delivery of services. Several SPRANS programs address teen pregnancy prevention and services for pregnant and parenting teens.³³

The Community Integrated Service System (CISS) program seeks to reduce infant mortality and improve the health of mothers and children, including those living in rural areas and those with special health needs. CISS supports projects to develop and expand integrated services at the community level. These systems are public/private partnerships of health-related and other organizations and individuals. The partnerships collaborate in using community resources to address community-identified health problems.³⁴

The CISS program was authorized by the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) as a separate set-aside federal program of the Maternal and Child Health Services Block Grant (Title V of the Social Security Act). It did not become operational, however, until fiscal year 1992 when the total MCH Services Block Grant appropriation exceeded $600 million for the first time. Under OBRA 89, 12 ¾ percent of the appropriated amount above $600 million is earmarked for CISS projects. CISS program funds may be used to support teen pregnancy prevention programs.³⁴

Healthy Tomorrows Partnership for Children Program (HTPCP) is a collaborative effort of the federal MCHB and the American Academy of Pediatrics. HTPCP aims to ensure access to quality health care for all children and pregnant women by promoting innovative, community-based, child health care projects. Of the 54 HTPCP projects funded in fiscal year 1996, 14 focus on improving the health status of adolescents. Community projects may offer primary or secondary pregnancy prevention programs and/or provide services to support families begun with a birth to a teen.³⁵

Center for Substance Abuse Prevention's (CSAP) provides leadership in the federal effort to prevent alcohol, tobacco, and illicit drug use problems which are also linked to other national problems such as teen pregnancy. CSAP connects people and resources to innovative ideas and strategies and encourages efforts to reduce and eliminate alcohol, tobacco, and illicit drug use problems in the United States and internationally. In a joint initiative with the MCHB, CSAP funds 147 demonstration projects. Teen parents are the target populations of several CSAP/MCHB programs. Advocates for Youth includes the federal funds for CSAP/MCHB programs in the expenditure calculation.³⁶

In fiscal year 1996, one-third of the Adolescent Family Life Program's total budget ($7,698,000) was dedicated to teen pregnancy prevention initiatives. Advocates for Youth calculated that the federal government invested over $2.5 million ($2,540,340) in teen pregnancy prevention through the Adolescent Family Life Program.

Program Description. The Adolescent Family Life (AFL) Program was enacted in 1981 as Title XX of the Public Health Service Act. AFL is administered by the Office of Adolescent Pregnancy Prevention in the U.S. Department of Health and Human Services. Funding for AFL is divided between pregnancy prevention initiatives and care programs for pregnant and parenting teens. AFL programs focus on developing and promoting abstinence-only programs and helping teens avoid sexual intercourse. In fiscal year 1996, the AFL program funded 17 projects in 14 states. Advocates for Youth included only those programs that focus on teen pregnancy prevention initiatives in the investment calculation.³⁷

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††† Columns may not total due to rounding.

Source/Citation:
Feijoo AN. Teenage Pregnancy, the Case for Prevention: An Updated Analysis of Recent Trends & Federal Expenditures Associated with Teenage Pregnancy. Washington, DC: Advocates for Youth, 1999.

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