A few weeks ago, the Trump Administration suddenly killed a modest federal program, the Teenage Pregnancy Prevention program. The Department of Health and Human Services (HHS) summarily ended grants to hospitals, schools, and community groups after only three years of work, leaving service delivery and evaluation efforts in limbo.
While first appearing to be just another skirmish in the culture wars, ending the program fits within the Administration’s larger efforts to devalue science, data, and evidence. Aside from causing harm by ending effective services, the Administration is quashing any faint hope that the Federal government can learn what programs work in order to solve persistent social challenges.
Conservative and progressive policy makers agree that bearing a child while a teenager harms the life chances of parent and child. But progressives and conservatives disagree on what to do. Conservatives argue for an emphasis on family values, abstinence, and marriage. Progressives add a role for education about sexuality and healthy decision making as well as access to contraception.
Despite these disagreements, teenage pregnancy and birth rates have plummeted. Births to teenage parents peaked in 1991 at 61.8 births/1,000 women ages 15-19, with the current rate 22.3 births per 1,000 women in this age group in 2015. The rate of teenage pregnancy also peaked in 1991. Disparities between Black and White and between Hispanic and White teenage birth rates have also narrowed.
But the problem remains significant. Teenage pregnancy and birthrates rates in the US remain substantially higher than in other developed nations. Rates of births to Black and Hispanic teens remain roughly twice the rate among Whites. But how to best make further progress and choose policies based on what actually works is where the Teenage Pregnancy Prevention program comes in.
The program was one of the Obama Administration’s signature evidence-based initiatives. Together with the Maternal and Child Health Home Visiting program and others, it embraced a rigorous and transparent evidence review process to select which programs to fund. These federal initiatives allocate three quarters of their dollars to approaches supported by high-quality experimental data. For the Teenage Pregnancy Prevention Program, these “evidence-based” programs include Cuidate!, Reducing the Risk, and Safer Sex, among others. The remaining funds go to promising but not yet proven interventions such as the Haitian American Responsible Teen and the Alaska Promoting Health Among Teens programs. All recipients receiving funds must participate in ongoing evaluations. Based on these evaluations, several programs, such as the Teen Options to Prevent Pregnancy Program, developed sufficient evidence to become “tier one” programs.
In his monograph on the Obama Administration’s evidence-based approach to social policy, conservative social policy expert Ron Haskins indicated that many progressive advocates preferred the Obama Administration simply fund comprehensive sex education and contraception. Yet the Administration stuck to the strategy of relying on data because they believed this would lead to more effective use of government resources and ultimately better address social needs.
I served as Deputy Assistant Secretary for Human Services Policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in HHS in 2015-2016. ASPE was established in the 1960’s as the in-house policy think tank for the Department. The unique value it brings into policy discussions is marshaling data and evidence. ASPE’s Human Services Policy office provided oversight for the Teenage Pregnancy Prevention program’s evidence review. This review identified which programs were eligible to receive funding. The office also supervised the ongoing evaluations.
Early in my tenure, career staff—who strongly supported the use of rigorous evidence in decision making—checked in with me on my views about whether we could include an abstinence-based program among those eligible for funding. My response was clear: if it met the evidence criteria previously established, we should include it. Relieved, but cognizant of my political naïveté, career staff double checked, noting that Democratic Administrations traditionally aren’t supportive of abstinence-based approaches while Republican ones are. Nonetheless, as a doctor and public health researcher, I felt we needed to embrace programs if high-quality evidence indicated they led to improved outcomes. As a member of the Obama Administration, I also believed our credibility depended on transparency and consistency in how we used data and evidence to make decisions. Three of the current evidence-based programs are oriented to abstinence education.
For a brief moment in time, this focus on evidence appeared to be gaining bipartisan traction. For example, late in the Obama Administration, Congress passed and President Obama signed the Evidence-Based Policy Commission Act that would seek to ease access to federal data sources to allow more rapid and lower cost evaluations.
But this brief moment has passed. In killing the Teenage Pregnancy Prevention program, the Trump Administration and Republicans in Congress—who have also repeatedly cut the program’s funding—have demonstrated that not only are they indifferent to the personal consequences that follow when effective government supported programs are cut. They are hostile to the use of data and evidence to inform policy intended to improve the well-being of all Americans. Sadly, social policy isn’t insulated from this far-reaching war on science.
Editor’s Note: This article has been updated to more accurately reflect the role of federal career staff vis-a-vis evidence-based policy.