Statement of the Hon. Bobby P. Jindal, Assistant Secretary for Planning and Evaluation,
U.S. Department of Health and Human Services

Testimony Before the Subcommittee on Human Resources
of the House Committee on Ways and Means

Hearing on Teen Pregnancy Prevention

November 15, 2001

Mr. Chairman and members of the Subcommittee, thank you for inviting me to come today to discuss the Department’s teen pregnancy prevention activities since the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. This welfare reform law highlighted the importance of addressing teen pregnancy prevention by recognizing the negative consequences of out-of-wedlock births, particularly for teens. We know from the research that more than 80 percent of teens age 17 and younger who become parents ultimately require public assistance. Teen mothers face challenges when they become parents too early because they often drop out of school, have few skills to prepare them for work, have low rates of marriage, and are not adequately supported by the fathers of their children. The children born to unmarried teen mothers are at higher risk of having low-birth weights, have problems in their cognitive development and in school achievement, and are more vulnerable to child abuse. These children are also more likely to become teen parents themselves and to require public assistance as young adults.

In response to these findings, the 1996 welfare reform law required the Department to establish a National Strategy to Prevent Teen Pregnancy. The Department’s three annual reports to the Congress provide descriptions of our programs, technical assistance, research, evaluation, and surveillance activities we conduct to address this issue. The law also required the Department to ensure that at least 25 percent of communities have teen pregnancy prevention efforts. I am happy to report that in 2001, the Department is supporting such efforts in at least 47 percent of America’s communities. This a conservative estimate because it does not include activities funded under block grant programs to States for which data are not readily available.

I will shortly highlight some of the major activities taken by the Department to prevent teen pregnancies and especially to encourage adolescents to remain abstinent. But first, let me briefly describe the latest trends in teen births and pregnancies.

Teen birth rates have been steadily declining, according to the latest data compiled from the Department’s National Center for Health Statistics. The overall birth rate for teenagers declined by 22 percent from 1991 to 2000, and is currently at its lowest level ever.

However, we should be clear–the U.S. teen birth rate is still too high, and it is considerably higher than rates for other developed countries. The U.S. rate in 2000 was 48.7 births per 1,000 teens. This compares to rates under 30 births per 1,000 teens in nearly all the other developed countries reported by CDC, and rates fewer than 10 births per 1000 teens in nearly one half of those countries.

These declines in U.S. teen birth rates cut across ages, states, races, and ethnic groups. Specifically--

• The birth rate for younger teens (ages 15-17 years) fell by four percent between 1999 and 2000, and 29 percent between 1991 and 2000. The 2000 rate is a record low for the Nation.
• The rate for older teens (ages 18-19 years) fell by one percent between 1999 and 2000, and is down 16 percent from its recent high in 1992.
• Between 1991 and 1999, teen birth rates fell by 25 percent or more in 9 states and the District of Columbia and the Virgin Islands, with declines in five of these states exceeding 30 percent.
• The overall birth rate for black teens fell 31 percent from 1991 to 2000 to reach a record low, and for young black teens (age 15-17) it dropped 40 percent This drop is to a great extent the result of teen mothers delaying second births.
• Among Hispanic teens, declines in birth rates have been more modest, falling by 13 percent between 1994 and 1999, and actually increasing by one percent in 2000.
• Rates among white non-Hispanic teens fell by 24 percent since 1991, and remain lower than rates among either black or Hispanic teens. Rates for Asian teens remain the lowest of all.

Birth rates for teens who are not married also declined in 1999 (our most recent year of data). Since 1994, the rate for teens ages 15-17 years has fallen 20 percent, and the rate for teens ages 18-19 dropped 10 percent. However, despite these declines in birth rates, the proportion of teen births to unmarried teenagers continues to rise and remained very high in 1999. The majority of births to 15 to 19 year olds were to unmarried teens. The increase in the percentage of unmarried teens having children reflects in part the fact that birth rates for married teens have fallen considerably in recent years, and fewer teens are getting married.

The teen pregnancy rate has also fallen. This rate takes account of teen births, abortions, and miscarriages. These data are less current and less detailed due to variability across states in collecting abortion data. We can measure U.S. teen pregnancy rates from 1976 to 1997. In 1997 the rate was 94.3 pregnancies per 1,000 teen women. This is 19 percent lower than its peak in 1991, and its lowest point in the 20 plus years for which we have data. Declines in teen pregnancy rates reflect reductions in both teen births and teen abortions. The drop in teen pregnancy rates during this period occurred across age and ethnic groups--

• Between 1990 and 1997 teen pregnancy rates for younger teens fell by 21 percent and rates among older teens fell by 13 percent.
• Declines in pregnancy rates during this period were steepest for non-Hispanic white and black teens, falling by 23 and 26 percent respectively. Among Hispanic teens, abortion rates did not start falling until 1994, and have fallen by 11 percent between 1994 and 1997.

Recent research from nationally representative surveys (such as the National Longitudinal Study on Adolescent Health (Add Health) and the Youth Risk Behavior Surveillance Survey (YRBSS)) gives us a great deal of information about how our young people are faring and what factors influence avoiding risky behaviors such as the initiation of early sexual activity. Add Health is a Congressionally-mandated study which asks students questions about their lives including their health, friendships, self-esteem, and expectations for the future. Twenty thousand students are being followed longitudinally and have already completed three waves of questions. Since 1996 we have seen a number of published reports using the data collected from this study. The YRBSS is a CDC survey administered every two years that is used to measure the incidence of risk behaviors nationally, as well as at the state level.

While the studies show that most teens are doing well, they do confirm that a significant proportion of teens put themselves at risk. Let me highlight some of the interesting findings. We have learned from the YRBSS that in 1999:

• 27 percent of 9^th graders and 51 percent of 12^th graders reported having had sexual intercourse in the previous three months.
• 50 percent of all students reported drinking alcohol on one or more occasions in the last month.
• 27 percent of students reported having smoked marijuana in the last month.

Findings from Add Health have taught us that the home environment plays a major role in teen decision-making. They have shown that students’ feelings of connection to school appear to protect them from health risks. Findings also show that teens who have strong ties to family and school are more likely than their peers to delay sexual intercourse and engage in less drug use, violence, and suicide. Conversely, Add Health also has shown that negative peer influences combined with poor parental supervision are associated with adverse health outcomes.

Specific findings from the Add Health study also included some related to virginity pledges Teens who have taken a public pledge to remain virgins until they are married are more likely to delay first sexual intercourse and to report that their parents disapproved of their having sex. Taking the pledge is most effective in schools where more than 30 percent of the student body also pledges. However, if there are no other pledgers, or if more than three-quarters of the students take the pledge, the pledge loses its power. In addition, if these teens become sexually active they are less likely to protect themselves from pregnancy or sexually transmitted diseases (STDs). Other studies are examining the best prevention methods for working with adolescents to help them protect themselves from risk.

In further support of what we have learned through Add Health, a new National Academy of Sciences study confirms that youth development strategies are critically important to the prevention of youth risk behaviors. The most effective youth development programs incorporate opportunities for physical, cognitive, and social/emotional development; opportunities for community involvement and service; and opportunities to interact with caring adults and a diversity of peers. Young people need a variety of experiences to develop their full potential and these experiences need to take place in an environment in which the family, school and community work together.

Abstinence-only education programs are a major focus of the Department’s activities to prevent teen pregnancies. The expansion of these programs was an important result of the 1996 welfare reform law. The law established the State Abstinence Education Block Grant Program (through Title V section 510 of the Social Security Act) and provided $50 million to be distributed annually to States to fund these activities. (Anecdotal evidence also suggests that some states are using Temporary Assistance to Needy Families (TANF) funds to support a broad range of teen pregnancy prevention activities, including abstinence-only education.) The authorization for this program, along with the other provisions of the law, is due to expire in FY 2002.

Under the Title V program, approximately 700 programs nationwide have been funded. The most frequently funded local program activities are social skills instruction, character-based education and assets building, public awareness campaigns, curriculum development and implementation, school-based abstinence programs, peer mentoring and education, and parent education groups. The two age groups most frequently served are 13-14 year olds and 9-12 year olds.

In addition, starting in FY 2001, a Community-Based Abstinence Education program was established. It follows the same legislative requirements as the Title V State program created under welfare reform. This program is funded at $20 million in FY 2001 and $30 million for FY 2002. Forty-nine communities were recently awarded grants.

The Adolescent Family Life Program awards approximately $10 million for abstinence education programs, also using the same legislative requirements as the Title V abstinence education program authorized under welfare reform.

Let me now mention other important efforts to prevent teen pregnancies within the Department. First, the Centers for Disease Control and Prevention (CDC) support 13 demonstration and evaluation sites funded through the Community Coalition Partnership Programs for the Prevention of Teen Pregnancy. These programs are mobilizing and organizing community leaders to create an effective network of resources to demonstrate and evaluate the effectiveness of teen pregnancy prevention programs that are based on a youth development approach. These demonstrations do not fund individual programs to deliver services. Rather, they work with agencies in their communities to expand the scope and number of services that are provided to youth. Outcomes are being evaluated.

Second, the Administration for Children and Families funds 13 states to develop and support innovative youth development strategies. These state grants support efforts that focus on all youth, including vulnerable youth in at-risk situations. This grant program put into practice the new findings from the National Academy of Sciences report.

We believe it is critical that teen pregnancy prevention efforts should also focus on the teen boys and emphasize the importance of fathers in the lives of children. Living with both a mother and a father helps to protect teen girls and boys against the risks associated with early initiation of sex and to slow the rate at which teenagers become sexually active. A number of our grant programs have especially targeted teen boys and work with young fathers to prevent subsequent unplanned pregnancies. Many projects that received abstinence education grants work with teen boys. Also, an HHS-funded male involvement initiative works with community-based organizations that provide health, education, and social services and integrates them with pregnancy prevention efforts directed to young men.

When teens are provided with educational opportunities, supportive environments, skills, and motivation, they make healthy choices. The Administration has been clear that it believes that providing these opportunities combined with a consistent abstinence-only message is the surest approach to preventing pregnancies or STDs. The Department funds programs that provide other services in addition to abstinence-only education. Teens do have access to family planning programs through either the Title X Family Planning Program or Medicaid, which provide assistance for all ages. Title X guidelines require grantees to discuss abstinence with all teen clients. The Administration is committed to pursuing funding parity between abstinence-only education and contraception services that go to teens.

Evaluating the impact of teen pregnancy prevention efforts is critically important to determining and documenting what works. Efforts to evaluate teen pregnancy prevention programs to date have shown mixed success, and the quality of many evaluations has been inconsistent. Sound rigorous evaluation is costly, time consuming, and requires high methodological standards such as random assignment. As a consequence, it is often avoided. In addition, depending upon the outcomes of interest, the results are often not available immediately.

This Committee clearly understood the importance of rigorous evaluation. A year after the 1996 welfare reform law was enacted this Committee authorized funding to conduct a rigorous evaluation of a selected number of programs funded under the Title V State Abstinence Education Program, with the final report due in FY 2005. This is a large and complex evaluation of the effectiveness of certain approaches to abstinence education, which my office manages for the Department. The study will allow us to take an empirical look at the differential effectiveness of several types of abstinence programs, but will not be a comparison of abstinence programs with other pregnancy/STD prevention programs. A competitive contract was awarded to Mathematica Policy Research to conduct this study and Dr. Rebecca Maynard is the Principal Investigator for the study. The findings will not be available in time for welfare reauthorization next year.

In addition to the Title V Abstinence Education Evaluation, Congressman Istook included an evaluation component when he added funds in FY 2001 Labor, Health and Human Services, Education appropriations bill to create community-based abstinence education programs. My office is also responsible for managing this evaluation effort, and we are now in the planning stages for developing evaluation design options. We are interested in making sure that these evaluation efforts are complementary to the State evaluation efforts. We also are committed to evaluating a range of teen pregnancy prevention approaches, including family planning. As we proceed with our feasibility study, we intend to consult with many key stakeholders, including researchers, advocates, program administrators, policy officials, and members of Congress.

We in the Department believe that sound, rigorous evaluation is what is needed to advance our knowledge of what works to prevent teen pregnancies.

I commend you, Mr. Chairman, for calling this hearing and recognizing the importance of looking at the risks our young people face and the impact they have on our welfare system. The Department looks forward to working with you as we reauthorize PRWORA.