Recent administrative actions signal a shift from promoting comprehensive sexual health information to abstinence-only education, which concerns reproductive rights advocates who question abstinence promotion’s efficacy at preventing teen pregnancy.

The administration already announced last year the discontinuation of a teen pregnancy prevention, or TPP, program that funded grants to communities that study ways to prevent teens from getting pregnant and run prevention programs. The Department of Health and Human Services has promoted more abstinence-only alternatives and increasingly uses the phrase “sexual risk avoidance,” another term for abstinence, in materials.

Promotion of abstinence-only programs is routinely panned by the left for being less successful than broader programs. States like Mississippi, which heavily emphasize abstinence education, also have some of the highest rates of teen pregnancy.

“Focusing on one ideological approach doesn’t meet the diverse needs of teens, and cannot be all things to all people,” said Rachel Fey, director of public policy at Power to Decide, an advocacy group dedicated to preventing unplanned pregnancies. She said using only one approach and not maintaining the high standards of evidence and evaluation that the current program uses “would be taking a step backwards in meeting the needs of young people.”

Supporters of abstinence-only education program argue that it is the only effective way to prevent teen pregnancy and minimize the risk of spreading sexually transmitted diseases. Some groups also emphasize the religious components of the importance of promoting abstinence among teens. And some also criticize the prevention program ended by the Trump administration.

“False assertions of success by TPP proponents tout the program as a major contributor to the decline in teen birth rates. However, as HHS leadership notes, the TPP program has reached a mere 1% of the teen population since 2010 and can hardly lay claim to the precipitous drop that has been observed since 1991,” read a blog post from Ascend, a national sexual risk avoidance program.

Actions pushing abstinence

The United States spent nearly $2 billion on abstinence-only-until-marriage, or AOUM, programs over the past 20 years, according to The Guttmacher Institute, a research organization that supports reproductive rights.

A September study from The Journal of Adolescent Health found that in both domestic and global contexts, abstinence-only education did not lead to delays in sexual intercourse or the adoption of more protective sexual behaviors. “The emphasis on AOUM approaches has harmed other public health efforts, such as family planning programs and HIV prevention efforts, domestically and globally,” the study reads.

Reproductive advocacy groups worry that recent changes instituted by the Trump administration hint at further attempts to push for abstinence-only education.

In November, HHS’s Office of the Assistant Secretary for Health and the Administration for Children and Families announced a new effort to promote sexual risk avoidance as a way to prevent teen pregnancy.

The $10 million program is billed by HHS as “a new research and evaluation collaboration to support and improve teen pregnancy prevention and sexual risk avoidance programs.”

“This shifts funds away from the evidence-based Teen Pregnancy Prevention Program and the office that administers it, the Office of Adolescent Health, and towards other agencies at HHS to further sexual risk avoidance education,” Fey said.

Last fall, HHS also introduced a plan, known as SMARTool, for creating a sexual risk avoidance curriculum.

“Most sexual risk-avoidance educators share the goal or expectation that youth are capable of understanding the risks of early sex, capable of choosing to delay sexual activity and capable of establishing strong, faithful future families,” the curriculum reads.

“We’re seeing this shift at the highest levels of the administration, but we also need to pay attention to how this is affecting state and local districts,” said Diana Thu-Thao Rhodes, director of public policy at Advocates For Youth, an advocacy organization focused on educating young people about sexual health.

“The other thing that’s harmful, is that abstinence-only education typically only centers around heterosexual couples and leaves couples on the LGBT spectrum out of the conversation,” said Terez Yonan, a fellow with Physicians for Reproductive Health, who specializes in adolescent medicine. She also expressed worries about increased rates of sexually transmitted diseases under abstinence-focused programs.

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Litigation over prevention program

Last week, nine organizations filed four lawsuits against HHS challenging the rollback of the pregnancy program last July. The TPP program provides grants to over 80 groups across the country but the Trump administration is ending the grants after June. 

HHS’s website states that the program was created in 2010 by cutting community-based abstinence education program grants and repurposing the funds. While HHS has not said how it intends to replace the TPP program, there is speculation the department could push for abstinence-only education.

One of the complaints filed last week said that Trump’s 2019 budget proposal this month proposes to spend $75 million for HHS to fund abstinence-only and personal responsibility sex education programs, while zeroing out funding for more comprehensive sex education programs, including TPP.

The same complaint expressed concerns with the 2017 appointment of Valerie Huber to chief of staff for the Office of the Assistant Secretary of Health. Last month, Huber became the acting deputy assistant secretary of the HHS Office of Population Affairs.

Prior to her appointment, Huber served as president of Ascend, previously known as the National Abstinence Educators Association. She also worked as an abstinence education coordinator for Ohio’s Department of Health from 2004 to 2007.

Huber could be a driving force behind a push for more abstinence-only efforts.

“I do think that her role in HHS is having an impact on a shift towards more abstinence until marriage and sexual risk avoidance programs,” Rhodes said.

In September, the bipartisan Commission on Evidence-Based Policymaking established by House Speaker Paul D. Ryan and Washington Democratic Sen. Patty Murray cited the pregnancy program in a bipartisan report as an example of a federal program developing increasingly rigorous portfolios of evidence.

“Yet despite this, the administration has stated its hope that the program will not be funded by Congress,” Fey said.

HHS did not immediately respond to a request for comment.