With the passage of health care reform legislation in March, U.S. federal policy on sex education and teen pregnancy prevention took another significant step forward, but also a step back.

In his first budget request shortly after taking office last year, President Obama called for an end to ineffective sex education efforts focused solely on promoting abstinence outside of marriage. Instead, he proposed that funding under two longstanding federal programs tied to a rigid, eight-point definition of abstinence-only education—the Community-Based Abstinence Education Program (CBAE) and the Title V program of abstinence education grants to the states—be shifted to support evidence-based, medically accurate and age-appropriate "programs that work." In December, as part of the FY 2010 Consolidated Appropriations Act, Congress responded by replacing CBAE with a new $114.5 million teen pregnancy prevention effort. The bulk of the money ($75 million) will go toward replicating programs that have been proven through rigorous evaluation to reduce teen pregnancy or its underlying or associated risk factors. A smaller pot ($25 million) is reserved to develop innovative strategies that have demonstrated at least some promise, and an additional $14.5 million is set aside for training, technical assistance, evaluation, outreach and additional program support activities (see chart). In April of this year, the newly created Office of Adolescent Health within the Department of Health and Human Services, which administers the program, issued two detailed funding announcements in the first step toward implementing this program.

Through health care reform, Congress took another major step forward by creating a more progressive state grant program, intended as a replacement for the Title V abstinence-only program (funding for which had expired in June 2009). This new, five-year "personal responsibility education" program (PREP) is to be administered by the Administration on Children, Youth and Families (ACYF). PREP’s stated purpose is to educate adolescents on both abstinence and contraception and prepare them for adulthood with the teaching of such subjects as healthy relationships, financial literacy, parent-child communication and decision-making. It will make available just over $55 million annually in grants to states to implement programs aimed at preventing teen pregnancy and sexually transmitted infections that replicate or substantially incorporate elements of demonstrably effective efforts, as well as $10 million in grants to public and private entities to implement innovative prevention strategies and target services to high-risk youth.

Although every state under PREP, as under the Title V abstinence-only program, is offered a guaranteed, formula-based allotment, the PREP funding stream differs from that of the abstinence-only program in two important ways. First, PREP does not require states to match their federal allotment with state or local contributions, a welcome development for states facing tight budgets. Second, if a state decides not to participate in PREP in the first two years, its allocation will be parceled out in the third year to community-based organizations working in the state. In contrast, under the Title V abstinence-only program, if a state decides not to participate in the program, its allocation reverts to the U.S. Treasury.

Unfortunately, even as Congress threw its support behind a new state grant program, it also agreed per another provision in the health care reform legislation to resuscitate— intact—the old Title V abstinence-only-until-marriage program for five years. As a result, the transformation of U.S. policy from an abstinence-only to a more comprehensive approach is substantial but not complete. In terms of funding, the bottom line is that about $190 million in federal funding is now available for more progressive sex education programs ($114.5 million from the new teen pregnancy prevention program and $75 million from PREP), while $50 million remains available to states to implement rigid abstinence-only programs under Title V. With regard to the latter, however, it is worth noting that in 2009, roughly half the states declined to apply for their Title V abstinence-only allotment, in large part because of the demonstrated ineffectiveness of this programming. It remains to be seen how many states will apply for these highly restrictive funds going forward.

—Heather D. Boonstra