[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
TEEN PREGNANCY PREVENTION
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RESOURCES
of the
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 15, 2001
__________
Serial No. 107-48
__________
Printed for the use of the Committee on Ways and Means
U.S. GOVERNMENT PRINTING OFFICE
77-054 WASHINGTON : 2002
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
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COMMITTEE ON WAYS AND MEANS
BILL THOMAS, California, Chairman
PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
E. CLAY SHAW, Jr., Florida FORTNEY PETE STARK, California
NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California
AMO HOUGHTON, New York WILLIAM J. COYNE, Pennsylvania
WALLY HERGER, California SANDER M. LEVIN, Michigan
JIM McCRERY, Louisiana BENJAMIN L. CARDIN, Maryland
DAVE CAMP, Michigan JIM McDERMOTT, Washington
JIM RAMSTAD, Minnesota GERALD D. KLECZKA, Wisconsin
JIM NUSSLE, Iowa JOHN LEWIS, Georgia
SAM JOHNSON, Texas RICHARD E. NEAL, Massachusetts
JENNIFER DUNN, Washington MICHAEL R. McNULTY, New York
MAC COLLINS, Georgia WILLIAM J. JEFFERSON, Louisiana
ROB PORTMAN, Ohio JOHN S. TANNER, Tennessee
PHIL ENGLISH, Pennsylvania XAVIER BECERRA, California
WES WATKINS, Oklahoma KAREN L. THURMAN, Florida
J.D. HAYWORTH, Arizona LLOYD DOGGETT, Texas
JERRY WELLER, Illinois EARL POMEROY, North Dakota
KENNY C. HULSHOF, Missouri
SCOTT McINNIS, Colorado
RON LEWIS, Kentucky
MARK FOLEY, Florida
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
Allison Giles, Chief of Staff
Janice Mays, Minority Chief Counsel
______
Subcommittee on Human Resources
WALLY HERGER, California, Chairman
NANCY L. JOHNSON, Connecticut BENJAMIN L. CARDIN, Maryland
WES WATKINS, Oklahoma FORTNEY PETE STARK, California
SCOTT McINNIS, Colorado SANDER M. LEVIN, Michigan
JIM McCRERY, Louisiana JIM McDERMOTT, Washington
DAVE CAMP, Michigan LLOYD DOGGETT, Texas
PHIL ENGLISH, Pennsylvania
RON LEWIS, Kentucky
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Ways and Means are also published
in electronic form. The printed hearing record remains the official
version. Because electronic submissions are used to prepare both
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unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
Page
Advisory of November 8, 2001, announcing the hearing............. 2
WITNESSES
U.S. Department of Health and Human Services, Hon. Bobby P.
Jindal, Assistant Secretary for Planning and Evaluation........ 7
______
Best Friends Foundation, Elayne G. Bennett....................... 38
Greater New Britain Teen Pregnancy Prevention, Inc., RoseAnne
Bilodeau....................................................... 62
Maynard, Rebecca A., University of Pennsylvania.................. 55
Medical Institute for Sexual Health, Joe S. McIlhaney, Jr., M.D.. 65
National Campaign to Prevent Teen Pregnancy, Sarah S. Brown...... 46
Virginia Department of Health, Abstinence Education Initiative,
Gale E. Grant.................................................. 33
SUBMISSIONS FOR THE RECORD
Abstinence Educators' Network, Inc., Mason, OH, Melanie Howell,
statement...................................................... 96
Alan Guttmacher Institute, New York, NY, Jacqueline E. Darroch,
letter......................................................... 98
Center for Law and Social Policy, Jodie Levin-Epstien, letter and
attachment..................................................... 100
Educational Guidance Institute, Front Royal, VA, Onalee McGraw,
statement...................................................... 103
Friends First, Longmont, CO, Lisa A. Rue, letter and attachments. 107
Green, Bob and Peggy, Cape Canaveral, FL, statement.............. 108
National Abstinence Clearinghouse, Sioux Falls, SD, Leslee J.
Unruh, statement............................................... 108
National Organization on Adolescent Pregnancy, Parenting and
Prevention, Inc., Mary Martha Wilson, letter and attachment.... 112
New Mexico GRADS, Roswell, NM, Kathy Van Pelt, letter............ 116
Pennsylvania Coalition to Prevent Teen Pregnancy, Harrisburg, PA,
statement...................................................... 116
Project Reality, Glenview, IL:
Kathleen M. Sullivan, statement.............................. 120
Statement.................................................... 120
REACH (Responsibility Education for Abstinence, Character &
Health), Arcanum, OH, statement................................ 121
Wood, William, Charlotte, NC, statement.......................... 125
TEEN PREGNANCY PREVENTION
----------
THURSDAY, NOVEMBER 15, 2001
House of Representatives,
Committee on Ways and Means,
Subcommittee on Human Resources,
Washington, DC.
The Subcommittee met, pursuant to call, at 10:00 a.m., in
room B-318, Rayburn House Office Building, Hon. Wally Herger
[Chairman of the Subcommittee] presiding.
[The advisory announcing the hearing follows:]
ADVISORY
FROM THE
COMMITTEE
ON WAYS
AND
MEANS
SUBCOMMITTEE ON HUMAN RESOURCES
CONTACT: (202) 225-1025
FOR IMMEDIATE RELEASE
November 8, 2001
No. HR-9
Herger Announces Hearing on Teen
Pregnancy Prevention
Congressman Wally Herger (R-CA), Chairman, Subcommittee on Human
Resources of the Committee on Ways and Means, today announced that the
Subcommittee will hold a hearing on national progress in reducing teen
pregnancy and related issues as the Subcommittee prepares for
reauthorization next year of key features of the 1996 welfare reform
law. The hearing will take place on Thursday, November 15, 2001, in
room B-318 Rayburn House Office Building, beginning at 10:00 a.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only.
Witnesses will include representatives of the U.S. Department of Health
and Human Services, program administrators, researchers, and other
experts in pregnancy prevention strategies. However, any individual or
organization not scheduled for an oral appearance may submit a written
statement for consideration by the Committee and for inclusion in the
printed record of the hearing.
BACKGROUND:
The Personal Responsibility and Work Opportunity Reconciliation Act
of 1996 (P.L. 104-193), commonly referred to as the 1996 welfare reform
law, made dramatic changes in the Federal-State welfare system designed
to aid low-income American families. The law repealed the former Aid to
Families with Dependent Children program, and with it the individual
entitlement to cash welfare benefits. In its place, the 1996
legislation created a new Temporary Assistance for Needy Families
(TANF) block grant that provides fixed funding to States to operate
programs designed to achieve several purposes: (1) provide assistance
to needy families, (2) end the dependence of needy parents on
government benefits by promoting job preparation, work, and marriage,
(3) prevent and reduce the incidence of out-of-wedlock pregnancies, and
(4) encourage the formation and maintenance of two-parent families.
In addition to a basic program orientation toward preventing teen
and other out-of-wedlock pregnancies as a key method of combating long-
term welfare dependence, the law includes several specific provisions
designed to address this issue, including: (1) the provision of $250
million in abstinence education funding, (2) permission for States to
limit cash welfare for unmarried teen parents, and (3) the requirement
that teens be in school and living at home or with an adult in order to
receive assistance. States also are authorized to use block grant funds
to provide, or assist in locating, adult-supervised living
arrangements, such as second-chance homes, for teen mothers.
In announcing the hearing, Chairman Herger stated: ``Teen pregnancy
cuts short the teen parents' opportunities to build a promising future,
and puts their child at a fundamental disadvantage in so many ways. It
means years of dependence for many struggling young families, which is
a cycle that has repeated itself too often in recent generations. It is
easy to see why preventing and reducing the incidence of teen pregnancy
is absolutely critical to progress on welfare reform. I look forward to
hearing about the effects of the welfare law's provisions and what
lessons we have learned that can help us as we move ahead next year.''
FOCUS OF THE HEARING:
This hearing will focus on teen pregnancy prevention efforts since
enactment of the welfare reform law in 1996, and recommendations for
further improvements to prevent and reduce the incidence of teen
pregnancy during the reauthorization of the TANF program in 2002.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Due to the change in House mail policy, any person or
organization wishing to submit a written statement for the printed
record of the hearing should send it electronically to
``[email protected]'', along with a fax copy to
202/225-2610, by the close of business, Thursday, November 29, 2001.
Those filing written statements who wish to have their statements
distributed to the press and interested public at the hearing should
deliver 200 copies to the Subcommittee on Human Resources in room B-317
Rayburn House Office Building, in an open and searchable package 48
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noted above.
Chairman Herger. Good morning, and welcome to today's Human
Resources Subcommittee hearing on Teen Pregnancy Prevention.
This hearing is a continuation of our review of welfare issues
in preparation for next year's reauthorization of the Temporary
Assistance for Needy Families (TANF) program at the heart of
the 1996 Welfare Reform Law. Three of TANF's four basic
purposes relate to preventing out-of-wedlock birth, and the law
included several provisions encouraging States to address the
problem of teen pregnancy.
The reasons are obvious. Recent decades of seeing teen
childbearing in particular and out-of-wedlock childbearing in
general become reliable predictors of welfare receipt. But
there is more to this issue than just welfare. As Isabel
Sawhill, President of the National Campaign to Prevent Teen
Pregnancy puts it, ``Almost no one thinks that teen unwed
pregnancy and parenting is a good idea.'' I fully agree. There
are important health consequences for young people who are
sexually active as we will hear today.
As we head for reauthorization of TANF in 2002, a key issue
will be what progress we have made in reducing out-of-wedlock
births starting with births to teens, who as a group are the
least equipped to support a baby. The good news is that the
progress made to date has been impressive. In the 1999-2000
annual report of the National Strategy to Prevent Teen
Pregnancy, the U.S. Department of Health and Human Services
(HHS) reported that: ``Teen pregnancy and birth rates in this
country have declined to record low levels. Further, trends
throughout the nineties have shown a steady reduction in teen
birth rate that is now significant for all 50 States.''
The bad news is that there is still a long way to go. The
United States has one of the highest teen pregnancy rates in
the industrialized world, but we are moving forward and are
interested in building on the progress we have made to date.
Thus, among other questions, today's hearing should help us
focus on two specific questions. First, why are we making
progress against teen pregnancy? And second, what further steps
should we consider during next year's reauthorization of the
1996 Welfare Reform Law.
I look forward to exploring these issues with all of our
witnesses today. Without objection, each Member will have the
opportunity to submit a written statement and have it included
in the record at this point.
Mr. Cardin, would you like to make an opening statement?
[The opening statement of Chairman Herger follows:]
Opening Statement of the Hon. Wally Herger, a Representative in
Congress from the State of California, and Chairman, Subcommittee on
Human Resources
Good morning and welcome to today's Human Resources Subcommittee
hearing on teen pregnancy prevention. This hearing is a continuation of
our review of welfare issues in preparation for next year's
reauthorization of the Temporary Assistance for Needy Families program
at the heart of the 1996 welfare reform law.
Three of TANF's four basic purposes relate to preventing out-of-
wedlock births, and the law included several provisions encouraging
States to address the problem of teen pregnancy. The reasons are
obvious--recent decades have seen teen childbearing in particular and
out-of-wedlock childbearing in general become reliable predicators of
welfare receipt.
But there is more to this issue than just welfare. As Isabel
Sawhill, President of the National Campaign to Prevent Teen Pregnancy,
put it: ``Almost no one thinks that teen unwed pregnancy and parenting
is a good idea.'' I fully agree. There are important health
consequences as well for young people who are sexually active, as we
will hear today.
As we head for reauthorization of TANF in 2002, a key issue will be
what progress we have made in reducing out-of-wedlock births, starting
with births to teens, who as a group are the least equipped to support
a baby.
The good news is that the progress made to date has been
impressive. In the 1999-2000 Annual Report of the National Strategy to
Prevent Teen Pregnancy, HHS reported that, ``teen pregnancy and birth
rates in this country have declined to record low levels.'' Further,
``Trends throughout the 1990s have shown a steady reduction in teen
birth rates that is now significant for all 50 States.''
The bad news is there is still a long way to go. The United States
has one of the highest teen pregnancy rates in the industrialized
world. But we are moving forward, and are interested in building on the
progress we have made to date.
Thus, among other questions, today's hearing should help us focus
on two specific questions: First, why are we making progress against
teen pregnancy and second, what further steps should we consider during
next year's reauthorization of the 1996 welfare reform law? I look
forward to exploring these issues with all of our witnesses today.
Mr. Cardin. Well, thank you, Mr. Chairman.
First let me welcome our witnesses that are with us today,
and I thank you for holding this hearing on an extremely
important subject.
There is no question that reducing teenage pregnancy is a
goal that enjoys broad bipartisan support here in Congress.
Reducing teen pregnancy is not a panacea for every social
program, but it will help promote better outcomes for family.
In short, convincing young people to delay pregnancy will put
them in a much better position to provide for and care for
their children.
Mr. Chairman, I think you stated it accurately in that we
are very pleased that we have been able to reduce teenage
pregnancy, but we still have the largest teenaged pregnancy of
any of the industrial nations of the world, developed nations
of the world.
So the question is, what can we do to buildupon the success
that we have had as we go to the next level of TANF and Welfare
Reform? And to answer that I think we first need to try to
understand why we have had the success that we have had in
reducing teenage pregnancy, and I would suggest that there are
multiple factors that have played a role in reducing the number
of teenage pregnancies in our society. Clearly the rising fear
of sexually transmitted diseases over the last decade decreased
sexual activity and unprotected sex among teenagers. Second,
increased access to contraception and more effective forms of
long-term contraception reduced the number of unintended
pregnancies. Third, local efforts to reduce teenage births
through counseling and other methods have produced some
positive results. While I have not seen any corroborative
evidence for this presumption, I would guess that a decade of
strong economic growth has had a positive impact on reducing
teenage pregnancy because there is more hope out there, and
that I think has led people to make more mature decisions about
their family.
I might point out though that I am not sure there is any
real evidence as to the direct actions that we took in the 1996
law, what impact that has had on our success in reducing
teenage pregnancies. We need to take a look at that, Mr.
Chairman. We need to take a look at what we should be doing on
welfare reform.
In terms of what this means for the future, I would say
that we should continue our focus on personal responsibility.
We should do a better job of not only funding local efforts to
combat teen pregnancy, but also highlighting successful
programs, which should increase access to youth development and
after-school programs that give teenagers productive activities
to pursue, and we should promote the value of abstinence
without undercutting our commitment to providing access to and
information about contraception.
On this last issue, I think it is important to remember
that discussing contraception has never been found to promote
sexual activity among teenagers, but there is evidence that
such discussion reduces unintended pregnancies. This means that
we can tell teenagers that abstinence is always the best
option, but if they do have sex, they should take precautions
against pregnancy and sexually transmitted diseases.
I look forward to learning today from the witnesses that we
have on the panel, and I will look forward to working with all
my colleagues in developing the right policy to promote the
goal of reducing teenage births.
[The opening statement of Mr. Cardin follows:]
Opening Statement of the Hon. Benjamin Cardin, a Representative in
Congress from the State of Maryland
Mr. Chairman, I am pleased to be here today to discuss our Nation's
effort to reduce teenage pregnancy--a goal for which there is broad
bipartisan support.
Reducing teen births is not a panacea for every social problem, but
it will help promote better outcomes for families. In short, convincing
young people to delay pregnancy will put them in a much better position
to provide and care for their children.
Fortunately, progress is being made on this important issue. Both
teen pregnancy and teen birth rates have been falling since 1991--with
the teen birth rate hitting a record low last year. However, even with
this improvement, the United States still has the highest teenage birth
rate among developed countries.
The question before this panel is how do we maintain the current
progress on reducing teen pregnancy. To answer that inquiry, we first
need to develop a consensus on what policy and societal changes
prompted the improvement in teen pregnancy rates that have occurred
over the last ten years.
As is so often the case, there is no single answer. Rather, there
are mix of causes, some of which are linked to changes in public policy
and some of which have nothing to do with any particular action taken
by the government.
First, a rising fear of sexually-transmitted diseases over the last
decade decreased sexual activity and/or unprotected sex among
teenagers.
Second, increased access to contraception and more effective forms
of long-term contraception, such as Depo-Provera, reduced the number of
unintended pregnancies.
Third, local efforts to reduce teenage births, through counseling
or other methods, may have produced some positive results.
Forth, while I have not seen any corroborative evidence for this
presumption, I would guess that a decade of strong economic growth had
a positive impact on reducing teenage pregnancies to the extent it
reduced the sense of hopelessness and hardship that sometimes leads to
unwise decisions.
And finally, a more general change may have occurred in young
people's attitude towards sex. Many factors may have contributed to
this last change, including government policies that stress personal
responsibility, such as the provisions on promoting work and on
enforcing child support obligations in the 1996 welfare law.
However, there is no evidence that any of the provisions in the
1996 welfare law that specifically targeted reducing teen and non-
marital births have had any discernable impact.
In terms of what this means for the future, I would say that we
should continue our focus on personal responsibility; we should do a
better job of not only funding local efforts to combat teen pregnancy,
but also of highlighting successful programs; we should increase access
to youth development and after-school programs that give teenagers
productive activities to pursue; and we should promote the value of
abstinence without undercutting our commitment to providing access to
and information about contraception.
On this last issue, I think it is important to remember that
discussing contraception has never been found to promote sexual
activity among teenagers, but there is evidence that such discussions
reduce unintended pregnancies. This means that we can tell teens that
abstinence is always the best option, but if they do have sex, they
should take precautions against pregnancy and sexually-transmitted
diseases.
I look forward to hearing from our witnesses about their views on
how best to continue our progress on reducing teen births. Thank you.
Chairman Herger. Thank you, Mr. Cardin.
Before we move on to our testimony this morning, I want to
remind our witnesses to limit their oral statements to 5
minutes. However, without objection, all the written testimony
will be made a part of the permanent record.
To welcome our first witness today, I will turn to Mr.
McCrery.
Mr. McCrery. Thank you, Mr. Chairman. Our first witness is
Bobby Jindal from the U.S. Department of Health and Human
Services. Bobby is from my home State of Louisiana, comes to
HHS with a very distinguished resume. He started his career in
my office as an intern, so a very distinguished record.
[Laughter.]
Mr. McCrery. He was an undergraduate at Brown. Went on to
earn a Rhodes scholarship, furthered his studies overseas. Came
back to the United States, became the Secretary of the
Department of Health and Hospitals in Louisiana at a fairly
young age of 24, I believe, something like that. And then
became the executive director of the Medicare Reform Commission
that was formed several years ago. When that work was
completed, Bobby went back to Louisiana to become president of
the Louisiana State Colleges and University system, and that is
where we found him and brought him back to Washington to be the
assistant secretary for planning and evaluation at HHS.
And we are indeed fortunate, Mr. Chairman, to have people
of the quality of Bobby Jindal serving the public in
Washington, D.C., and so I am very pleased to introduce our
first witness, Bobby Jindal.
Chairman Herger. Thank you, Mr. McCrery. And with that, Mr.
Jindal, your testimony, please.
STATEMENT OF THE HON. BOBBY P. JINDAL, ASSISTANT SECRETARY FOR
PLANNING AND EVALUATION, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Mr. Jindal. Thank you, Mr. Chairman.
Thank you, Representative McCrery for that kind
introduction. I have often referred to the internship as the
highlight of my career and resume as well.
[Laughter.]
Mr. Jindal. Mr. Chairman, Members of the Subcommittee, I
thank you for this opportunity. I thank you for inviting me to
come discuss with you today the Department's teen pregnancy
prevention activities, especially those since the passage of
the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996.
Like the Chairman and other Members have noted, I think
this is a very important topic, and I do appreciate the
opportunity to come and share some information with you this
morning. The 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, to require public
assistance as young adults, and are more likely to have trouble
with the law.
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 activities, and surveillance
activities that we have conducted 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 pleased to report that in 2001 the Department is
supporting such efforts in at least 47 percent, almost half, of
America's communities. This is likely a conservative estimate
because it does not include activities funded under block grant
programs to States for which data are not readily available. So
this only includes direct grants to communities, not the many
dollars expended to block grant programs.
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. We
heard some references to these trends already. 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 Center for
National Health Statistics. The overall birth rate for
teenagers declined by 22 percent from 1991 to 2000, and is
currently at its lowest rate ever.
However, we should be clear, as the Chairman and others
have noted, that the U.S. teen birth rate is still too high,
and of particular importance, it is still 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 the Centers for Disease Control and
Prevention (CDC), and rates fewer than 10 births per 1,000
teens in nearly one half of those countries.
The declines in U.S. teen birth rates cut across ages,
States, races and ethnic groups. Specifically, the birth rate
for younger teens, those aged 15 to 17 years of age, fell by 4
percent between 1999 and 2000, and 29 percent between 1991 and
2000. The 2000 rate is a record low for our country.
The rate for older teens, those aged 18 and 19 years of
age, fell by 1 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 nine States and the District of Columbia and the
Virgin Islands, with declines in five of these States exceeding
30 percent. As the Chairman noted, the declines have happened
in all 50 States.
The overall birth rate for black teens fell 31 percent from
1991 to 2000 to reach a record low, and for young black teens,
those aged 15 to 17, it dropped by 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 1 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
the different subgroups.
Birth rates for teens who are not married also declined in
1999, our most recent year of data. Since 1994 the rates for
teens aged 15 to 17 years of age has fallen 20 percent, and the
rates for teens aged 18 and 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 years old
were to unmarried teens. I think it was something over 75
percent over three quarters. 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 also the fact that many 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 only since 1976 to 1997 due to that lack of
consistent national data. In 1997 the rate was 94.3 pregnancies
per 1,000 teen women.
I notice that I am getting close to the end of my time, so
with the Chairman's permission, I will just take a minute to
skip forward and get to the program descriptions.
My testimony does include much more detail on what we
found. The quick summary is that teen pregnancy rates have also
fallen, just as the birth rates have fallen.
Let me quickly describe what we know from the research, and
I will refer you again to research in the written testimony
from the National Institute of Health, both through
longitudinal study and a Youth Risk Behavior Surveillance
Study.
One of the things I want to stress in my testimony is that,
as a Department, we think that the Congress's actions in
instructing us and giving us the opportunity to do this
research and evaluate programs is very important, and so we
thank you for that opportunity, and we think that it will help
inform the conversations we have going forward.
The research shows you several important things in terms of
the likelihood for teens to engage in risky behavior, including
sexual activity, as well as drinking and taking other chances.
What I do want to get to before I close, however, are what
some of the evaluations are saying on programs and
interventions. Studies show that those programs that include a
youth development component are those that have demonstrated
more success. For example, the way that it is commonly
paraphrased, the more that we can allow students to say yes,
not just say no, tends to improve our success rates. Specific
findings also show that virginity pledges have been successful,
in many instances, in convincing teens to delay their first
sexual intercourse. It is most effective in schools where 30
percent of the student body also pledges. However, it also
shows that if teens do become sexually active, they are less
likely to protect themselves.
Let me close there just by saying in one sentence that the
Department funds several programs, both abstinence-only and
other programs, aimed at at-risk teens. The details are in your
testimony. I will stop there since I am well over time, and I
have submitted a more comprehensive set of written comments.
And I do know that on the panel, you also have somebody
that is working directly with the Department to do the
evaluation on Title V Abstinence Education Program. Rebecca
Maynard is here. She is the investigator that was chosen
through a competitive process to evaluate the abstinence
programs funded by this Congress.
And I will just close where I started with saying this is
obviously a very important issue. We are pleased that teen
pregnancy and birth rates are declining. We have a lot more
work to do, and we do think the evaluation components will be
very important in informing the debate going forward.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Jindal follows:]
Statement of the Hon. Bobby P. Jindal, Assistant Secretary for Planning
and Evaluation, U.S. Department of Health and Human Services
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.
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.
What We Know from the Research
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 9th graders and 51 percent of 12th
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 decisionmaking. 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.
The Department's Major Teen Pregnancy Prevention Activities
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.
Evaluation Efforts
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.
Conclusion
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.
Chairman Herger. Thank you, Mr. Jindal, and your full
testimony will be submitted for the record. With that, the
gentleman from Louisiana, Mr. McCrery to inquire.
Mr. McCrery. Thank you, Mr. Chairman.
Mr. Jindal, based on what we know about trends involving
teen pregnancy and the early effects of the 1996 Welfare Reform
Law, are there any changes or new provisions that your
Department is ready to recommend as we start the process of
reauthorizing TANF next year?
Mr. Jindal. Two things. First, we are certainly working
very closely with Wade Horn at the administration for Children
and Families (ACF) internally in the Department looking at
reauthorization. I know that the administration is going to
begin its series of consultations with Members of Congress and
congressional leadership. Currently Wade is engaged in a series
of national listening tours across the country to get input
from representatives to find out more about what has worked and
what might need tweaking as we go forward. Overall, certainly,
I think the Secretary, it would be fair to say, views Welfare
Reform both in Wisconsin and across the country as a success
and would like to build on that success.
It would be too early for me to comment at this time on the
administration's perspectives on particular aspects of Welfare
Reform in terms of changes or not making changes, but I do know
that process has started. I know the national listening tours
are taking place and I do know the administration is going to
start coming up to the Hill literally over the next few days to
start consulting with Members as it does these national
listening tours.
The second piece that I would emphasize is the importance
of evaluation activities. Rebecca can talk more about this.
Next year will be the final year that they will be collecting
data. Some of those results will therefore be coming out in the
next couple of years.
There is also another evaluation component on the
community-based programs that is only now just starting. We
will soon release the competitive request for proposals, and so
the only thing I would emphasize is that we do believe the
evaluation is an important component of moving forward.
Mr. McCrery. So it is safe to say that Welfare Reform
reauthorization is on your radar screen, it is on the radar
screen of the administration, and you are going to be working
with us to fashion the reauthorization next year?
Mr. Jindal. Yes, sir, and we do look forward to working
with you to get that input.
Mr. McCrery. Thank you, Mr. Jindal. Thank you, Mr.
Chairman.
Chairman Herger. Thank you, Mr. McCrery. The Ranking Member
from Maryland, Mr. Cardin.
Mr. Cardin. Thank you, Mr. Chairman.
And thank you very much for your testimony. It is a very
comprehensive report as to current status and a blueprint to
move forward. In your written testimony, and you mentioned it
very briefly, you highlighted the importance of developing
constructive activities for young people so that they could
avoid risky activities, such as after-school programs and other
ways in which young people can work together, become more
responsible rather than being at risk.
We have certain funding that is available at the Federal
government for abstinence programs, and I am just wondering
what your position would be, considering that we want to give
flexibility to local governments to be able to develop the best
types of programs. It seems to me that if constructive
activities are a good remedy for putting children at risk,
shouldn't those types of programs be qualified for Federal
abstinence dollars, even if there isn't a direct educational
component to the use of those funds?
Mr. Jindal. Let me start by setting the larger context, and
then talk in particular about abstinence dollars. The
Department is very interested in promoting rigorous
comprehensive research on what works and doesn't work. The
early trends certainly suggest, as you have said, that those
interventions that include adolescent development components
are going to be the more successful programs. I do want to put
in a huge caveat, that we are still in the early stages of
learning about what works and what doesn't work, and we do
believe there needs to be more rigorous comprehensive work
across the country. There have been isolated studies. I think
you can find studies to say a wide range of things, looking at
very, very particular local programs, but we want to make sure
there is rigorous research with control groups that look across
a variety of programs.
To answer your particular question, the Department has many
funding sources for teen pregnancy programs and adolescent
programs in its Maternal and Child Health Bureau, in ACF, and
certainly with the block grants to States. The administration
is very committed to parity between the abstinence-only
programs and the other programs, and is working toward reaching
that parity. The administration believes that the abstinence
programs are an important component of that overall range of
programs that are available to communities. However, knowing
that there are these other funding sources, I think it is
important that there be dollars available for abstinence
programs.
Mr. Cardin. And that is a good point. But let me, one of
the real changes for the 1996 law was to give flexibility to
the States within broad Federal guidelines of goals that we
wanted to achieve, and States have really developed some very
innovative programs. I guess I am concerned that if you
pigeonhole too tightly for abstinence by itself and don't allow
States to be able to use those types of funding source to
develop comprehensive solutions, we might lose an opportunity.
So I would just urge you to carry out the real policy that was
developed by the Congress on giving flexibility to the States
to not to be so prescriptive that it becomes difficult for
States to do innovative programs.
You mentioned a balance, and that is a very good point. I
would just caution again the virginity pledges, there is no--
one of my concerns is that it may very well just postpone
activity and that when the adolescent becomes sexually active,
that person may not have the education necessary to make the
right decisions. So I would just also urge, as you look at
balance, again not to pigeonhole so much. I think there is
general agreement that abstinence is a value that we want to
instill in our children but we also want them to understand the
consequences of sex, and we want them to understand
contraception. We want them to understand sexually transmitted
diseases. And if you pigeonhole it too tightly, you end up
maybe postponing but not avoiding some undesired consequences.
And it is important, I think, to try to combine these rather
than pigeonholing.
Mr. Jindal. And I appreciate the suggestion to look into
giving States more flexibility. Two quick comments. I know
Congress set up some requirements in the law in terms of what
requirements these abstinence programs would have to meet, and
so we are very interested in making sure we are compliant with
congressional intent. And in terms of giving States more
flexibility, that is consistent with the Department's overall
direction, and certainly, given the multiple funding sources, I
think we would encourage States and communities to make those
choices consistent with their own values and norms. But again,
the point is well taken, and certainly we will consider ways we
can give States and communities more flexibility.
Mr. Cardin. I thank you. Thank you, Mr. Chairman.
Chairman Herger. Thank you, Mr. Cardin. And now the
gentlelady from Connecticut, Mrs. Johnson to inquire.
Mrs. Johnson. Thank you. And thank you for your testimony,
Mr. Jindal. It was very complete and very impressive that we
are making progress in reducing teen pregnancy.
You mentioned a couple things that were particularly
important to me. One, you mentioned that you are finding if you
connect students to other activities that that helps, very
logical, very simple. I would hope that just because we do not
have some of the evaluations done, that we do not miss this
opportunity, when we reauthorize Welfare Reform, to deal with
this issue of connectivity, because what we are finding in my
hometown of New Britain, which is an old manufacturing center
going through all the processes of losing its major employees
and having intense pockets of poverty and isolation, which
Welfare Reform now has impacted by bringing people into the
workforce, you have a desperate need to connect kids into
stable situations. And what we are finding with teen pregnancy
prevention is, that it is not just about teen girls or teen
boys--and I am glad you mentioned teen boys--it is about family
systems. And we do have a program with 8\1/2\ years experience,
and only two pregnancy events, one by a male--maybe both by a
male, I do not know that, I am not up to date on that. But the
fact is, this is essentially 100 percent over 8\1/2\ years. But
it is through family systems. Yes, it is through children and
connecting them into, and particularly with their mothers gone
now for work. But what we are finding is, you have got to reach
down. You can't wait till they are teenagers.
So some of that money has to enable us to enlarge these
programs that have had at least Robert Wood Johnson review, to
reach down so that they can get the third and fourth grade
sisters and brothers of the kids who in the program, and you
can impact the whole family. We are seeing family change, and
in the end, since these kids are mostly the product of teen
pregnancies, if you don't get family change, you don't get
system reform.
Now, if we are going to bring women into the workforce with
young children, we have to think about how do we make sure that
those children don't become teen parents. And we do have models
of teen pregnancy prevention. But I am as concerned, as is my
colleague, Mr. Cardin, about the narrowness of the funding
smokestacks or pipes, because if we judge a program by its
outcome, did its outcome result in abstinence? Can you tell by
its outcome that the teens were abstinent? Then we ought to
honor that, and we ought not to look at whether they
accomplished that by teaching kids about responsible
contraception, because if they teach kids about responsible
life living skills and one of those is contraception, right now
we don't give them any money. But if their outcomes are close
to 100 percent, far better than most pledge programs or lower-
level interventions, and we see family system change, isn't
that what we want?
Mr. Jindal. Thank you for the questions, Mrs. Johnson. And
also I want to thank you, before I get to the question. I know
that you were personally involved in some of the evaluation
components of this, and I absolutely appreciate and support
that. Again, if you look at the written testimony, I think it
covered this. When you look at the programs most likely to be
funded, because there is quite a bit of discretion in both the
abstinence and the non-abstinence funding; a wide-range of
approaches. They do involve teaching life skills, and they
involve bringing in the parents and siblings as well. That is
something we find very common among successful grant
recipients.
And, again, I agree. I think the administration agrees with
the need for flexibility and for a multiple number of
approaches. And the good news is, if you look at communities,
you will see that they are in--and I am not familiar with this
program in particular in Connecticut; I am happy to learn more
about it and will do so--but you will see that the States are
using a variety of funding sources from HHS. There is $90
million in the abstinence programs. There is over $135 million
in the other types of programs. You will see that communities
have done a good job of using those multiple sources of funding
to provide programs that are consistent with their local
community values, the local norms and local desires.
Mrs. Johnson. Right. And I think just as in Welfare Reform,
we found that if we gave States flexibility, they were much
more creative in getting people off welfare. In this next kind
of welfare reform, as the author of last year's, co-author with
Mr. Cardin of last year's Fatherhood Bill, in many ways it is
outdated. We need to integrate the education of fathers of
children on welfare into welfare reform, just as we need to
integrate teen pregnancy prevention into Welfare Reform,
because we have to make whole family change if Welfare Reform
is to achieve its ultimate goal of economic viability of
families. So I would hope that the Department, as we move into
Welfare Reform, will think with us about systems change rather
than about grants for fatherhood, grants for teen pregnancy,
and how do we reach the real problem, which is as mothers go to
work, family systems disintegrate because there is no parental
oversight, and we are sort of dealing with that as a day care
subsidy issue. It is not just a daycare subsidy issue.
So I look forward to working with you, and I thank you for
your good testimony.
Mr. Jindal. Thank you. We look forward to working with you
as well.
Chairman Herger. Thank you, Mrs. Johnson. Now we turn to
the gentleman from Washington, Mr. McDermott, to inquire.
Mr. McDermott. Thank you, Mr. Chairman.
It always gives me pause to be here as a sort of middle-
aged man with a bunch of other middle-aged people deciding how
teens are not going to get pregnant.
But one of the questions that I have, in looking at this,
where you have 600,000 failures every year, I mean 750,000 kids
get pregnant, 80 percent are unintended. So that is about
600,000 young women get pregnant. I am very eager to hear how
somebody can call that a successful program. And what I have
trouble with in these two pots of money is how you look at a
young woman and say, ``Well, you are one that abstinence is
going to work in, so we are going to put you in this pot. And
you, you abstinence won't work with you, so we are going to put
you over here where we will also tell you about birth
control.''
I can't see why you have an abstinence-only program unless
you have some magic marker on young women that they are going
to somehow show up and you can spot them and say, ``Well, now
there is one we have got to do this abstinence program on.''
How do you select these people? Because, obviously, if you had
all 600,000 who got pregnant and put them in the abstinence
program, it wouldn't do a bit of good. So what is the reason
for having an abstinence program? Why don't you just have a sex
education program, which is what the Kaiser Family Foundation
says 73 percent of adults in this country say is the right
thing to do?
Mr. Jindal. Thank you for the question, Representative, and
it is certainly good to see you again after the Commission.
The very simple reason why these programs exist is they
were set up and required in the Welfare Reform Act, so we are
required to give those dollars for abstinence-only programs.
But going beyond that, again, we are only now at the beginning
of the research--and you will hear more from Rebecca Maynard on
the research into abstinence-only programs, plus the
Department's intent when it looks at the community-based
programs. We are only now at the beginning of doing rigorous
research to understand the impact of all these programs. The
administration does believe that the abstinence-only programs
do play an important role.
To answer your particular question, though, in terms of who
decides where these programs go, which individuals go into
which particular program, that is a decision that is made at
the local level, the States and the local communities getting
these dollars, and again, there are multiple programs, multiple
pots of money they can apply to within HHS. If States want to,
they can certainly access these other dollars as well, and
currently there are more dollars outside of the abstinence-only
programs for preventing teen pregnancies.
So the answer to your question in terms of who decides
which interventions to direct at a particular teenager would be
up to the State and the local communities. That is not a
decision the Federal Government is making on their behalf, but
I think Congress correctly decided to leave it to local
communities and States to decide how best to intervene on
behalf of their communities, on behalf of their teenagers in a
way that is consistent with their norms, with their values, in
a way that they judge will be most successful. And Welfare
Reform gives them a tremendous amount of flexibility to decide
how best to do that.
Mr. McDermott. And so if they have a reduction in the area,
do you get more money the next year, or how do you measure
success, or are we just shoveling money out there? Well, first
of all, let me ask a more important question: who gets this
money? Who are the--I mean the programs? Are they all faith-
based?
Mr. Jindal. Again, there are a large number of programs.
The $50 million in Welfare Reform for abstinence goes in a
block grant to the State. In terms of the dollars that were
added by Congress, $20 million is now going to many
organizations as part of a competitive grant process through
Health Resources and Services Administration (HRSA). I don't
know right now, and I can certainly get it to you, how many of
those are faith-based organizations. I would imagine a good
portion of them are. I don't know what portions of those are
faith based.
Mr. McDermott. Do you have such a listing so that somebody
could find out who gets this money?
Mr. Jindal. I can find out from HRSA and get back to you
after today.
[The information was subsequently received:]
HHS FISCAL 2001 ABSTINENCE EDUCATION IMPLEMENTATION GRANTS
----------------------------------------------------------------------------------------------------------------
Organization City State Amount
----------------------------------------------------------------------------------------------------------------
State of Alabama Department of Public Montgomery................. Ala........................ $661,902
Health.
Mid-South Christian Ministries.......... West Memphis............... Ark........................ 277,179
Fayetteville Public Schools............. Fayetteville............... Ark........................ 465,631
Arkansas Department of Health........... Little Rock................ Ark........................ 800,000
Westcare Arizona, Inc................... Bullhead City.............. Ariz....................... 239,951
Teen Awareness, Inc..................... Fullerton.................. Calif...................... 239,645
The Await and Find Project.............. Union City................. Calif...................... 285,000
Bay County Health Department............ Panama City................ Fla........................ 131,000
Empowering the Vision................... Miami...................... Fla........................ 156,297
United Students for Abstinence/Pinellas Pinellas Park.............. Fla........................ 223,642
Crisis.
Economic Opportunity FHC................ Miami Springs.............. Fla........................ 698,169
Choosing the Best, Inc.................. Marietta................... Ga......................... 593,422
Family Centered Educational Agency...... Phoenix.................... Ill........................ 279,807
St. Vincent Hospital and Health Services Indianapolis............... Ind........................ 578,022
YMCA of Cumberland...................... Cumberland................. Md......................... 251,338
Michigan Department of Community Health. Lansing.................... Mich....................... 800,000
Freedom Foundation of New Jersey, Inc... Newark..................... NJ......................... 515,481
Catholic Charities Diocese of Syracuse/ Syracuse................... NY......................... 442,086
Neighborhood Centers.
Greenburgh-Graham Union Free School Hastings on Hudson......... NY......................... 800,000
District.
Catholic Charities of Buffalo, New York. Buffalo.................... NY......................... 800,000
Tri-County Right to Life Education Springfield................ Ohio....................... 386,095
Foundation.
Pregnancy Decision Health Centers....... Columbus................... Ohio....................... 500,000
Abstinence Educators, Inc............... Mason...................... Ohio....................... 800,000
Women's Care Center of Erie County...... Erie....................... Pa......................... 262,357
Heritage Community Services............. North Charleston........... SC......................... 800,000
AAA Women's Services, Inc./Why Know Chattanooga................ Tenn....................... 254,530
Abstinence Education Program.
Fort Bend Independent School District... Sugarland.................. Texas...................... 351,815
Worth the Wait.......................... Pampa...................... Texas...................... 371,691
Scott and White Memorial Hospital....... Temple..................... Texas...................... 625,970
McLennan County Collaborative........... Waco....................... Texas...................... 800,000
Teen-Aid................................ Spokane.................... Wash....................... 751,352
Rosalie Manor Community and Family Milwaukee.................. Wis........................ 630,797
Services.
Community Actions of South Eastern West Bluefield.................. W.Va....................... 433,599
Virginia.
=============
TOTAL............................... ......................... ......................... 16,206,778
----------------------------------------------------------------------------------------------------------------
------
HHS FISCAL YEAR 2001 ABSTINENCE EDUCATION PLANNING GRANTS
----------------------------------------------------------------------------------------------------------------
Organization City State Amount
----------------------------------------------------------------------------------------------------------------
Boys and Girls Club of East Central Anniston................... Ala........................ $88,500
Alabama.
The Crisis Pregnancy Centers of Greater Phoenix.................... Ariz....................... 76,913
Phoenix.
Roseland Christian Health Ministries.... Chicago.................... Ill........................ 98,048
YWCA of Greater Baton Rouge............. Baton Rouge................ La......................... 99,362
Lao Family Community of Minnesota....... St. Paul................... Minn....................... 74,920
New Jersey Family Policy Council........ Parsippany................. NJ......................... 92,650
Several Sources Foundation.............. Ramsey..................... NJ......................... 75,000
Action for a Better Community, Inc...... Rochester.................. NY......................... 99,903
Community Services of Stark County...... Canton..................... Ohio....................... 75,000
Citizen Potawatomi Nation............... Shawnee.................... Okla....................... 62,358
Municipality of Caguas.................. Caguas..................... PR......................... 99,295
Christ Community Medical Clinic......... Memphis.................... Tenn....................... 74,578
Centerstone Community Health Centers.... Nashville.................. Tenn....................... 74,067
S.A.G.E. Advice Council................. Alvin...................... Texas...................... 99,725
Catholic Charities of the Diocese of Fort Worth................. Texas...................... 65,654
Fort Worth.
Shannon Health System................... San Angelo................. Texas...................... 75,000
Boys and Girls Club of Murray/Midvale Murray..................... Utah....................... 84,238
and Coalition.
Spokane School District #81............. Spokane.................... Wash....................... 74,500
Youth Health Services, Inc.............. Elkins..................... W.Va....................... 85,000
AIDS Resource Center of Wisconsin....... Milwaukee.................. Wisc....................... 91,690
=============
TOTAL............................... ......................... ......................... 1,666,401
----------------------------------------------------------------------------------------------------------------
Mr. McDermott. I would appreciate it. I think it would be
useful for the Committee to understand who it is that applies
for this abstinence-only money, because certainly people like
Planned Parenthood would not, because they recognize that they
have got a broader problem here. And the American Medical
Association and the American Pediatric Association, the
American Nursing Association, every responsible medical
organization says you ought to teach people about both. There
is no reason to say, ``We are just here going to tell you about
contraception. We say the best thing is abstinence, but.'' And
if you have got 600,000 young women last year who didn't want
to get pregnant, got pregnant, it seems to me that there is
falling through the cracks everywhere.
Mr. Jindal. If I can make--I know we are running out of
time, but I would like to offer two quick pieces of
information. In terms of who does apply for this money, again,
I don't know the particular organizations. I do know there are
some organizations who participate in other programs within the
Department. For example, some of the applicants do receive
money for non-abstinence programs. There are successful
applicants that also get money for other programs.
Mr. McDermott. How do you keep the dollars separated in an
organization?
[The information was subsequently received:]
U.S. Department of Health and Human Services
Washington, DC 20201
When applying for SPRANS Community-Based Abstinence Education
grants, applicants are required to provide an assurance that any
discussion of other forms of sexual conduct or provision of services
will be conducted in a setting different from where and when the
abstinence-only education is being conducted.
Mr. Jindal. Again, we can give you the information. It will
be important for that program that it is separate, but second,
I would just close by saying we do think that the abstinence-
only programs play an important role, and it is not that
communities have to do one or the other. There are multiple
programs within the Department. We think, given the wide range
of services, the abstinence-only programs do play a very
important role as a part of that range of services that are
available from the Department.
Chairman Herger. Thank you very much for your testimony.
The gentleman's time has expired.
Mr. Jindal, I understand that HHS also reviewed programs in
State and local areas that provide maternity group homes of
second-chance homes. This was an important provision in the
Welfare Reform Law aimed at ensuring that teen parents have a
structured and supervised environment in which to raise their
children. Can you please tell me how many such programs are
operating and what the Department has learned from its review
of these programs?
Mr. Jindal. I think there are approximately 130 such homes
operating in roughly 20 States, and I think in our current
budget we have asked for $33 million for these second-chance or
maternal group homes, depending on what you would like to call
them. When I say there is $33 million, please understand there
are other areas they can get funding from within our Department
and Housing and Urban Development, so those would not be the
only dollars that are available to them, and I will be happy to
provide that information to the Committee or to you, Mr.
Chairman. There are a couple of documents that the
Administration for Strategic Planning and Evaluation has
produced on these group homes and on sources of funding
available to those providers in case they are interested in
accessing the Department's various opportunities for
partnership.
[The information was subsequently received:]
U.S. Department of Health and Human Services
Washington, DC 20201
Second Chance Homes
WHAT ARE THEY?
Second Chance Homes are adult-supervised, supportive group homes or
apartment clusters for teen mothers and their children who cannot live
at home because of abuse, neglect or other extenuating circumstances.
Second Chance Homes canalso offer support to help young families become
self-sufficient and reduce the risk of repeat pregnancies. They provide
a home where teen mothers can live, but they also offer program
services to help put young mothers and their children on the path to a
better future. Several federal resources are available to help state
and local governments and community-based organizations create Second
Chance Homes that provide safe, stable, nurturing environments for teen
mothers and their children.
``I have to say Visions (a Second Chance Home in
Massachusetts) helped me quite a bit, I loved them. I wanted to
go somewhere [with my life], and the staff respected me for
that.''
TARA, AGE 18
``When I was younger I said, `I'm never going on welfare. I'm
going to college' (but) school was just too much. . . . I know
I need help for me and my son. I always wanted to be a lawyer
when I was a kid, but now with a kid and all, I just want to go
one step at a time--be a paralegal, and then college and law
school.''
SABRINA, AGE 19
Second Chance Homes programs vary across the
country, but generally include:
An adult-supervised, supportive living arrangement
Pregnancy prevention services or referrals
A requirement to finish high school or obtain a GED
Access to support services such as child care,
health care, transportation, and counseling
Parenting and life skills classes
Education, job training, and employment services
Community involvement
Individual case management and mentoring
Culturally sensitive services
Services to ensure a smooth transition to
independent living
WHY ARE THEY IMPORTANT?
Second Chance Homes offer a nurturing home for society's most
vulnerable families B teen mothers and their children with nowhere else
to go. Almost half of all poor children under six are born to
adolescent parents. Children of teen mothers are 50 percent more likely
to have low birthweight, 33 percent more likely to become teen mothers
themselves, and 2.7 times more likely to be incarcerated than the sons
of mothers who delay childbearing. Teen mothers are half as likely to
earn their high school diplomas or GEDs and are more likely to be on
welfare than mothers who are older when they give birth.\1\ In
addition, research shows that over 60 percent of teen parents have
experienced sexual and/or physical abuse, often by a household
Member.\2\ Limited early findings indicate that residents of Second
Chance Homes have fewer repeat pregnancies, better high school/GED
completion rates, stronger life skills, increased self-sufficiency, and
healthier babies.\3\
---------------------------------------------------------------------------
\1\ Rebecca Maynard, Kids Having Kids, Robinhood Foundation's
Special Report on Cost of Adolescent Childbearing, 1996.
\2\ Debra Boyer and David Fine, Victimization and Other Risk
Factors for Child Maltreatment among School Age Parents: A Longitudinal
Study, US Department of Health and Human Services, 1990.
\3\ Evaluation of Programs for Teen Parents and Their Children,
Boston University School of Social Work, June 1998.
---------------------------------------------------------------------------
Second Chance Homes help teen mothers and their children comply
with welfare reform requirements. Under the 1996 welfare law, an
unmarried parent under 18 cannot receive welfare assistance unless she
lives with a parent, guardian or adult relative. However, if such a
living arrangement is inappropriate (for example, if her family's
whereabouts are unknown or if she was abused), states may waive the
rule and either determine her current living arrangement to be
appropriate, or help her find an alternative adult-supervised
supportive living arrangement such as a Second Chance Home. Also, in
states where alternatives such as Second Chance Homes are currently not
available, teen mothers could be forced to choose between inappropriate
living arrangements and losing their cash assistance. Making Second
Chance Homes available to teen mothers in need could provide these
teens with stable housing, case management, and preparation for
independent living.
Second Chance Homes can support teen families who are homeless or
in foster care. State foster care systems may not have the capacity to
place the teens and their children together, and frequently, homeless
shelters, battered women's shelters, and transitional living facilities
cannot accept teen parents under age 17. Unfortunately, homelessness
poses the threat of separation in young families. For vulnerable
families with no safe, stable places to go, Second Chance Homes can
help fill the gap.
WHO IS ELIGIBLE?
Eligibility criteria for Second Chance Homes vary from program to
program. Some programs are targeted for adolescent mothers (between the
ages of 14 to 20, for example), mothers receiving welfare assistance,
or homeless families. Other programs are open to any mother in need of
a place to live--regardless of age, income or the assistance program
for which she qualifies. Teen mothers can be referred to Second Chance
Homes through welfare agencies, homeless shelters, or foster care
programs, or by community organizations, schools, clinics, or
hospitals. Mothers may also self-refer.
WHERE ARE THEY?
Nationwide, at least 6 states have made a statewide commitment to
Second Chance Home programs: Massachusetts, Nevada, New Mexico, Rhode
Island, Texas and Georgia. In statewide networks, community-based
organizations operate the homes under contract to the states and
deliver the services. States share in the cost of the program, refer
teens to homes, and set standards and guidelines for services to teen
families. In addition, there are many local Second Chance Home programs
operating in an estimated 25 additional states. For a directory of
programs, please visit: http://www.span__online.org/
seeking__supervision.html.
WHAT FEDERAL RESOURCES ARE AVAILABLE?
State legislatures may allocate Temporary Assistance to Needy
Families (TANF) block grant funds for Second Chance Homes. Like TANF,
state maintenance-of-effort (MOE) funds and the Social Services Block
Grant (SSBG) are flexible, and largely under states' discretion in
terms of how they are spent. States and communities may also explore
other sources of funding from HHS and HUD (see the attached chart).
Additional state and private sources of funding are available to fill
in funding gaps, help providers acquire or rehabilitate Second Chance
Homes, or develop specialized Second Chance Homes for foster care and
homeless teens.
WHERE CAN I LEARN MORE?
The attached chart contains detailed information on the major
sources of Federal funding for Second Chance Homes that are available
from HHS and HUD. In addition to the Federal sites that are included in
the chart, more general information about the Administration for
Children and Families (the agency that oversees most of the programs
within the Department of Health and Human Services) and the Department
of Housing and Urban Development can be found at http://
www.acf.dhhs.gov and http://www.hud.gov respectively. An HHS paper
describing Second Chance Homes and some things that decisionmakers at
the state and local levels may want to consider as they start or
implement a Second Chance Home program can be accessed online at http:/
/www.aspe.hhs.gov/hsp/.
There are a number of non-governmental organizations that have been
actively assessing Second Chance Homes and providing technical
assistance to states. The Social Policy Action Network (SPAN) has been
a leader in documenting existing programs, identifying best practices
and developing guides and a directory of homes. For more information
about SPAN, call 202-434-4767 or online at http://www.span-online.org.
Other organizations that can provide useful information about providing
services to teen parents in need include The Child Welfare League of
America, Florence Crittenton Division http://www.cwla.org, the Center
for Law and Social Policy (CLASP) http://www.clasp. org and the Center
for Assessment and Policy Development (CAPD) http://www.capd.org.
______
WHAT MAJOR RESOURCES ARE AVAILABLE?
----------------------------------------------------------------------------------------------------------------
What Aspects of
SCH Can These Restrictions on Who Receives Where can I get
Funds Pay For? Funding Funds? more information?
----------------------------------------------------------------------------------------------------------------
HHS Sources of Assistance
Temporary Assistance for Needy Planning & Cannot be used for States, in the State contacts for
Families (TANF) Block Grant and operating costs; facility form of formula this funding
State Maintenance of Effort cash assistance construction or block grants; stream are
Dollars (MOE). to teens; medical care states decide how provided through
parenting & life except family funds are spent this site:
skills classes; planning; within context of www.acf.dhhs.gov/
child care; job ``assistance'' a TANF plan that programs/ofa/
training & such as housing must be reviewed
placement; and cash aid can and certified by
counseling; case only go to needy HHS. For MOE,
management; teens. For MOE, state decides how
follow-up all funds must be funds are spent.
services. Also, spent on needy
anything else families. States
that reasonably define who is
meets the four needy.
broad purposes of
TANF. For MOE all
of the above.
Child Care Development Fund Child care CCDF cannot be States, State contacts for
(CCDF). assistance for used for Territories, and this funding
low-income construction or Indian Tribes in stream are
families who are major renovation the form of provided through
working or (except for formula block this site:
attending Indian Tribes). grants. www.acf.dhhs.gov/
training/ Families programs/ccb/
education; receiving
quality subsidies must
improvement meet income
efforts such as eligibility
grants or requirements and
training for have children
child care under age 13 (or
providers. age 19 if not
capable of self
care).
Social Services Block Grant Planning & Cannot be used for States, in the State contacts for
(SSBG). operating costs; facility form of formula this funding
parenting & life purchase, block grants; stream are
skills classes; construction states must provided through
child care; job renovation; report to HHS on this site:
training & medical care how funds are www.acf.dhhs.gov/
placement; except family spent and who is programs/ocs/ssbg
counseling; case planning; cash served.
management; aid; unlicensed
follow-up child care; drug
services. rehab; public
education; room
and board;
services in
hospitals,
nursing homes, or
prisons.
Child Welfare Services Title IV- Child welfare All children States and Indian www.acf.dhhs.gov/
B Subpart 1 and 2 Funds. services, family receiving State Tribes receive programs/cb/
preservation and or Federal foster Title IV-B programs/index.htm
reunification, care funds must subpart 1 and 2
family support, also receive funds on a
adoption certain formula basis.
promotion and protections under
support. Title IV-B.
----------------------------------------------------------------------------------------------------------------
WHAT MAJOR RESOURCES ARE AVAILABLE?--Continued
----------------------------------------------------------------------------------------------------------------
What Aspects of
SCH Can These Restrictions on Who Receives Where can I get
Funds Pay For? Funding Funds? more information?
----------------------------------------------------------------------------------------------------------------
HHS Sources of Assistance
Independent Living Program...... Room and board Funds must be States, on a www.acf.dhhs.gov/
(for youth aged spent on youth formula basis. programs/cb/
18-21 only); between the ages programs/index.htm
education; life of 18 and 21 to
skills training; assist them in
counseling; case making the
management. transition from
foster care to
independent
living.
Transitional Living Program for Housing, life Funds can only be HHS awards 3-year www.acf.dhhs.gov/
Homeless Youth. skills training, used to serve competitive programs/fysb/
interpersonal youth aged 16-21 grants to multi- programs/
skills building, for up to 18 purpose youth pgm__tlp.htm
education, job months who are: service
training, health homeless, organizations.
care. including those
for whom it is
not possible to
live in a safe
environment with
a relative; and
who do not have
an alternative
safe living
arrangement.
HUD Sources of Assistance
Community Development Block Facility purchase, At least 70 States, major Contact your local
Grant (CDBG). construction, percent of funds cities, urban HUD office. A
renovation; must benefit low counties, in the listing is
planning and moderate form of formula available at:
operating costs; income families; block grants. http://
parenting & life states and www.hud.gov /
skills classes; communities must local.html
child care; job prepare action
training & plan with
placement; community input.
counseling; case
management;
follow-up
services.
----------------------------------------------------------------------------------------------------------------
WHAT MAJOR RESOURCES ARE AVAILABLE?--Continued
----------------------------------------------------------------------------------------------------------------
What Aspects of
SCH Can These Restrictions on Who Receives Where can I get
Funds Pay For? Funding Funds? more information?
----------------------------------------------------------------------------------------------------------------
HUD Sources of Assistance
HUD Supportive Housing Program.. Facility purchase, Funds must be HUD awards 3-year, Contact your local
construction, spent on homeless renewable HUD office. A
renovation; new persons only; 25 competitive listing is
or increased percent set aside grants to states, available at:
services to the for families with tribes, cities, http://
homeless; children; 25 counties, other www.hud.gov/
operating percent set aside governmental local.html.
expenses; some for disabled; 10 entities, private
admin costs. percent set aside non-profits,
for supportive community mental
services not health
provided with associations.
housing. Homeless
minors may be
eligible to
receive services
under this
funding source
unless they are
considered wards
of the state
under applicable
state law.
HUD Emergency Shelter Grants.... Facility Funds must be States, major Contact your local
renovation; spent on the cities, urban HUD office. A
operating costs; homeless or those counties, in the listing is
homelessness at risk of being form of formula available at:
prevention; homeless; only 5 grants. http://
employment, percent of funds www.hud.gov/
health, drug can be used for local.html.
abuse, education admin costs, and
services. 30 percent for
prevention and
services.
Homeless minors
may be eligible
to receive
services under
this funding
source unless
they are
considered wards
of the state
under applicable
state law.
----------------------------------------------------------------------------------------------------------------
WHAT MAJOR RESOURCES ARE AVAILABLE?--Continued
----------------------------------------------------------------------------------------------------------------
What Aspects of
SCH Can These Restrictions on Who Receives Where can I get
Funds Pay For? Funding Funds? more information?
----------------------------------------------------------------------------------------------------------------
HUD Sources of Assistance
Rental Assistance Vouchers...... In general, the Teenage mothers In order to Contact your local
voucher pays the may be eligible receive a Public Housing
landlord the for vouchers. voucher, a renter Authority.
difference However, the must apply to his/
between 30 voucher program her local Public
percent of a requires that a Housing Authority.
renting family's lease be signed
gross income and by the renter,
the price of the and in some
rental unit, up states minors may
to a local not sign a lease.
maximum. Individual PHAs
determine whether
a shared housing
facility is an
acceptable use
for the voucher.
The PHA must
approve the
renter and the
unit according to
various
eligibility
criteria.
HUD's Dollar Homes Program...... Property ................ Local governments http://www.hud.gov/
acquisition. (cities and dollarhomes
counties) can Also, the full
purchase HUD text of Housing
owned homes for Notice 00-7
$1 each, plus (``Implementation
closing costs, to of $1 Home Sales
create housing to Local
for families and Governments
communities in Program'') can be
need. Local downloaded at
governments can http://
purchase these www.hudclips.org
homes and then (Click on ``2000
convey them to Housing
non-profit Notices'')
organizations for
use.
----------------------------------------------------------------------------------------------------------------
WHAT MAJOR RESOURCES ARE AVAILABLE?--Continued
----------------------------------------------------------------------------------------------------------------
What Aspects of
SCH Can These Restrictions on Who Receives Where can I get
Funds Pay For? Funding Funds? more information?
----------------------------------------------------------------------------------------------------------------
HUD Sources of Assistance
HUD's Non-Profit Sales Program.. Property Direct sales of Non-profit www.hud.gov/
acquisition. properties organizations can goodneighbor/
foreclosed by the purchase nonprofitsales/
Federal Housing properties at a index.html
Authority. discount through
Discounts of 30 this program.
percent off the
list price are
offered if the
property is not
eligible for FHA
insurance and is
located in a HUD-
designated
``revitalization'
' area. Other
properties are
offered at 10
percent discounts
off list price
(or 15 percent if
five or more
properties are
purchased and
closed in a
single
transaction).
These discounts
apply to sales in
both restricted
and general
property listings.
HUD Sources of Assistance
McKinney Act Title V Program.... Property Properties are Surplus properties Within HUD: at the
acquisition. leased without can be made Office of Special
charge for a available to Needs Assistance
period of 1 to 20 States, local Programs (202)
years, but the governments and 708-1234
entity providing non-profit From HHS: (301)
homeless services organizations for 443-2265
must pay for use to assist the
operating and homeless.
repair costs.. Available
properties are
listed in the HUD
Federal Register
notice listing
property
availability HHS
handles the
application
portion of the
program.
Military Base Closures.......... Property ................ When a military Contact your Local
acquisition. base is being Redevelopment
closed, a Local Authority
Redevelopment
Authority is
designated to
redeploy the
assets of the
base.
----------------------------------------------------------------------------------------------------------------
Early indications are that we do see some positive results
in terms of not only outcomes for the mother, but also for the
child. We do see some early positive trends in terms of the
likelihood that the mother will get work force skills and
education. Going back to the points made by previous questions,
we do see early indications that the child is also more likely
to have positive health care outcomes. I say ``early
indicators'' because it is still early and there isn't
comprehensive or rigorous research. Part of the challenge has
been that these programs are fairly small, they serve a small
number of people, there hasn't been a very good control group
to compare the results with, but the early indicators are
certainly very positive that in giving a structured environment
for these women who may not otherwise have had structured
environments, you can accomplish good things both for the
mothers and for the children. Combined with Welfare Reform, as
you know, which allows States to require teen mothers to live
with adult supervision or in a structured environment, these
group homes can play an important role. And that is why the
administration has asked for $33 million in the 2002 budget.
Chairman Herger. Thank you very much, Mr. Jindal, and I
thank you for your outstanding fine testimony.
Mr. Jindal. Well, thank you, Mr. Chairman. Thank you,
Members of the Committee.
[Questions submitted from Chairman Herger to Mr. Jindal,
and his responses follow:]
1. In your testimony, you mention that teen boys ought also to be
the focus of teen pregnancy prevention efforts. Can you describe the
types of programs that are effective in encouraging teen boys to remain
abstinent?
The Department recognizes that boys and girls have a shared
responsibility in the prevention of teen pregnancy. Many abstinence
programs target both girls and boys and recently, providers have begun
developing curricula aimed specifically at addressing the concerns of
boys. Unfortunately these programs are too new to have been fully
evaluated. The national evaluation of abstinence education will provide
gender specific outcome information for the mixed gender programs it is
studying.
2. Please compare Federal and State funding for family planning,
including contraception, with funding for abstinence education for each
year since 1996.
1. FAMILY PLANNING SERVICES TO ALL WOMEN OF ALL AGES \1\
Funding (in millions dollars)
----------------------------------------------------------------------------------------------------------------
Progarm 1996 1997 1998 1999 2000 2001
----------------------------------------------------------------------------------------------------------------
Federal and State funding for family planning, including contraception, to women of all ages \2\
Title X \3\........................................ 192.6 198.5 203.5 215 238.9 253.9
Medicaid:
Federal Share.................................... 454.7 394.3 393.4 483.8 535.5 925.4
State Share...................................... 45.5 39.4 39.3 48.4 53.6 92.5
Total.......................................... 692.8 632.2 636.2 747.2 828 1,271.8
2. Abstinence Education Funding \1\
Adolescent Family Life Program..................... \4\ 1.8 \4\ 10.2 \4\ 10.8 \4\ 10.4 10.5 10.4
Title V section 510:...............................
Federal Share \5\................................ ........ ........ 50 50 50 50
State Match \6\.................................. 37.5 37.5 37.5 37.5
SPRANS \7\......................................... ........ ........ ........ ........ ........ 20
Total.......................................... 1.8 10.2 98.3 97.9 98 107.5
----------------------------------------------------------------------------------------------------------------
\1\ This represents Federal programs that we know states use to fund these activities. States may be using other
funds, but we do not have the reporting capability to know.
\2\ Several other Federal programs fund family planning services, including Title V MCH Block Grant, Title XX
SSBG, TANF and TANF bonuses for reduction in illegitimacy rates.
\3\ An estimated 90 percent of the total expenditures goes for services.
\4\ Includes projects that also have a care component for pregnant and parenting teens.
\5\ This is the total amount of Federal funding available. Not all states and territories have applied for
funding in each year. In 2001, the total amount awarded was $43.5 million.
\6\ The required state match is $3 for every $4 Federal dollars. The total amount will vary with the amount of
Federal funds awarded.
\7\ This is the Special Projects of Regional and National Significance community-based abstinence education
grant program. The FY 01 budget included an advance appropriation of $30 million for the SPRANS program for
2002. The FY 02 Labor/HHS appropriation included an additional $10 million for a total of $40 million in FY
2002.
3. Do you feel the funding streams for abstinence, family planning,
and adolescent life programs are sufficiently flexible to provide
opportunities for a broad array of program approaches that address teen
pregnancy prevention and teen sexuality?
Through the abstinence, family planning and adolescent life
programs, along with other programs at HHS, a range of teen pregnancy
prevention activities are funded. While the uses of abstinence funding
through the Title V state program, the SPRANS community-based program
and the Adolescent Family Life program, have been Congressionally
prescribed, the Department's health agencies have a variety of funding
streams for the prevention of adolescent risk behaviors. States and
communities can use these funds quite flexibly to improve overall
adolescent outcomes. In addition states receive Federal block grant
funding, such as TANF, that can be used to provide a range of pregnancy
prevention services.
Chairman Herger. And at this time if the witnesses for our
second panel would please have a seat at the table.
On the second panel this morning, we will be hearing from
Gale Grant, director of the Virginia Abstinence Education
Initiative in Richmond, Virginia; Elayne Bennett, president of
Best Friends Foundation, which is the subject of a recent
``Washington Times'' article that I would like included in the
hearing record.
[The Washington Times article follows:]
D.C.'s Best
Cheryl Wetzstein
The Washington Times
Published 11/6/01
Asriel-Janifer wants to go into the Air Force and fly jets.
Derrenzo Hines wants to play football. Their friend Ryan Vaughn isn't
quite sure where his destiny lies.
For now though, these three 13-year-old D.C. boys are pursuing
something else--good reputations.
``We don't want people to mess with the Best Men,'' said Derrenzo.
The three boys, all eighth-graders at Jefferson Junior High School
in Southwest Washington, are Members of the fledgling Best Men program,
a companion to the highly praised Best Friends for girls.
Like Best Friends, which was founded in 1987, Best Men uses an in-
class study program, physical exercise and mentoring to teach teens how
to say no to smoking, drugs, alcohol and sex--and yes to self-respect
and healthy lifestyles.
Best Men also stresses an ideal of manhood: Its logo carries the
image of an eagle as a symbol of vision, a lion as a symbol of
strength, an anchor as a symbol of courage and strength, and a gavel as
a symbol of truth and justice.
Boys learn ``how to carry themselves as gentlemen, how to conduct
themselves and have respect for themselves, women, young ladies and
authority figures in general,'' said Alan Holt, dean of students at
Southwest Washington's Amidon Elementary School, which has had all its
sixth-grade boys in the program last year and this year.
Best Men started in the 2000-2001 school year at Jefferson and
Amidon, and in several Milwaukee public schools. This year, the program
is in the same schools, plus others in Texas and New Jersey.
It teaches boys ``how to choose good friends, how to make the right
decisions, and why you stay away from dangerous activities, such as
sex, drug use and alcohol use,'' said DeLeon Ware III, a math teacher
who helps lead the program at Jefferson.
Elayne Bennett, founder of Best Friends, said Best Men was created
``because every time we would talk about what we're doing for the
girls, someone would say, `But what about the boys?' ''
Despite concerns that Best Men would siphon off resources from the
rapidly growing Best Friends program--which now has 5,000 girls in 99
public schools in 14 states, the District and the U.S. Virgin Islands--
Best Friends Foundation leaders decided ``we just have to try,'' Mrs.
Bennett said.
Evidence of the Best Men's positive impact could be seen after the
first year in the District, said Mrs. Bennett, who is married to former
Education Secretary William J. Bennett and is the mother of two sons.
In a survey taken at the beginning of the Best Men program, 31
percent of some 60 teen-age boys said they had had sexual intercourse
in the past 3 months. By the end of the year, 20 percent of the boys
said they had had sexual intercourse in the previous 3 months.
It was especially heartening that eight of the previously sexually
active boys said they would abstain from sex either until they
graduated or got married, said Mrs. Bennett.
Hundreds of abstinence-education programs are in place nationwide,
but few target boys exclusively, according to the Abstinence
Clearinghouse in Sioux Falls, S.D.
A program introduced this year--the Game Plan Abstinence Program--
by Miami Heat basketball star A.C. Green and Project Reality of Golf,
Ill., uses a sports motif, but can be used with both boys and girls.
Abstinence researchers say single males face formidable obstacles
in sexual self-control--the popular culture has exploded with
permissive sexual imagery, while social messages to stay chaste and
marry have weakened.
As a result, many teen-pregnancy-prevention programs stress sexual
abstinence with young teen males, but later, ``assuming that most older
teen boys and young men will be sexually active,'' focus on
contraception, the National Campaign to Prevent Teen Pregnancy said in
a 1997 publication, ``Not Just For Girls: The Roles of Boys and Men in
Teen Pregnancy Prevention.''
Still, studies in the 1990s indicate that boys were hearing
abstinence messages. According to the Federal Youth Risk Behavior
Survey, in 1991, 57.4 percent of high school males had sexual
intercourse. This figure dropped to 48.8 percent in 1997 and upticked
to 52.2 percent in 1999.
The number of sexually active high school girls fell also, but less
dramatically: In 1991, 50.8 percent of girls had sexual intercourse.
This figure was 47.7 percent in both 1997 and 1999.
The District's Best Men program involves 30 boys at Amidon and 60
boys at Jefferson, program leaders said. The boys have monthly
meetings, where they study the Best Men curriculum and delve into such
things as manhood, decision-making and relationship skills.
The boys learn that girls have pickup lines--like ``Come on, prove
you're a man''--and how to resist them, said Mrs. Bennett. ``We also
teach boys that their role is to protect and take care of the girl,''
and realize, that for a teen-age girl, ``pregnancy would not be in her
best interest,'' she said.
Best Men Members meet weekly for martial arts, which builds fitness
and mental discipline, and have frequent contact with male mentors at
their school. There are also field trips, sports activities, tutoring
and community-service projects. Adult females are welcomed and
appreciated, but the goal is to connect young men to strong male role
models, program leaders said.
Derrenzo said that joining Best Men has helped him with self-
control. ``I had self-respect, but if an adult would say something to
me that I didn't like, I would just say something back,'' said the
youth, who lives with his parents and an older brother. ``Since I've
been in the program, I've been able to catch myself before I say
something.''
``When I was in elementary school, I had just a little, tiny
attitude problem,'' said Ryan, who grinned as Mr. Holt, his former
teacher, shot him a knowing look.
``When I heard about Best Men,'' continued Ryan, whose parents have
recently reunited, ``I thought that this would help me to have some
self-control and bring a brighter future for me.''
``I wanted to be in Best Men because I heard it was like Best
Friends, and they're so disciplined and have a good reputation,'' said
Asriel, who lives with his parents and two sisters. ``Best Men helped
me learn about drug abuse,'' he added. ``There are messages `about just
say no,' but really, you just can't say no. [Best Men] teaches you the
real thing, what to do when somebody tells you to take some drugs.''
In Best Friends, girls graduate into the Diamond Girls program in
high school; many are eligible for college scholarships from the Best
Friends Foundation. A companion program for high school boys, called
the Iron Men, is being discussed, said Lori Anne Williams, the Best
Friends cultural-arts director.
Copyright News World Communications, Inc. All rights
reserved.
Chairman Herger. Rebecca Maynard, university trustee
professor of education and social policy at the University of
Pennsylvania in Philadelphia.
And, Mrs. Johnson, would you like to introduce the next
witness?
Mrs. Johnson. I certainly would, Mr. Chairman, and thank
you very much for this opportunity.
There is not very many of us that really change people's
lives, and I am please to introduce RoseAnne Bilodeau, who
really has changed the lives of so many kids in my hometown.
She came into a neighborhood that was gang-ridden, one of the
most dangerous, one of the poorest neighborhoods in a city with
a lot of problems, and she has created opportunity for those
kids. Over 8\1/2\ years only two instances in which one of
those young people was involved in a pregnancy.
You know, I have visited a lot of young parents' programs.
And who is there? The girls with their babies. I visit this
program, and who is there? The girls and the boys. They did a
poetry book. Most of the poems were written by the boys.
So we can do it. We can take this opportunity to help
families in our society grow in such a way that they don't
become at risk and into the Department of Children and Families
and all the family agencies. But we have to be smarter. And I
just am so thrilled to have RoseAnne Bilodeau here, who has
done such a wonderful job of impacting the lives of young
people and their parents. Thank you for being here.
Chairman Herger. Thank you, Mrs. Johnson.
We also have Dr. Joe McIlhaney, president of the Medical
Institute for Sexual Health in Austin, Texas; and Sarah Brown
from the National Campaign to Prevent Teen Pregnancy in
Washington, D.C.
Again, I would like to welcome each of you, and if we could
begin with the testimony. Ms. Grant.
STATEMENT OF GALE E. GRANT, DIRECTOR, ABSTINENCE EDUCATION
INITIATIVE, VIRGINIA DEPARTMENT OF HEALTH, RICHMOND, VIRGINIA
Ms. Grant. Good morning, and thank you, Chairman Herger and
other Members of the Committee for allowing me to be here
today. I am Gale Grant, director of the Virginia Abstinence
Education Initiative which operates through the Virginia
Department of Health.
Having been involved in teen pregnancy prevention for quite
a number of years for personal reasons, primarily because I was
born to a 15-year-old. And also when I went to graduate school
I focused on human development, and have really studied the
life span from infancy to older age to elderly. I focused in
though on the adolescent period, preadolescence and
adolescence, because I had particular interest in that, and
particularly adolescent sexuality and the issues related to
that.
During my work in teen pregnancy prevention I saw grueling
work, and I love the work, trying to work with girls and their
families, and young men, to have some impact on what would
happen to those young people as they were being parented,
either as a girl emancipated herself or if she stayed in the
home with other family Members. And I found that I just felt
like I was spinning my wheels. So many times it was so
difficult to prevent the second pregnancy. And I decided to
take a step back and look at how did we get here? And that led
me to much more emphasis in primary prevention and actually
started hearing about abstinence education and looking into
what that was all about. I realized that until we deal with
teens engaging in sexual activity, we truly cannot have an
impact on teen pregnancies. We must deal with the source and
the sexual activity, young people engaging in sexual activity
that leads to pregnancies and other consequences of that
activity.
Consequently, I felt very prepared, after spending pretty
much most of the 1980s training people in abstinence education
around the State for this job as Director of the Abstinence
Education Initiative for Virginia. And in Virginia we took a
different approach with our monies. We decided that we wanted
to look at the impact of teaching abstinence until marriage
education. So we designed a large quasi-experimental
longitudinal study. We did receive some flack around the State
for doing that because we just didn't take our dollars and
throw them out there, let people apply and do good as people
want to do a lot of times with monies like this. They want to
help kids, which is of some merit, but we really wanted to take
an empirical approach to this.
So we had a request for proposal process, which was
competitive, and funded six agencies to provide abstinence
until marriage education. We provide a great deal of training
to those agency staff. We provide technical assistance. And
consequently, we have what we believe is the foundation for a
very strong quasi-experimental evaluation, because we don't
have random assignment to control and treatment groups, but we
do have match comparisons.
And what we are finding right now, we are looking at our
preliminary data, first year, and annual follow-up, and we are
finding that we have very strong linkages between our pre- and
post-test, we are not losing kids from the time that they take
our pre-test to the time they take our post-test. We have
fairly good strong linkages from year one to year two, from
when kids take that post-test that first year they are in our
programs, and then when they take their annual follow-up, which
we give them every year, along with a booster session after
they have left that primary year, the first year they come in,
we provide booster sessions for young people each subsequent
year, and we are finding that we have good strong compatibility
between our program and our comparison group, and that our
scales on our survey are very reliable and strong.
One of the major findings I wanted to share with you right
now is that two of our four projects with our longitudinal data
are showing significant pre-post movement on most or all of our
short-term predictors, and I have those predictors listed in my
written testimony, as compared to our comparison group which
showed no change at all. The other two projects did not show
short-term change on our short-term measures.
It is interesting to us in Virginia, as we look at our data
and start to analyze, because with respect to our prediction
model and our evaluation model, we would expect that those
programs would show change in the short-term predictors if they
really, really are good predictors of behavioral intent, to
show change in our short-term predictors. If they really are
good predictors to also show change in the longer term in terms
of our behavioral data. And I feel, I would like to say, that
what we are finding with our model is that those factors that
predict behavioral intent for young people leaning toward
sexual activity were showing that our construct, our picking up
those factors, and that right now from year one to year two--
and we have other years to follow with these kids--that we are
showing some change in terms of kids not transitioning from a
virgin to non-virgin status. And I hope that wasn't confusing,
but that is our dependent variable in Virginia. We are trying
to keep kids from moving from virginal to non-virginal status
in terms of our design.
Thank you.
[The prepared statement of Ms. Grant follows:]
Statement of Gale E. Grant, Director, Abstinence Education Initiative,
Virginia Department of Health, Richmond Virginia
Introduction
In general, evaluation research and its findings serve three
primary functions:
1. to judge merit or worth
2. to improve programs and policies
3. to generate knowledge.
Research should never be undertaken to ``prove'' something--
research probes. A substantive finding or hypothesis is one that
repeatedly survives such probing. A single piece of work should never
be looked upon as either complete or conclusive. In order to make any
kind of conclusive statements about the function, efficacy, and/or
contributions of abstinence education, there must exist a body of
literature.
The literature on the effectiveness of abstinence education
programs is meager at best. None of the small number of published
studies have demonstrated reductions in sexual activity levels, but
each study suffers design flaws that prevent conclusions about either
positive or negative effects. Thus, we presently have no scientific
basis for judging the merit or worth of such programs, for improving
these programs, or for developing policies related to these programs.
Is Rigorous Evaluation of Abstinence Education Programs Possible?
The strength or rigor of any program evaluation research is
dependent in large part upon the following contributing factors:
1) The strength and integrity of the program that is being
evaluated
2) The strength of the research design/methodology
3) The use of assessment instruments whose measures are both
reliable (consistent) and valid (accurate)
4) The replicability of the research findings
Each of these contributing factors are controllable, thus making
rigorous evaluation of abstinence education programs theoretically
possible.
What are the Challenges to the Rigorous Evaluation of Abstinence
Education Programs?
By its very nature, human subjects research occurs outside of a
controlled laboratory environment. Programs are rarely implemented
exactly as they are intended, unanticipated outside influences often
come into play, etc. The accuracy and completeness of documentation of
the processes and events that took place during the period of the study
are crucial for the interpretation of research data.
The use of strong research designs is often hampered by lack of
resources (evaluation is expensive), political pressures (rarely do
people want to serve as the control/comparison group and not receive
the intervention), structural limitations (class assignments and
student schedules), and poor planning (in most cases, evaluation is an
after-thought). There are four primary designs for measuring program
outcomes and impacts. The first two are the only ones which allow for
true assessments of program outcomes/impacts:
1) Random Assignment/Experimental Design
--This is the strongest design available because it
eliminates all sources of bias.
--This design must be developed prior to program
implementation
2) Comparison Group with Pre and Post Measures/Quasi-
Experimental Design
--Next strongest design
--The primary limitation to this design is that it
does not control for pre-existing differences in
unmeasured attitudes/values/behaviors/risk factors
3) Comparison Group with Post Measures Only
--Has serious limitations since it runs the risk of
peer group selection biases and does not control for
pre-existing differences in measured or unmeasured
attitudes/values/behaviors/risk factors
4) Pre-post test with Program Participants Only
--Has serious limitations because it does not control
for maturation
The definition of abstinence and abstinence education is often
confusing/ambiguous. In addition, consensus regarding program goals and
outcomes is not always easy to come by. For example, decreases in
sexual activity or delays in the initiation of sexual activity are
definitely seen as positive outcomes. However, the definition of sexual
activity (intercourse versus other forms of sexual involvement) is
frequently a subject of debate.
Different types of knowledge are generated based on the type of
evaluation research being conducted. For example, formative evaluation
research assists programs with the documentation of program processes
and their implementation. This leads to programs that are more
effective. Summative evaluation research, on the other hand, assists
sponsors with information about program success/effectiveness. This
leads to greater accountability for resources and more effective policy
decision-making.
It has been said by opponents of abstinence education that the
efficacy of it has not been demonstrated. In fact, opponents have
attempted to say that it does not work. The truth is that the
literature on the efficacy of abstinence education programs is meager
at best, and that the jury is still out on whether or not it is
effective. Where there is literature on the efficacy of abstinence
education programs, that literature has historically been replete with
methodological weaknesses. Many of these methodological problems were
due to compromises of program integrity from weak or poor program
design/implementation resulting from inadequate funding.
History
The Virginia Abstinence Education Initiative is a five-year, multi-
component effort to implement new approaches that will help adolescents
develop the attitudes and skills necessary to delay sexual involvement
until marriage, and to evaluate systematically the effectiveness of
those approaches. Unlike many of the evaluation of abstinence education
efforts around the country both past and present, systematic evaluation
of the program was built into the Virginia Abstinence Education
Initiative (VAEI) from the very beginning. Due to the criticisms thrown
at abstinence education programs, the VAEI sought two things as a
priority: 1) adequate funding to support strong program design and
integrity of program implementation and 2) adequate funding to support
formative and summative program evaluation.
Consequently, the Virginia Department of Health (VDH), which has
the responsibility for VAEI program administration, built evaluation
expectations into its Request for Proposals. In addition, VDH
established an Evaluation Consortium comprised of faculty from five
public universities in Virginia (University of Virginia, George Mason
University, James Madison University, Virginia Commonwealth University,
Christopher Newport University) with expertise in program evaluation
and one national expert on the evaluation of abstinence education
programs. The Evaluation Consortium provides technical assistance to
local program sites, provides guidance around the design of data
collection and evaluation methodology, and data analyses and
interpretation. In addition, VDH has subcontracted with the Survey and
Evaluation Research Laboratory (SERL) at Virginia Commonwealth
University to design and implement a data reporting system to support
evaluation and monitoring activities.
Overview
The VAEI evaluation system is comprised of both formative and
summative evaluation components. Data for the VAEI evaluation system is
collected using the the following five tools:
1. Quarterly Implementation Progress Reports (QIPRs): The QIPR
serves as a qualitative report on each program's activities and
barriers related to achieving the overall program goals. The QIPR is
used to record the history of the program, including any events that
occur in the school or community that may influence the participants in
the program.
2. Community Education Information Reports (CEIRs): The CEIR serves
as a way to capture basic information on activities and audiences that
are very diverse in nature. Community education is defined as a one-
time or short-term program where it is impractical or unfeasible to
capture attendance data (or for short series of sessions where there is
no expectation that the same participants will return for each
session).
3. Intervention Project Attendance Reports (IPARs): Intervention
projects are defined as projects where there is an expectation that
individuals will be ``enrolled'' into a planned approach or curriculum
that includes multiple contacts where the information in each
subsequent session builds upon information that has been covered
previously.
4. Survey of Youth Attitudes and Behaviors: The purpose of the
survey is to capture the attitudes and behaviors of youth related to
marriage, sex, and sexual abstinence. This questionnaire is
administered to all participants at the first or second session (pre-)
and at the final session (post-) to assess the level of impact of the
program's activities. The questionnaire is also administered to program
participants annually over the course of program funding (longitudinal
design). This longitudinal design allows for the capturing of both long
and short term changes. Additionally, in order to attribute any change
to the program's activities, the same survey is also administered to a
comparison group within two weeks of the participant administrations.
This quasi-experimental design helps to insure that any changes noted
pre-to-post program can be attributed to the intervention and not due
to normal maturation or other events that may happen in the
environment. Since this initiative is implemented over five years, the
longitudinal and quasi-experimental nature of the design creates a
rather complex but rich source of data. (see Table 1).
5. Other Methods as needed as determined cooperatively between the
program site, the evaluation consortium member assigned to that site,
in consultation with all members of the Evaluation Consortium.
Preliminary Findings
Six program sites were selected to receive VAEI funding during the
first year of the initiative. By nature of human subjects research that
is outside of a controlled laboratory environment, there will never be
a perfect study. However, results from the first year of a five-year
study show strong scale reliability and strong comparability between
program and control groups in all but one of the six sites. Having
accurate and complete recording of processes and events that take place
during the period of the study, a strong design/methodology from the
very beginning, and the use of reliable/valid assessment instruments
establishes a good foundation for a strong study.
In addition, during the first year, three of the six funded sites
had enough participants and strength and integrity of program
implementation to warrant some in-depth analyses about short-term
program effects. Of the three sites, one had very strong statistically
significant short term treatment effects in the desired direction, one
had moderate statistically significant short term treatment effects in
the desired direction, and one showed little significant short term
treatment effects in the desired direction. These types of outcomes are
generally not attainable in the first year of a pilot project since
first year projects generally have weak program elements and
problematic rates of participation. On the flip-side, three of the six
sites did experience the expected problems related to weak program
implementation or less than optimal participation rates. However, it is
anticipated that with the feedback and lessons learned from the first
year, these already positive findings will become increasingly so over
the next three years.
The strength of the VAEI design not only shows great promise in its
ability to contribute to the body of knowledge about the efficacy of
abstinence education programs, but has also attracted national
attention and recognition. Due to the groundwork laid by the VAEI, one
of the six VAEI program sites has been selected by Mathematica Policy
Research (MPR) as a model program site for their federally funded
national evaluation of abstinence education programs.
Data Summary for Years 1 and 2 of 5
Year 1 data showed very strong pre- and post-test
linkages in 3 of 6 programs. Year 2 data showed very strong
pre- and post-test linkages in all programs being evaluated.
Year 1 and Year 2 data show strong comparability
between program and control groups in more than half of the
programs being evaluated. Some work remains to be done to
increase group comparability in two of the sites.
Year 1 and Year 2 data show that there is very
strong scale reliability on all measures.
Year 1 data showed moderate to very strong program
effects in the majority of programs. Year 2 data showed
moderate program effects, but also showed similar movement in
the desired direction among comparison group youth.
Two of the four projects with longitudinal data
showed significant pre-post movement on most or all of the
short-term predictors as compared to the comparison groups,
which showed no change. The other two projects did not show
short-term change on the short-term measures. This is
interesting to us for several reasons. With respect to our
evaluation model, we would expect those programs which show
change in short term predictors, if they really are good
predictors, to also show change in short term predictors, if
they really are good predictors, to also show change in the
longer term--on the behavioral data.
Highlights
Virginia has been selected to be one of only four states to present
their evaluation study at the national abstinence evaluator's workshop
in July 2000. Selection criteria included strength of design, positive
progression of the study, and availability of data.
The Association of Maternal and Child Health invited Virginia to
participate as a panelist for a teleconference on abstinence program
evaluation.
Most recently, we presented at both the American Public Health
Association and the National Organization of Adolescent Pregnancy
Parenting and Prevention conferences.
TABLE 1: THE VIRGINIA ABSTINENCE EDUCATION INITIATIVE SURVEY ADMINISTRATION AND LONGITUDINAL TRACKING TIMETABLE
--------------------------------------------------------------------------------------------------------------------------------------------------------
Year Pre-test Post-test Annual Annual Annual
--------------------------------------------------------------------------------------------------------------------------------------------------------
1998-1999.......................... Post(Cohort 1--....... Pre(Cohort 1--........
Program and Program and
Comparison). Comparison).
1999-2000.......................... Pre(Cohort 2--........ Post(Cohort 2--....... Annual (Cohort 1--...
Program and Program and Program and
Comparison). Comparison). Comparison).
2000-2001.......................... Pre(Cohort 3--........ Post(Cohort 3--....... 2nd Annual (Cohort 1-- 1st Annual (Cohort 2--
Program and Program and . .
Comparison). Comparison). Program and Program and
Comparison). Comparison).
2001-2002.......................... Pre(Cohort 4--........ Post(Cohort 4--....... 3rd Annual (Cohort 1-- 2nd Annual (Cohort 2-- 1st Annual (Cohort 3--
Program and Program and . .
Comparison). Comparison). Program and Program and Program and
Comparison). Comparison). Comparison)
--------------------------------------------------------------------------------------------------------------------------------------------------------
______
TABLE 2: KEY PREDICTORS OF BEHAVIOR INTENTIONS (1ST YEAR DATA)
------------------------------------------------------------------------
First order Second order
------------------------------------------------------------------------
Peer environment........... Future orientation
Opportunity................ Reasons to wait
Sexual values.............. Love justifies sex
Personal efficacy.......... Value of marriage
Prior experience........... Religiousness
Parental respect and
approachability
------------------------------------------------------------------------
Chairman Herger. Thank you very much for your testimony,
Ms. Grant. Now Mrs. Bennett.
STATEMENT OF ELAYNE G. BENNETT, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, BEST FRIENDS FOUNDATION
Mrs. Bennett. Thank you so much for inviting me here.
Chairman Herger and Congresswoman Johnson, my name is
Elayne Bennett. I am the President, founder, chief executive
officer, instructor, chief cook and bottle washer, I guess, of
the Best Friends Foundation.
I want to tell you how we at Best Friends have found a way
to reduce sexual activity and pregnancies among teenage girls.
We have accomplished through a long-term program that is
presented during the school day. It is initiated, operated and
financed at the local level, and it teaches abstinence. That is
the message we believe young girls want to hear.
When Marian Howard of Atlanta's Emory University asked
1,000 teenage mothers what they wanted to learn in sex
education, 82 percent of them said how to say no without
hurting my boyfriend's feelings. Best Friends' girls learn how
to say no, and we don't particularly care whether they hurt
their boyfriends' feelings.
A recent survey conducted--that is actually something you
can laugh at I hope.
[Laughter.]
Mrs. Bennett. A recent survey conducted by the American
Association of University Women--it is the foundation of AAUW--
survey conducted on 2000 11- to 17-year-old girls found that
the vast majority said that sex and how to say no in
emotionally-charged relationships was their number one concern.
And the National Campaign to Prevent Teen Pregnancy found that
93 percent of teens said that, ``It is important for teens, for
us, to be given a strong message from society that we should
abstain from sex until we are at least out of high school.''
The abstinence message, as everyone knows, is hard to get
across when much of the popular culture, movies, magazines,
television, and in many cases sex ed. in public schools is
giving the opposite view. Of the 58 television shows monitored
by ``U.S. News & World Report'' almost half contain sexual acts
or references to sex. A study by Robert Lichtner & Associates
found a sexual act or reference occurred on average of every 4
minutes on shows during prime time. Media Research Center found
portrayals of premarital sex outnumbered sex within marriage by
eight to one on television. So is it any wonder that between
1960 and the early nineties there was a 450 percent rise in
out-of-wedlock births, that among industrialized nations the
U.S. has the highest teen birth rate and one of the highest
child poverty rates, which is related to high poverty rates
among single mothers, and particularly those who became mothers
as teenagers. Teenage pregnancies are costing our economy more
than 7 billion annually and 49 billion is going to families
begun by unwed teenage mothers.
Now I recently added a page here because I know the issue
is funding for abstinence and abstinence-only education, so I
am going to quickly just cite a few things. The press is
obviously on an alarmist campaign regarding Federal
expenditures on abstinence education. A case in point was an
article in ``New York Times'' a few months ago. The article
compared Federal funding for abstinence education with Federal
funding for HIV prevention education. It notes that beginning
in 1996 Congress set aside 250 million for 5 years to fund
abstinence education programs. But what it doesn't make clear
is that the 250 million is a cumulative 5-year figure, not an
annual expenditure of 250 million. This was, I believe,
intentionally confusing to the reader. It accuses this
administration of allocating to abstinence education, ``A
figure which dwarfs contraceptive education expenditures.''
This again is gratuitously misleading. In fact, the 50 million
from Title V and the 17.1 million from Maternal and Child
Health or SPRANS, Special Projects of Regional and National
Significance, totals 67 million for abstinence education. This
is dwarfed by the 274 million spent on Title X Family Planning
Clinics. This 274 million, coupled with the 220 million a year
spent on 1,000 school-based health clinics, which either
dispense contraception or refers students to community clinics
which do. This is 500 million on two relatively small programs
and does not even count the millions allocated within the
States. Twenty-three States require that sex ed. be taught; 47
recommend or require--either recommend or require, and all 50
require AIDS education programs.
One of the things I would also just like to add, that----
Chairman Herger. If you could sum up your testimony.
Mrs. Bennett. I will. I will sum it up right now. Sorry.
Chairman Herger. Thank you.
Mrs. Bennett. I would just like to tell you quickly how we
have been successful because we focus on a character-building
in-school curriculum with an abstinence-only philosophy, an
intensive peer support structure, and long-term adult
involvement. We address the issue of sexual abuse, by
emphasizing that sexual abuse is wrong and never the victim's
fault. We do know that many young girls, their first sexual
experience is by adult men 21 and older. But we foster self
respect by promoting self control and telling girls they have a
place to go, they have someone to talk to, and that they can
stop if they have begun sexual activity. And most sexual
activity among middle-schoolers, particularly in the inner
city, is not by the young girl's choice.
Chairman Herger. I thank you for your testimony.
Mrs. Bennett. That is it.
Chairman Herger. And your full testimony will be submitted
for the record.
Mrs. Bennett. We have copies of 10-page testimony showing
our research, which is quite impressive. Thank you.
[The prepared statement of Mrs. Bennett follows:]
Statement of Elayne G. Bennett, President and Chief Executive Officer,
Best Friends Foundation
I. INTRODUCTION
For the past 14 years, the Best Friends Foundation has been
reaching out to adolescents throughout the United States with a very
simple message: enjoy adolescence by abstaining from sexual activity,
drugs and alcohol. While this message may not be new to young people,
the method in which it is delivered is profoundly different, and its
impact is unsurpassed by traditional youth development models. The
model is unique. It combines the elements of intensity, duration, and
saturation.
The Foundation reaches over 5,500 girls each year through its Best
Friends program and this year will reach about 500 boys through the new
Best Men program. These programs operate in 26 cities and 14 states,
plus the District of Columbia and the U.S. Virgin Islands. Sexual
activity among youth in the program is almost nonexistent. In 1999, an
independent evaluation of the Washington D.C. Best Friends program
showed that 4.2 percent of 7th and 5.6 percent of 8th grade girls were
sexually active. This is in comparison with the Youth Risk Behavior
Survey data for Washington D.C. 7th and 8th grade girls, where 18.5
percent of 7th grade and 34.7 percent 8th grade girls indicated that
they were sexually active.
The Best Friends and Best Men programs are successful through a
very consistent message and approach.
Adolescents are not provided mixed messages. The
program teaches that abstinence is the best and most effective
way of preventing teen pregnancy and STDs. Many programs and
schools teach abstinence as an option along with contraception.
Best Friends/Best Men staff members do not support this dual
philosophy, and as a result, youth are not confused by
conflicting messages.
Saturation. Many programs are expensive to implement
and take place after school when children are involved in other
responsibilities. Best Friends/Best Men recognizes that the
school is the surest way to reach the maximum number of youth
and their peers. All curriculum sessions are provided at
school, and most sessions take place during the school day.
School principals view the Best Friends/Best Men curriculum as
important for young people as core academic courses. The Best
Friends/Best Men model is the most effective way to saturate an
entire region with the abstinence message.
Duration. Youth may join the Best Friends and Best
Men as early as 5th grade. The program leaves abstinence as the
only option. Curriculum and support are provided each and every
month of the school year and continues through middle and high
school. A trustworthy mentor is always there to help youth with
difficult decisions.
Intensity. Each youth receives more than 110 hours
of program services each year. (1) Youth participate in monthly
90-minute core curriculum and peer discussion sessions during
the school year. This is augmented by (2) weekly one-on-one
meetings with volunteer school mentors, (3) male and female
role model presentations from the community, (4) culturally
enriching field trips, (5) weekly fitness and nutrition
classes, (6) participation in community service projects, (7)
and a Family and School Recognition Ceremony to honor students
and parents for their commitment and accomplishments.
II. DOCUMENTATION OF NEED/STATEMENT OF THE PROBLEM
A. Teen Pregnancy
The United States has the highest rates of teen pregnancy and
births in the western industrialized world, more than double that of
the United Kingdom, which has the second highest rate. Every state in
the nation has a higher pregnancy rate than the UK. In 1998 in the
U.S., there were 51.1 births for every 1,000 teen girls aged 15-19; in
1998, there were 97 pregnancies per 1,000 girls in that age group. More
than 4 of 10 young women become pregnant at least once before they
reach the age of 20--nearly one million a year; 8 of 10 of these
pregnancies are unintended and 90 percent are to unmarried teens. Over
$7 billion is spent annually on more than 500,000 out-of-wedlock babies
born to teenage mothers with an estimated cost to the economy in lost
productivity of at least $29 billion a year.
Each year the Federal government alone spends about $40 billion to
assist families which began with a single, teenage mother, initiating
or perpetuating the poverty cycle which underlies most major social
problems in the United States. The median income for a single mother is
less than $20,000 a year. Daughters of single parents.
Research has consistently shown that children growing up with a
single mother are more likely to drop out of school, to give birth out
of wedlock, to divorce or separate, and to be dependent of welfare
(Garfinkel, I. and McLanahan, S.S., 1986). Seventy-two percent (72
percent) of America's adolescent murderers, 70 percent of long-term
prison inmates and 60 percent of rapists come from fatherless homes.
Numerous recent studies document the importance of fathers in the lives
of their children. Even if a marriage fails, children born into a
married couple family have advantages over those born to unmarried
women (Popenor, David, 1996).
Each year the Annie E. Casey Foundation tracks the well being of
children in its Kids Count publication. The data shows that while
programs in the 1990s have successfully addressed the reduction of teen
pregnancy, there has not been a corresponding reduction in children
born out of wedlock. In fact, there has been a disturbing increase. The
nationwide percent of total births to unmarried women increased from 41
percent in 1990 to 43 percent in 1998. In Washington D.C., the target
area for this proposal, the percent of births to unmarried mothers was
an alarming 63 percent in 1998. Moreover, the likelihood of a child
receiving a child support award reflects the marital status of parents
at the time of birth. Only 22 percent of never married single parents
received child support payments in 1997, compared with 47 percent of
divorced single parents. Further, only 10 percent of mothers ages 15 to
17 received child support payments in 1997.
B. Teen Birthrates
Child Trends reports that preliminary data for 1998 from the
National Center for Health Statistics show that the teen birth rate has
declined since the early 1990s. In 1998, there were 51.1 births per
1,000 to teen girls age 15-19. However, the number of teen births since
1991 represents a 7 percent decline compared with an 18 percent decline
in the rate of teen births since 1991. Despite a decrease in the teen
birthrate, the total number of births to teens increased slightly
between 1997-99 due to an increase in the number of teen females in the
1990s.
Researchers have begun to acknowledge that the decline in teen
birthrates is directly linked to fewer teens having had sex. KIDS COUNT
reports that in 1999, 50 percent of the nation's high school students
reported having had sex, compared with 54 percent in 1991. Public
acceptance and support of teens abstaining from sex is credited for the
recent success. Abstinence has gained credibility among foes; opponents
no longer disparage abstinence as an unrealistic method of preventing
teen pregnancy.
C. Birthrates by Marital Status
Seventy-nine percent (79 percent) of all births to teenagers occur
outside of marriage. Among mothers ages 15-17, the proportion that are
unmarried more than doubled, from 43 percent in 1970 to 87 percent in
1997. The proportion of unmarried mothers, ages 18-19, has more than
tripled--from 22 percent in 1970 to 72 percent in 1997. Birthrates of
married teens declined 23 percent between 1990-1997. Unmarried teen
birthrates peaked in 1994. In 1998, 79 percent of teen births occurred
outside of marriage (up from 71 percent of births in 1992). According
to the Annie E. Casey KIDS COUNT Report, 97 percent or births to teens
in Washington D.C. were to unmarried teens in 1996. The majority of
teen mothers choose to keep their children rather than put them up for
adoption.
Today's teen parents face very different circumstances than that of
their counterparts in the 1960s. In the 1960s, more than two-thirds of
births to teens occurred within the context of marriage, even when
conception occurred beforehand. Marriage was viewed as a goal to strive
for, offering social and financial stability. Even though the stigma
has lessened since the 60s, it is clear that children in single parent
homes do not have the same economic resources as those growing up in
two parent households.
Sociologists Sara McLanahan and Gary Sandefur examined family
structure and its impact on whether a child will succeed. They examined
a decade worth of data and found, ``Compared with teenagers of similar
background who grow up with both parents at home, adolescents who have
lived apart from one of their parents during some period of childhood
are twice as likely to drop out of high school, twice as likely to have
a child before age twenty, and one and a half times as likely to be
`idle'--out of school and out of work--in their teens and early
twenties.''
There is reason to be hopeful. According to KIDS COUNT, after
peaking in 1996, the nationwide percentage of children living in single
parent families fell to 27.8 percent in 2000. This can, in part, be
credited to the Landmark Welfare Reform legislation of 1996, which
began to encourage states with financial incentives to lower their
proportion of single parent households. Programs like Best Friends and
Best Men will contribute to a continued reduction.
D. Birthrates and Abortion
While still perceived as an epidemic by public health officials and
still at the highest rate of all industrialized nations, the teen
pregnancy rate, birthrate and abortion rate have all declined slightly
in the past several years. Thus, the decline in the birthrate is NOT
due to an increase in abortion. However, it should be noted that the
total number of births to teens increased slightly between 1998-1999.
According to the Allan Guttmacher Institute, the teen pregnancy
rate declined by 16 percent between 1991-96, while the abortion rate
declined by 22 percent between 1991-96. The District of Columbia had
the highest rate of abortion per 1,000 women (155) of any state, more
than triple that of Nevada (44), the next highest state. The easy
availability of abortions clearly has not had a significant effect on
reducing the birthrate.
E. Contraceptive Use
Data from the National Survey of Family Growth show different
trends in contraceptive use at first and most recent sexual encounter
among teens. There is an increase in the percentage of adolescent
females who report using any contraceptive method at first sex from 48
percent in 1982 to 76 percent in 1995. However, and more importantly,
there has been a decline in contraceptive use at most recent sex among
sexually active teen females (those who had sex in the last three
months). The proportion of sexually active females who use
contraception at most recent sex declined from 77 percent in 1988 to 69
percent in 1995. This data does not support the argument that increased
contraceptive use resulted in decreased teen birth rates because it is
obvious there is a much higher risk of pregnancy with repeated sexual
intercourse. Although advocates of contraceptive education may claim
that increased contraceptive use is a major cause of the decrease in
teen pregnancy and birth rates, these data demonstrate quite the
opposite.
F. STDs
Another devastating result of increased promiscuity by our teens is
the increase in sexually transmitted diseases (STDs). There are 3
million new cases of STDs diagnosed in teenagers in the United States
each year, requiring more than $2 billion in direct treatment costs
annually. Teenagers are far more susceptible to STDs than adults. For
example, a 15-year-old girl has a one in eight chance of contracting a
STD if she has sex, while a 21-year-old woman has a one in eighty
chance under the same circumstances. Moreover, the AIDS virus is also
on the rise among our youth. Nearly 20 percent of all AIDS patients are
in their 20s, which means many of them were infected as adolescents.
Today teenage sex is not only harmful; it is deadly. Surpassing even
homicide, AIDS is the number one killer of African-American men ages
24-45 in the U.S. It is the number two killer of African-American women
of the same age. Condoms offer little or no protection for a number of
STDs (including HPV--human papilloma virus which causes genital warts).
In a single act of unprotected sex with an infected partner, a teenage
girl has a 1 percent risk of contracting HIV, a 30 percent risk of
infection with genital herpes (HPV) and a 50 percent chance of
contracting gonorrhea (Allan Guttmacher Institute--Facts in Brief: Teen
Sex and Pregnancy, 1998).
G. Oral Sex
Oral sex is a gateway behavior to other sex, alcohol and drug use.
Oral sex is highly dangerous because of the physical risk, STDs (HPV
virus is easily transmitted through oral sex). In the last seven years,
it appears that girls are having sex at an earlier age. The proportion
of girls engaged in sex before age 15 rose from 11 percent to nearly 20
percent. For most of these girls, oral sex was their first sexual
experience. Recent news stories about the prevalence of oral sex among
middle-schoolers points to the dire need for guidance and clear-cut
standards of behavior.
H. Consequences for Young Mothers
The Casey Foundation report also speaks to the consequences for
young parents. A young woman who has a child before graduating from
high school is less likely to complete school than a young woman who
does not have a child. About 64 percent of teen mothers graduated from
high school or earned a GED within 2 years of their scheduled
graduation date, compared with 94 percent who did not give birth. Best
Friends has a 100 percent graduation rate for girls who stick with the
program in high school.
Nearly 80 percent of teen mothers eventually go on welfare and end
up in the child support system. According to Child Trends, more than 75
percent of all unmarried teen moms went on welfare within 5 years of
the birth of their first child. An alarming 55 percent of all mothers
on welfare were teenagers at the time their first child was born.
I. Consequences for Young Fathers
Consequences also exist for teen fathers. They are more likely to
be in the criminal justice system, use alcohol, deal drugs, or quit
school. Among married men, those who were teen fathers had the least
schooling and earned lower wages than those who fathered children with
mothers who were 20 or 21 (Casey Foundation, KIDS COUNT).
Data from the March 2000 Current Population Survey show that only
58 percent of males ages 16 to 19 have any earned income in 1999 and
that the average annual income for those who worked was less than
$6,000 annually. Teen fathers are unable to provide the required
financial support for their children. This causes an added strain
between the relationship of the teen mother and father.
III. STRATEGIES THAT WORK
The Casey Foundation summarized in brief, without endorsing
specific programs, strategies that work at preventing teen pregnancy.
All of the essential elements they highlighted are contained within
Best Friends/Best Men programs.
A. Unwavering Commitment by Families--Best Friends/Best Men parents
give permission for his/her child to participate in the program. Each
school holds a parent information meeting at the beginning of the
school year. The Best Friends/Best Men introduction video is shown and
parents ask questions of the Best Friends/Best Men staff. In the 15
years of program operation, only two parents did not allow their
children to participate. Once enrolled, not a single parent has ever
removed his/her child from the program. Families celebrate the
commitment of their children at the Family and School Recognition
Ceremony. 80-90 percent of parents attend this event. Each Best Friend/
Best Men participant acknowledges his/her parent with a symbol of
gratitude at the Recognition Ceremony.
B. Services must be holistic, comprehensive and flexible--Best
Friends/Best Men is not sex education. The eight-step curriculum
discussion sessions look at the ``whole'' person. The curriculum
examines the life and social skills needed to resist the negative
pressures that lead to teenage pregnancy. The support system is
comprehensive--mentors, role models, teachers, parents, peers and the
community at large learn how to support the youth's very important
decision of abstaining from sex. The program is flexible to meet each
child's needs. Best Friends/Best Men curriculum is taught during the
school day. Children who have after-school responsibilities do not miss
out on the program. Diamond Girls who are in high school meet at times
convenient to their busy schedules. The needs of the youth dictate how
the program is delivered.
C. The information is revised and updated yearly-- Founder Elayne
Bennett, her staff, lead research consultant, and medical experts have
examined volumes of research. Through peer review, only the most
credible findings have been used to develop the curriculum. All
curriculum materials have gone through numerous peer reviews and are
updated annually to ensure the most up-to-date information. The message
to adolescents is accurate and consistent. The participants are the
most knowledgeable spokespersons for the program. They present end of
the year essays titled, ``What Best Friends Means to Me,'' and these
essays are a testimonial to the accuracy and consistency of the
message.
D. Teens need to be provided with more targeted academic and job
information--Graduation from high school and post secondary education
is a major tenet of Best Friends and Best Men. Elayne Bennett felt so
strongly about the importance of showing young girls that there is a
very promising future ahead of them, that she created a generous
scholarship program. Each program participant who stays with the
program through high school is offered the opportunity for a college
scholarship. Since 1993, more than 70 young women have attended college
with Diamond Girl Scholarships, attending top universities. Girls who
are not collegebound receive career counseling and choose careers such
as the military.
E. Teens need information about how their bodies work and how to
keep them safe--Staying healthy and protecting one's body from physical
harm are key ingredients to the Best Friends/Best Men programs. Girls
and boys participate in weekly group fitness classes. Girls exercise,
dance and discuss health and nutrition. Boys participate in martial
arts and discuss health and nutrition. Through the curriculum, youth
learn skills to avoid physical confrontations with peers and adults.
F. Messages from adults must be clear--The coordinators and
facilitators attend training conferences in the utilization of a
carefully designed curriculum in which abstinence from sex, drugs and
alcohol is clearly conveyed.
G. Discussions must be frank to ``deglamorize'' the barrage of
sexual images provided through the media--To counter the glamorization
of sex, Best Friends has glamorized abstinence. Girls earn jewelry, t-
shirts, and other incentives that they wear to symbolize as a peer
group that abstinence is attractive. Girls learn that one can be
attractive without being sex symbols, something that many have thought
as being one and the same. Boys learn that they can be cool when they
do not drink, do drugs and have sex. Male role models reinforce that
abstinence is cool. Videos, theme songs and dance performances
reinforce that Best Friends/Best Men is cool.
H. Students learn techniques in making good decisions,
communication and work skills to prepare for the adult world--Best
Friends/Best Men has an entire curriculum session dedicated to
decision-making skills. Youth learn how to make good decisions and to
take responsibility for their actions. Communication skills are
addressed in every aspect of the program. Most participants have
teacher/mentors who utilize their mentor guides with specified
discussion activities. Role-plays are used to simulate difficult
decisions. Peers give feedback on how they would handle difficult
situations.
Best Friends utilizes the social learning theory (Bandura,1977)
that explains human behavior in terms of continuous reciprocal
interaction between cognitive, behavioral and environmental influences.
Best Friends/Best Men is structured to provide adolescents with 100-200
hours of interaction with responsible adult leaders who serve as role
models of behavior that we wish to develop in our youth. Our cognitive
input is reflected through the messages presented in the curriculum
units, which are repeated throughout the program year. Social and
environmental influences are brought about through community service
and culturally enriching field trips. The Family and School Recognition
Ceremony is an opportunity for the participants to express their
appreciation while showcasing their talent through essay reading, song
and dance. As girls and boys mature with the program, they become role
models for their younger classmates.
Bill Mosher and Stephanie Ventura of the National Center for Health
Statistics co-authored a study released in February 2000 by the Center
for Disease Control. The study found that the number of births,
abortions and miscarriages in the United States declined by half a
million in just six years. Much of the drop can be attributed to a
change in teenagers' behavior. Among other factors, they cite ``the
message of abstaining from sexual intercourse has gotten across to a
good number of teenagers.'' In fact, recent survey data show that 51
percent (both boys and girls) are choosing to abstain from sexual
activity (KIDS COUNT).
The Adolescent Health Study (ADD Health), which surveyed over
90,000 middle school students, clearly demonstrated that a protective
factor in delaying the onset of first sexual behavior as well as the
prevention of pregnancy was the perceived parental disapproval of
adolescent contraception and adolescent sex. It is surprising to the
Best Friends Foundation that the advocates of comprehensive sex
education that involve condom distribution are not rethinking their
position based on this significant research study.
IV. BEST FRIENDS/BEST MEN PROGRAM DESIGN/METHODOLOGY
Elayne Bennett founded the Best Friends Program in 1987, when she
was a faculty member of the Georgetown University Child Development
Center. Elayne continues as the President of the Foundation, teaches
curriculum in Washington D.C. schools, and has trained more than 1,000
educators in 26 cities in 14 states, including the District of Columbia
and the U.S. Virgin Islands. Nationally, the Best Friends program
serves almost 5,500 girls as well as nearly 500 boys in the recently
piloted Best Men program.
Students may enter as early as the 5th grade and continue through
middle school. Girls who continue in the program in high school enter
the Diamond Girls program; boys enter Iron Men in high school.
Best Men Messages
The primary goal of Best Men is to provide boys with the tools and
the environment needed to help them develop into responsible young men.
This goal is accomplished with the implementation of a multi-faceted
program which:
Defines manhood.
Teaches boys that to abstain from sex in high school
is a good decision and to abstain from sex until marriage is
the best decision.
Provides boys with positive adult male mentors to
support and encourage them in their goal to become men worthy
of respect.
Develops positive peer support.
Encourages ongoing parental support, especially
fathers.
Best Friends Messages
Best Friends is designed to reach girls in early adolescence when
their attitudes toward life are forming, when they need to discuss
their personal concerns and receive support from friends and respected
adults. The following messages permeate the Best Friends program:
The best kind of friend is one who encourages you to
be a better person.
Friends help each other make good decisions.
Without self-respect, it is difficult to say ``no''
to anyone or anything.
Boys and girls often have different agendas in their
romantic relationships.
Sex is never a test of love.
The decision not to have sex in high school is a
good one. The decision to wait until marriage is the best one.
Children deserve to begin life with married adult
parents.
The decision not to take drugs is a good one. It is
illegal to take drugs.
The decision not to drink alcohol in high school is
a good one. In most jurisdictions, it is illegal to drink
alcoholic beverages before the age of 21.
Tomorrow is the first day of the rest of your life.
Past mistakes do not mean that one must continue the same
pattern.
Operational Structure
Best Friends/Best Men is a school year program. Girls and boys may
enter as early as 5th grade and participate in an eight-step school
year curriculum program, augmented by mentors, role models, fitness
program, cultural activities/field trips and a Family and School
Recognition Ceremony. Best Friends/Best Men succeeds because it is an
ongoing education and support system. Each girl and boy is invited back
to the program at the start of the school year. Those who graduate from
high school may qualify for educational scholarships funded through the
program.
Recruitment
Best Friends/Best Men coordinators and grade level teachers recruit
youth into the program. Special efforts are made by school staff to
recruit students who demonstrate risk factors, such as poor school
attendance, drinking, smoking, physical aggression, etc. Experience has
shown that a blend of students consisting of high and average
achievers, along with those who fall below the mark, provides a
productive learning environment. Youth connect with both the positive
and negative experiences of peers and draw from these experiences to
make positive changes in their lives.
Curriculum/Discussion
The most important component of the Best Friends curriculum are the
group discussions conducted by a Best Friends/Best Men instructor at
least once a month for 90 minutes. The group sessions provide
opportunities for students to discuss topics important to adolescents--
(1) friendship, (2) love and dating, (3) self-respect, (4) decision-
making, (5) alcohol abuse, (6) drug abuse, (7) physical fitness and
nutrition, (8) AIDS and sexually transmitted diseases. Participants
record their thoughts in a Best Friends/Best Men Student Journal. The
Best Friends instructor uses the Best Friends/Best Men Program Guide to
lead discussions. The instructor uses a combination of lectures and
discussion, videos, news clips and journal writing. Each session always
concludes with the Best Friends Theme Song and the Best Men Chant.
1. Friendship: participants learn that the best kind of
friend is one who encourages you to be a better person and that
friends help each other make good decisions. They learn skills
and techniques for saying ``no'' in response to peer pressure.
2. Relationships/Love and Dating: This session addresses the
difference between love and infatuation and that sex is never a
test of love. It is reassuring to young people to realize that
the pressures that they are experiencing are shared by many
adolescents. They learn that the decision not to have sex in
high school is a good one and the best decision is to wait
until marriage.
3. Self-Respect: Participants learn that respecting oneself
is very important. Without self-respect, it is difficult to say
``no'' to anyone or anything. They learn to take responsibility
for their decisions and that these decisions have an impact on
their lives. Each student is encouraged to be in control of his
or her life, to set positive goals to look forward to the
future.
4. Decision-Making: Best Friends/Best Men boys and girls
learn skills for making good decisions, taking responsibility
for their own behavior, and evaluating the messages in the
media. Best Friends safety rules are discussed.
5. Alcohol Abuse: Participants learn why drinking alcoholic
beverages before the legal drinking age is dangerous. We teach
techniques for avoiding alcohol and riding in cars with drivers
who have been drinking. Youth learn that drinking alcohol makes
them more vulnerable to sexual advances. Videos, news articles
and role-plays are particularly useful in this session.
6. Drug and Tobacco Abuse: The Best Friends Program conveys a
clear ``no use'' message. Boys and girls learn the dangers of
experimenting with drugs, how drugs can steal their goals and
dreams and hurt their family and friends. Youth learn that
drugs contribute to sexual activity.
7. Physical Fitness and Nutrition: Good health helps
adolescents gain self-respect and have a more positive outlook
on life. Once a week, all Best Friends participants have a one-
hour fitness class where they exercise, dance, discuss the
importance of health and nutrition and have fun with their
friends. Best Men participate in self-defense classes.
8. AIDS and STDs: Participants learn that abstinence from
sexual activity and drug use is the only guaranteed protection
against sexually transmitted diseases and the HIV virus. Candid
information is shared about the most common STDs, the symptoms,
treatment and consequences.
Fifteen years of experience in curriculum development and direct
instruction in hundreds of schools with thousands of adolescent girls
and most recently adolescent boys, has convinced me that our youth want
to hear the abstinence message. Students will respond when it is
presented in a developmentally sound approach that involves positive
peer pressure and promotes a sense of connection to their school.
We urge the committee here today to understand that by setting the
expectations of abstinence until marriage we are at the very least
promoting a standard that has been a part of our traditional moral
values for centuries.
It is especially important at this time of crisis in our country
that we not compromise the values that have been time honored in our
society. Our children deserve no less than our highest expectations.
In summation, Best Friends believes that as adults ``If we give our
children our best, they will surely respond with their best.''
Chairman Herger. Thank you very much, Mrs. Bennett. Now our
next witness will be Sarah Brown, director of National Campaign
to Prevent Teen Pregnancies. Ms. Brown.
STATEMENT OF SARAH S. BROWN, DIRECTOR, NATIONAL CAMPAIGN TO
PREVENT TEEN PREGNANCY
Ms. Brown. Good morning, Chairman Herger, Ranking Member
Cardin, and Members of the Subcommittee. Let me greet in
particular Congresswoman Nancy Johnson, who is a wonderful
leader of our congressional bipartisan House Advisory Panel,
and we are very grateful to you for your interest in our work.
My name is Sarah Brown. I am the director of the National
Campaign to Prevent Teen Pregnancy, and on behalf of Isabel
Sawhill, our president, and former governor Tom Kean of New
Jersey, our chairman, I want to thank you for inviting me here
today.
We commend this Subcommittee for focusing on teen pregnancy
prevention in the context of welfare reform. As many of you
well know, reducing teen pregnancy is a highly effective way to
make progress on a number of related social issues: child
poverty, welfare dependency, out-of-wedlock childbearing and
responsible fatherhood.
Written testimony and many of the documents and citations
referred to in the testimony back up these points I am going to
cover, and I hope they will be entered into the record.
The good news, as we have heard this morning already, is
that teen pregnancy and birth rates have declined steadily over
the past decade. They are now at record low levels. But as many
people have pointed out, we still have a long, long way to go.
Four in 10 girls in this country become pregnant before they
turn 20. Two in 10 go on to become single mothers, therefore,
obviously, contributing to our high levels of out-of-wedlock
childbearing. So there is no reason for complacency.
Why are the rates of teen pregnancy going down? Chairman
Herger, you posed that question at the beginning of this
hearing. Basically there are only two possible explanations: a
smaller proportion of teens are having sex and/or contraceptive
use among sexually active teens has increased. Unfortunately,
the exact contribution of these two factors just can't be
nailed down precisely, but a reasonable conclusion supported by
all of us is that both less sex and more contraception are
making an important contribution to the decline.
Another important question: what community-level programs
actually prevent teen pregnancy? Fortunately, we now have some
answers here, and having been in this field for a long time, it
is lovely to be able to sit in front of this Subcommittee and
offer some good news. This past May, the National Campaign
released a comprehensive research review entitled ``Emerging
Answers: Research Findings on Programs to Reduce Teen
Pregnancy.'' Let me give you a very few of the highlights.
First, there are some programs that work. Interestingly,
some focus on sex and some don't at all. There are three types
found to be effective. One cluster includes a variety of sex
and HIV education programs that have been shown to delay sex
and/or increase contraceptive use for up to 30 months. These
effective programs have some very definable, well-described
characteristics, and as a number of people have already said,
the evidence is clear that teaching young people about sex and
sexuality does not increase sexual activity. It was a
reasonable important question to ask, but the jury is now
``in'' on this question: It does not.
A second cluster includes two youth development programs
(which we also talked about this morning), that offer
opportunities for community service, adult mentoring and so
forth. They are very impressive in their results. It is not
exactly clear why they are so effective, but we can talk about
that later if you would like.
A third category of programs found effective combine good
sexuality education, family planning services, and a vigorous
youth development program. I think we are going to hear from
one such model from New Britain, Connecticut, in just a minute.
Having this array of effective programs gives us another
piece of good news. Communities now have choices. When they
want to reduce teen pregnancy, they can look at a rich array of
options, and they can pick ones to suit their budgets, their
local values and their situation.
What do we know about abstinence education? Our review
finds in this case that the jury is ``out'' on abstinence-only
or abstinence-until-marriage education, and this is for two
particular reasons: very little rigorous research of these
programs have been completed, and the few studies that do show
positive effects are really not capturing the rich array of
programs that are currently offered. I know that Dr. Maynard,
who is testifying next, is going to be talking about her
important work in this area.
I would like to add that I think it is critically important
that our evaluations of abstinence programs answer two
questions. First, do they delay first sexual intercourse? And
for those program participants who do become sexually active,
are they less likely to use contraception?
Although some may find this second question beside the
point, I would argue that it is no different than asking
whether sex education programs might actually encourage young
people to have sex. Our first goal must always be to do no
harm. Now, having said this, remember, there is enormous public
support for abstinence messages for school-age youth in
particular. Remember too, the reality is that many teens in
high school become sexually active, whether we like it or not.
At present, about 65 percent of high school seniors have had
sex, so we need to offer services for them and information, but
all in a context of abstinence as their first and best choice.
One final comment. What are the implications for Welfare
Reform reauthorization in all of this? As a general matter,
States and communities need adequate resources to prevent teen
pregnancy. They need access to good information about what
works. They need a clear signal from the Federal Government
that teen pregnancy prevention is important and is directly
linked to the other goals of Welfare Reform. And they need
flexibility to design strategies that suit their local
situations and cultures. This is consistent with the devolution
philosophy underlying the rest of Welfare Reform, and it is
consistent with the view that family and community values
rather than Federal mandates should be the primary influence
regarding what we should do about such sensitive issues as teen
sexuality.
Thank you for inviting me here today.
[The prepared statement of Ms. Brown follows:]
Statement of Sarah S. Brown, Director, National Campaign to Prevent
Teen Pregnancy
SUMMARY
Chairman Herger, Ranking Member Cardin, and Members of the
Subcommittee:
My name is Sarah Brown. I am the Director of the National Campaign
to Prevent Teen Pregnancy, a nonpartisan, nonprofit organization
dedicated to the goal of reducing the teen pregnancy rate by one-third
over a ten-year period. I also want to recognize Congresswoman Nancy
Johnson who we are so fortunate to have as one of the leaders of the
Campaign's bipartisan House Advisory Panel. On behalf of Isabel
Sawhill, our President, and former Governor Tom Kean of New Jersey, our
Chairman, thank you for inviting me to testify today. We commend this
subcommittee for focusing on teen pregnancy prevention. As many of you
recognize, reducing teen pregnancy is a highly effective way to make
progress on a number of related social issues: child poverty, welfare
dependency, out-of-wedlock childbearing, and responsible fatherhood.
Said another way, reducing teen pregnancy is one of the most effective
single steps we can take to improve the life prospects of young women
and men, and most important, their children. My full written testimony
goes into the points I am about to make in more detail, and contains
citations for additional information.
Good news but still more work to be done
The good news is that teen pregnancy and birth rates have declined
steadily over the past decade and are now at record-low levels.
However, we still have a long way to go: four in ten girls become
pregnant at least once before age 20, the U.S. still has the highest
rates of teen pregnancy in the fully industrialized world, and every
year teen childbearing costs U.S. taxpayers at least $7 billion. We
must not let the good news lull us into complacency and must redouble
our efforts to help more young people avoid becoming parents too soon.
What's behind the good news?
A commonly asked, and hotly debated, questions is ``Why are the
rates of teen pregnancy going down?'' Basically, there are only two
possible explanations: a smaller proportion of teens are having sex,
and/or contraceptive use among sexually active teens is improving. The
exact contribution of each of these factors--less sex and more
contraception--is difficult to determine precisely. A reasonable
conclusion supported by all recent analyses is that both less sex and
more contraception are making important contributions to the decline.
Understanding what motivates young people to choose either of these
paths is also critically important. That is, why are teens being more
prudent? Most experts believe it is some combination of more cautious
attitudes among young people about sex, fueled in part by fear of AIDS
and other sexually transmitted diseases and by growing support for the
value of abstaining from sex at least until teens have finished high
school; greater public and private efforts to reduce teen pregnancy;
the availability of more effective forms of contraception; the strong
messages about work and personal responsibility (including child
support) in welfare reform; and perhaps the strong economy in recent
years. As this subcommittee knows, there are a number of provisions in
the 1996 welfare reform law aimed at reducing teen pregnancy and out-
of-wedlock childbearing. While there is little evidence that any one of
these provisions on its own has had an effect on teen pregnancy rates,
we believe that they have, in the aggregate, sent a powerful message to
both young women and men about the importance of waiting to become
parents until they are grown up, preferably married.
What works to prevent teen pregnancy?
Fortunately, I have good news here. I've been involved in this
field for nearly 30 years, and, frankly, for most of that time it has
been discouraging work--the rates of teen pregnancy and childbearing
were high, often increasing, and we didn't know what to do about it.
Finally, we have some answers. This past May, the National Campaign
to Prevent Teen Pregnancy released a comprehensive research review
called Emerging Answers: Research Findings on Programs to Reduce Teen
Pregnancy. Let me briefly summarize what this review found. Most
importantly, there are a variety of programs that are effective--some
that focus on sex and some that do not. The review identified three
particular types:
Several sex and HIV education programs have been
shown to delay sex or increase contraceptive use for up to 30
months. The effective programs share ten clearly definable
characteristics. It is also important to point out that the
overwhelming weight of research evidence clearly shows that sex
and HIV education programs such as these do not increase sexual
activity, as some people have reasonably feared.
Two youth development programs that give young
people opportunities to do community service and have mentoring
relationships with adults have the strongest evidence of any
intervention that they actually reduce teen pregnancy while the
youth are participating in the program. It is not clear exactly
why these programs are so successful, but keeping empty hours
filled with useful activities is certainly one plausible
explanation.
The third category of programs includes both
sexuality education and youth development. One such program
combines family life and sex education with tutoring, work and
sports-related activities, and comprehensive health care--and
it substantially reduced teen pregnancy and birth rates among
girls.
These findings offer leaders around the country some encouraging
news, but more importantly, communities now have a list of effective,
credible programs to choose from to suit local needs, values and
culture, which is particularly important when dealing with an issue as
complex and sensitive as teen pregnancy. As we all know, one size
doesn't fit all.
What do we know about abstinence education? Our review finds that
the jury is still out on abstinence-only or abstinence-until-marriage
education. This is true for two reasons: (1) very little rigorous
evaluation of abstinence-only programs has been completed and (2) the
few studies that show no positive effect do not reflect the great
diversity of abstinence-only programs currently offered. Fortunately,
Dr. Maynard (who is also testifying today) is conducting a very
rigorous study of several abstinence-only programs that I expect will
shed more light on this important group of interventions.
I would add that I think it is critically important that our
evaluations of abstinence programs answer two questions: (1) do they
delay first sexual intercourse? and (2) for those program participants
who do become sexually active, are they less likely to use
contraception? Although some may find this second question beside the
point, I would argue that it is no different than asking whether sex
education programs actually encourage young people to have sex. Our
first goal should always be to do no harm. Having said this, let me be
very clear that there is great value in, and public support for, a
strong abstinence message, especially for young people. In fact, our
polling data on this point are quite dramatic.
But even if the number of teens who choose abstinence grows
significantly--and even if some sexually active teens make a conscious
decision to refrain from sexual intercourse--the reality is there will
still be many teens who are sexually active (for example, 65 percent of
all high school seniors have had sexual intercourse at least once).
Therefore, preventing teen pregnancy requires that contraceptive
services and information be available. The analogy here is that we urge
young people not to drink, but if they do, not to drive. In this same
spirit, we can give a strong ``abstinence-first'' message, especially
for school-age teens, and also offer critically important information
and health care.
A final point about ``what works'': while we now know that
effective programs to reduce teen pregnancy exist, it would be
unrealistic to rely exclusively on such programs to address teen
pregnancy. Most teens aren't in programs, and many programs are small,
fragile, and poorly funded. Other forces, such as parents, the media,
moral and religious values, and especially popular culture, play
critical roles as well. The Campaign works actively on each of these
fronts and so should we all.
Implications for Welfare Reform Reauthorization
What are the implications of all this for welfare reform
reauthorization? As a general matter, states and communities need: (1)
adequate resources to prevent teen pregnancy; (2) access to good
information about what works so they can make informed choices about
the best way to invest their resources; (3) a clear signal from the
federal government that teen pregnancy prevention is important and is
directly linked to the other goals of welfare reform; and (4)
flexibility to design strategies to reduce teen pregnancy that respect
diverse local values and cultures. Consistent with the devolution
philosophy underlying the rest of welfare reform, family and community
values, rather than federal mandates, should prevail, especially on
such sensitive issues as teen sexuality.
Conclusion
In conclusion, all of us committed to reducing teen pregnancy need
not get bogged down in strident arguments about abstinence versus
contraception. Both approaches are important, both have contributed to
the recent progress in reducing teen pregnancy, and we need more of
both to make additional progress. Our survey data indicate that large
majorities of adults and teens agree that policymakers should place
greater emphasis on encouraging teens not to have sex and greater
emphasis on contraception for those who do. Survey data also confirm
that this common sense, combined approach is not seen by teens or
adults as a ``mixed message.'' As outlined more fully in my written
statement, welfare reform offers Congress and the nation an important
opportunity to do even more to prevent teen pregnancy, and by doing so,
achieve the goals that we all want: strong, stable, self-sufficient
families.
______
FULL WRITTEN STATEMENT
Teen Pregnancy's Link to Other Critical Social Issues
Teen pregnancy is closely linked to a host of other critical social
issues--welfare dependency and overall child well-being, out-of-wedlock
childbearing, child poverty, responsible fatherhood, and workforce
development, in particular. There is compelling evidence that progress
on all of these issues can be materially advanced by reducing teen
pregnancy.\1\ Teen mothers and their children experience a number of
adverse consequences in the areas of education, health, and income.\2\
For example, compared to similarly situated women who delay
childbearing until age 20 or 21, teen mothers are less likely to
complete high school and their children have more problems in school.
This puts them at a disadvantage for obtaining the higher education
necessary to qualify for a well-paying job and support their families.
Teen childbearing also has important economic consequences for society:
U.S. taxpayers shoulder at least $7 billion each year in direct costs
and lost tax revenues associated with teen pregnancy and child-bearing.
Helping young women avoid too-early pregnancy and childbearing--and
young men avoid premature fatherhood--is easier and much more cost
effective than dealing with all of the problems that occur after the
babies are born. Simply put, if more children in this country were born
to parents who are ready and able to care for them, we would see a
significant reduction in a host of social problems afflicting children
in the United States, from school failure and crime to child abuse and
neglect. Therefore, we urge those interested in achieving one or more
of these goals to give serious attention to teen pregnancy prevention.
---------------------------------------------------------------------------
\1\ The National Campaign to Prevent Teen Pregnancy. (2001). Not
Just Another Single Issue: Teen Pregnancy's Connection with Other
Important Social Issues (forthcoming). Washington, DC: Author.
\2\ The National Campaign to Prevent Teen Pregnancy. (2001).
Halfway There: A Prescription for Continued Progress in Preventing Teen
Pregnancy. Washington, DC: Author.
---------------------------------------------------------------------------
The Good News: Teen Pregnancy and Birth Rates Are Declining
Fortunately, there is much good news to report about teen
pregnancy. After years of high and often increasing levels, the teen
pregnancy and birth rates have both steadily declined during the 1990s,
in all states and among all ethnic groups.\3\ These encouraging
declines show that we can make progress on what once seemed an
intractable social problem. Nonetheless, the United States still has
the highest rates of teen pregnancy and birth in the fully
industrialized world. And, it remains the case that close to one
million teenagers get pregnant annually and that 4 in 10 girls become
pregnant at least once before turning 20. Almost all of these teen
pregnancies are unintended and nearly eight of ten births to teenage
mothers are now out-of-wedlock.
---------------------------------------------------------------------------
\3\ Ibid.
---------------------------------------------------------------------------
Why Are the Rates Declining?
One of the questions we are most frequently asked at the Campaign
is, ``why have the rates been declining?'' There is a short answer and
a long answer to this question. The short answer is that teen pregnancy
rates are declining because of less sex and more contraception. That
is, a smaller proportion of teens are having sex, and those that are
sexually active are using contraception more consistently. Because of
data limitations, however, it is difficult to determine what the
precise contribution of each of these factors is to the good news of
declining teen pregnancy. Our own analysis suggest that each of these
two factors probably accounted for between 40 and 60 percent of the
decreased teen pregnancy rates. A reasonable conclusion, supported by
all recent analyses, is that both less sex and more contraception are
making important contributions to the decline, and more of both should
be encouraged.\4\ Interestingly, public opinion about how to reduce
teen pregnancy supports such a two-part strategy. For example, several
polls conducted by the National Campaign reveal a strong preference--
among both adults and teens--for school-aged teenagers especially to
avoid sexual intercourse altogether, coupled with a practical view that
those young people who are sexually active should have access to
contraception.\5\
---------------------------------------------------------------------------
\4\ Flanigan, C. (2001). What's Behind the Good News: The Decline
in Teen Pregnancy Rates During the 1990s. Washington, DC: The National
Campaign to Prevent Teen Pregnancy.
\5\ The National Campaign to Prevent Teen Pregnancy. (2001). With
One Voice: America's Adults and Teens Sound Off About Teen Pregnancy.
Washington, DC: Author. http://www.teenpregnancy.org/april2001/
chrtbook.pdf
---------------------------------------------------------------------------
Now, for the long answer. Given that teenagers are already being
more careful (having less sex and using contraception more), the
interesting question is: why are they doing so? Presumably, if we could
pinpoint the reasons that have motivated teens to act more prudently,
we could build on those insights to accelerate the decline. Most
experts believe that teen pregnancy rates have declined over the past
decade because some combination of the following:
Greater public and private efforts to prevent teen
pregnancy. States have dramatically increased their efforts to
reduce teen pregnancy--in 1990 only 16 states had an official
policy requiring or encouraging pregnancy prevention programs
in public schools; by 1999 this had increased to 28.\6\
Similarly, at present there are some 41 teen pregnancy
coalitions at the state level, up from 32 in 1995.\7\
---------------------------------------------------------------------------
\6\ Wetheimer, R., Jager, J., & Moore, K. (2001). State Policy
Initiatives for Reducing Teen and Adult Nonmarital Childbearing. Policy
brief. Washington, DC: Urban Institute.
\7\ Flanigan, C. (2001). What's Behind the Good News: The Decline
in Teen Pregnancy Rates During the 1990s. Washington, DC: The National
Campaign to Prevent Teen Pregnancy.
---------------------------------------------------------------------------
Fear of AIDS and other sexually transmitted
diseases. In conversations with the Campaign, teens say time
and again that fear of STDs, and AIDS in particular, factors
heavily into their decisions about sex.
More conservative attitudes among the young. An
Urban Institute study shows that the proportion of adolescent
males approving of premarital sex decreased from 80 percent in
1988 to 71 percent in 1995.\8\ And, the proportion of college
freshmen who agree that ``it's all right to have sex if two
people have known each other for a short time'' declined from
52 percent in 1987 to a record low 40 percent in 1999,
according to an annual survey conducted by UCLA.\9\
---------------------------------------------------------------------------
\8\ Ku, L., Sonenstein, F., et al. (1998). Understanding changes in
sexual activity among youth metropolitan men: 1979-1999. Family
Planning Perspectives 30(6): 256-262.
\9\ UCLA. 27 Jan. 1999. College freshmen: Acceptance of abortion,
casual sex at all-time low. Kaiser Daily reproductive health Report
online. http://report.KFF.org/archive/repro/1999/01/kr990127.6/html
---------------------------------------------------------------------------
Better and more consistent contraceptive use as well
as more effective contraceptives. For example, contraceptive
use at first sex has improved dramatically in recent years
(although there has been a downward trend in contraceptive use
at most recent sex).\10\ Depo-Provera, a new long-acting and
highly effective contraceptive method, has also been quite
popular among some teens.
---------------------------------------------------------------------------
\10\ Terry, E. & Manlove, J. (2000). Trends in Sexual Activity and
Contraceptive Use Among Teens. Washington, DC: National Campaign to
Prevent Teen Pregnancy.
---------------------------------------------------------------------------
New messages about work and child support embedded
in welfare reform. The 1996 welfare reform law contained
several important messages. To young women, it said, ``if you
become a mother, this will not relieve you of an obligation to
finish school and support yourself and your family through work
or marriage. And any special assistance you receive will be
time-limited.'' To young men, it said, ``if you father a child
out-of-wedlock, you will be responsible for supporting that
child.'' It may be the case that these messages may be far more
important than any specific provisions contained in the welfare
reform legislation.\11\
---------------------------------------------------------------------------
\11\ Sawhill, I. (2001). What Can Be Done to Reduce Teen Pregnancy
and Out-of-Wedlock Births? Policy Brief. Washington, DC: The Brookings
Institution. http://www.brookings.edu/wrb/publications/pb/pb08. htm
---------------------------------------------------------------------------
What Works to Prevent Teen Pregnancy?
What do we know about what works to prevent teen pregnancy?
Fortunately, there is some good news here, too. For decades, those
involved in the teen pregnancy field have been discouraged by the fact
that the rates of teen pregnancy and childbearing remained high, were
sometimes increasing, and we didn't know what to do about it. The
research was just not there to tell us what programs worked to help
teens avoid sex or to use contraception effectively.
Finally, we have some answers. This past May, the National Campaign
to Prevent Teen Pregnancy released Emerging Answers: Research Findings
on Programs to Reduce Teen Pregnancy, a comprehensive research review
by the well-respected researcher, Douglas Kirby, Ph.D.\12\ To summarize
what this review found: (1) the overwhelming weight of research
evidence clearly shows that sex and HIV education programs do not
increase sexual activity, as some people had feared, and (2) there are
a variety of programs that seem to work. Some focus on sex and some do
not. Kirby identified three particular types:
---------------------------------------------------------------------------
\12\ Kirby, D. (2001). Emerging Answers: Research Findings on
Program to Reduce Teen Pregnancy. Washington, DC: National Campaign to
Prevent Teen Pregnancy. http://www.teenpregnancy.org/053001/
emeranswsum.pdf
Several sex and HIV education programs have been
shown to delay sex or increase contraceptive use for up to 30
months. The effective programs share ten clearly definable
characteristics.
Two youth development programs that give young
people opportunities to do community service and have mentoring
relationships with adults may actually have the strongest
evidence of any intervention that they reduce actual teen
pregnancy rates while the youth are participating in the
programs. Among the programs with the best evidence of
effectiveness are the Teen Outreach Program and Reach For
Health service learning program. The research does not indicate
why these youth development programs are so successful,
although the review suggests several possible explanations:
participants develop relationships with caring adults, they
gain a sense of autonomy and feel more competent in their
relationships with peers and adults, and they feel empowered by
the knowledge that they can make a difference in the lives of
others. Taken together, all these factors may help increase
teenager's motivation to avoid pregnancy. In addition, of
course, participating in supervised activities reduces the
opportunities for teens to engage in risky behavior.
The third category of programs includes both
sexuality and youth development components. The Children's Aid
Society-Carrera Program combines family life and sex education
with such things as tutoring, work and sports-related
activities, and comprehensive health care. Research shows that
the program has substantially reduced teen pregnancy and birth
rates among girls. In fact, according to the research in
Emerging Answers, the Carerra Program and the Teen Outreach
Program reduced pregnancy rates among girls by as much as half.
Together, this information offers leaders around the country
encouraging news and the opportunity to choose an intervention that
best fits the needs and values of their own communities. Having a
variety of options is particularly important when dealing with an issue
as complex and sensitive as teen pregnancy.
What do we know about abstinence education? Our review finds that
the jury is still out on abstinence-only or abstinence-until-marriage
education. This is true for two reasons: (1) very little rigorous
evaluation of abstinence-only programs has been completed, and (2) the
few studies that show no positive effect do not reflect the great
diversity of abstinence-only programs currently offered.\13\
Fortunately, Dr. Rebecca Maynard is now conducting a very rigorous
study of abstinence-only programs that should shed more light on this
important group of interventions.
---------------------------------------------------------------------------
\13\ Ibid.
---------------------------------------------------------------------------
I would add that I think it is critically important that our
evaluations of abstinence programs answer two questions: (1) do they
delay sexual intercourse? and (2) for those program participants who do
end up having sex, are they less likely to protect themselves from
disease and pregnancy? Although some may find this second question
beside the point, I would argue that it is no different than asking
whether sex education programs inadvertently encourage young people to
have sex. Our first goal should always be to do no harm.
Programs Can't Do It All
While it is true that effective programs to reduce teen pregnancy
exist and should be expanded, it is unrealistic and unfair to assume
that community programs alone will solve this problem entirely. Not all
teens are enrolled in programs and many community-based programs are
small, fragile, and often given too little money to do their important
job as well as they would like.
But there is another reason why community programs can't shoulder
the burden alone: teen pregnancy is rooted in broad social phenomena,
including the images portrayed in the entertainment media, the values
articulated by parents and other adults, and popular teen culture most
of all. Simply put, it's fine to work with states and communities to
make their efforts better--more research-based, more media savvy, more
tolerant of differing views, and offering a wide variety of ways to
act. But doing so will be a hollow exercise if the entire culture,
especially popular teen culture, is sending kids messages that getting
pregnant at a young age is no big deal, that having sex ``early and
often'' is just fine, that contraception is not all that important,
that refraining from sex is square and unrealistic, and that parents
can't do anything about their children's sexual attitudes and behavior.
The research assessing the effectiveness of media campaigns to
prevent teen pregnancy is not nearly as extensive as the research
evaluating community-based teen pregnancy prevention programs. There
is, however, some encouraging research that indicates media campaigns
can be effective. One meta-analysis of 48 different health-related
media campaigns--from smoking cessation to AIDS prevention--found that,
on average, these types of campaigns caused seven to 10 percent of
those exposed to the campaign to change their behavior (compared to
those in a control group).\14\ Given how hard it is to actually change
behavior, these findings are encouraging.
---------------------------------------------------------------------------
\14\ Snyder, Leslie B. (2000). How Effective Are Mediated Health
Campaigns In Public Communication Campaign, edited by Ronald E. Rice
and Charles K. Atkin. Thousand Oaks, CA: Sage.
---------------------------------------------------------------------------
From its inception, the National Campaign to Prevent Teen Pregnancy
has recognized that reducing teen pregnancy requires, among other
things, a change in social values and standards; that the entertainment
media has a major influence on popular culture; and that conveying
important messages through the entertainment media is both powerful and
efficient. The Campaign works in two primary ways with the
entertainment media: influencing the content of television shows and
magazines and placing PSAs in both print and broadcast media. To
encourage media leaders to weave prevention messages into the content
of their work, we offer specially tailored face-to-face briefings to
key editors, script writers, and producers about the problem of teen
pregnancy and its solutions. We discuss with them selected messages
well suited to their shows or magazines and talk about different ways
that these messages can be presented in their media. To date, the
National Campaign has worked with over 57 media partners on messages
that have reached millions of teens and their parents.
Implications for Welfare Reform Reauthorization
The National Campaign to Prevent Teen Pregnancy believes that
preventing teen pregnancy should be a central focus in reauthorizing
welfare reform. Sustained progress in reducing teen pregnancy could
contribute significantly to the continued success of welfare reform.
Welfare caseloads have declined dramatically since 1996, millions of
low-income parents have moved into the labor force, child poverty has
declined, teen birth rates have declined, and out-of-wedlock birth
rates have leveled off. However, this good news could be short-lived if
every welfare recipient who goes to work and begins moving toward self-
sufficiency is replaced by a pregnant younger sister or daughter who is
not prepared to support a family.
Moreover, teen pregnancy prevention is closely tied to the goal of
reducing out-of-wedlock childbearing and increasing the number of
children growing up with married parents. Three out of ten out-of-
wedlock births in the U.S. are to teenagers and nearly half of all
first out-of-wedlock births are to teen mothers. Furthermore, 80
percent of teen births are out of wedlock. Welfare caseloads are
disproportionately made up of women who had their first birth as a
teen. The teen years are frequently a time when unmarried families are
first formed. Teenagers who have a non-marital birth are less likely to
get married later and even if teen parents do get married, teen
marriages are highly unstable and far more likely to fail than
marriages between older individuals.\15\
---------------------------------------------------------------------------
\15\ Sawhill, I. (2001). Op Cit.
---------------------------------------------------------------------------
Specific ideas
1. As a general matter, provide states and communities with
adequate resources to prevent teen pregnancy, access to good
information about what works so they can make informed choices about
the best way to invest their resources, and a clear signal from the
federal government that teen pregnancy prevention is important and is
directly linked to other goals of welfare reform. They also need
flexibility in deciding how best to reduce teen pregnancy, given local
circumstances. Setting performance goals and expectations is a good
idea. Rigidly prescribing how to achieve these goals is not. Consistent
with the devolution philosophy underlying the rest of welfare reform,
family and community values, rather than federal mandates, should
prevail, especially on such sensitive issues a teen sexuality.
2. Strengthen the monitoring of and reporting on state efforts to
reduce teen pregnancy. States are already required to include their
goals and strategies for reducing teen pregnancy in their TANF plans
but this information is not widely available and has received little
attention within states or at the national level. In order to enhance
accountability and visibility, we believe there is more that could be
done by the federal government to shine a light on the portion of state
TANF plans that address teen pregnancy. Similarly, the federal
government should more closely monitor states progress in meeting their
teen pregnancy prevention goals. This would encourage states to
continue their work on this issue and inspire other states to do more.
3. Establish a national resource center to collect and disseminate
information about what works to prevent teen pregnancy. Until very
recently, little high quality information was available to states and
communities about the best ways to prevent teen pregnancy and they had
no way of learning about each other's efforts. A national resource
center would provide easy access for people to get information about
the latest research evidence, as well as promising practices. We
believe the scope of this resource center should be defined broadly to
include information about programs, as well as strategies on how to
work through the media to promote responsible messages and content
related to teenage sexuality. Helpful ideas should also be available
about engaging parents, schools, and faith communities in teen
pregnancy prevention.
4. Maintain or increase present funding levels for the TANF block
grant in order to preserve resources and flexibility for states to
expand their teen pregnancy prevention initiatives, while carrying out
other important functions of TANF. The latest federal data show that
states are spending less than one percent of TANF funds on pregnancy
prevention. There are many competing priorities for TANF dollars, and
these demands are likely to grown in the current economic downturn.
Additional ideas for welfare reform reauthorization include: make
preventing teen pregnancy an explicit purpose of the TANF program;
reward states that make the most progress in reducing teen pregnancy or
teen births (without increasing abortion); and, retain in the overall
welfare reform legislation a very strong abstinence message accompanied
by support for information about and access to contraception. Both
approaches help to reduce teen pregnancy and both merit support.
[The attachments are being retained in the Committee
files.]
Chairman Herger. Thank you very much, Ms. Brown. And I
would like to again remind all our witnesses, as well as our
Members, that we do have 5 minutes. All of your testimony,
without objection, will be submitted for the record.
And with that, we would like to hear from Dr. Rebecca
Maynard, university trustee professor of education and social
policy, University of Pennsylvania, Philadelphia, Pennsylvania.
Dr. Maynard.
STATEMENT OF REBECCA A. MAYNARD, PH.D., UNIVERSITY TRUSTEE
CHAIR PROFESSOR, UNIVERSITY OF PENNSYLVANIA, AND DIRECTOR,
NATIONAL TITLE V ABSTINENCE EDUCATION PROGRAM EVALUATION
Dr. Maynard. Thank you, Chairman Herger and Members of the
Committee for giving me the opportunity to submit testimony on
this important issue.
I am both professor of education at the University of
Pennsylvania, and the director of the National Title V
Abstinence Education Program Evaluation being conducted by
Mathematica Policy Research under a contract to the U.S.
Department of Health and Human Services.
I am going to talk about three topics. The, first very
briefly, is the need for scientifically rigorous research to
improve policies and practice. The second is the ways in which
the Federal support for abstinence education has changed the
local conversations and approaches to reducing teen sexual
activity. And third, I want to talkabout what the National
Title V Program Evaluation evaluation is going to contribute to our
knowledge.
You have heard the evidence of why we need to continue to
invest in careful research. What I would tell you is that the
1996 Welfare Reforms have really heightened public awareness
about the nature and the extent of these problems that you have
heard about, and it has fostered a number of efforts to address
them, including the provision of $50 million annually in
support for the Title V abstinence education programs. And
while we don't yet have definitive evidence linking this
specific reform or any other specific reform to the favorable
trend in the teen birth rate, what we do know is that Title V
has fostered three major changes at the State and local level
that I want to talk a little bit about.
First, Title V has expanded and changed the conversation
about the role of abstinence education in local communities and
schools. The most striking evidence of this is the tenfold
increase in the proportion of high schools in this country that
are requiring the teaching of abstinence as the sole way to
prevent pregnancy and sexually transmitted diseases.
The second is that Title V has fostered the development of
many new strategies for promoting abstinence and expanding the
concept of abstinence education. Abstinence programs are no
longer ``just say no.'' The earliest grass roots abstinence
education programs tended to be classroom based, short term,
and emphasized the benefits of abstinence and the negative
consequences of sex. But many of the current programs,
including the Best Friends program you heard about here in
Washington, D.C., and nationwide, take a much broader approach,
often including extensive mentoring components, including
educational and cultural enrichments, and teaching about
healthy friendships and marital relationships--things that many
of you have been alluding to. We also have a number of
abstinence-only initiatives that are community wide systemic
change efforts.
Third, Title V has been a huge boost to the abstinence-
until-marriage movement. The Federal funds have leveraged at
least $50 million again in local funds to support more than 700
abstinence-until-marriage programs nationwide. And, if
additional funds were available, it is really clear that many
current programs would grow and that new programs would emerge,
particularly in communities that have these more intensive,
youth development focus abstinence programs. There are lines at
the door, and people are ready to expand and to add new
programs.
All of this is happening because Congress identified the
promotion of abstinence education as an important strategy for
preventing teen sexual activity and non-marital pregnancies and
births. And, the evaluation of Title V is going to provide the
much needed scientific evidence about which of these program
models are effective, for whom and under what conditions. I
want to emphasize our focus on, which programs are effective,
for whom, and under what condition?
I want to note six features of the study that we are
conducting that are central to the credibility and the utility
of the findings we are going to be able to share with you
beginning in about another year. First, we are measuring
program impacts using scientifically rigorous experimental
design methods. This is the only means of insuring with any
degree of certainty how successful the programs are overall,
and for key subgroups of youth.
Second the impact evaluation is examining five quite
different programmatic strategies geared in part to the needs
of the communities in which they are operating, so we are
respecting local autonomy and values.
Third, we have designed our student surveys to ensure that
program and control youth apply common definitions when
answering question about sexual activity. This is really
important because the abstinence education programs have
changed how people think about sexual activity.
We're using interviewers who are independent of the
programs to collect all of our student data, which is important
because we need to avoid problems of under reporting of sexual
activity due to students' linkages with the program staff.
Fifth, we are following youth for between 18 and 36 months
after sample enrollment to allow us to observe more of them as
they reach the age when they are making these critical
decisions about whether to engage in sex.
And sixth, we are using large samples in all of our sites
to protect against the possibility that we would fail to detect
true program impact simply because we have low statistical
power.
We are going to release our first results in 2003 when we
will have follow-up data for the entire study sample.
The one final statement, I want to make a plea to Congress
to continue to support youth risk avoidance and pregnancy
prevention initiatives, but I also want to encourage you to
support other scientifically rigorous studies to complement
what we are learning. We are going to learn something very
important, but it is a small piece of what we need to know.
Thank you.
[The prepared statement of Dr. Maynard follows:]
Statement of Rebecca A. Maynard, Ph.D., University Trustee Chair
Professor, University of Pennsylvania, and Director, National Title V
Abstinence Education Program Evaluation, and Amy Johnson, Ph.D., Senior
Researcher, Mathematica Policy Research, Inc.
Thank you for giving us the opportunity to submit testimony on this
important issue and to share some information based on our experiences
from the national evaluation of Title V abstinence education programs
being conducted by Mathematica Policy Research, Inc., under contract to
the U.S. Department of Health and Human Services. We will focus our
remarks on three main topics. First, we will discuss the need for
scientifically rigorous research to improve future policies and
practice aimed at reducing teen sexual activity and its adverse
consequences, including nonmarital childbearing and sexually
transmitted diseases (STDs). Second, we will discuss important ways in
which federal support for abstinence education has changed local
conversations and approaches to reducing teen sexual activity. Third,
we will describe what the national evaluation of Title V abstinence
education programs will contribute to our knowledge base and when we
will report study findings.
The Need for Investing in Careful Research
Teen pregnancy and birth rates have declined steadily since the
early 1990s. However, five years after passage of the Personal
Responsibility and Work Opportunity Reconciliation Act (PRWORA), teen
sexual activity and its consequences remain important issues,
particularly nonmarital and unintended births and sexually transmitted
diseases. We need to pay close attention to some of the significant
efforts launched in recent years to combat these problems. We need to
build on their successes. We also need to learn about and respond to
those areas where efforts are not achieving their intended goals.
Despite the steady decline in the teen birth rate
between 1991 and the present--from a high in 1991 of 62 births
per 1,000 females age 15 to 19, to 49 births per 1,000 last
year \1\ many concerns persist:
---------------------------------------------------------------------------
\1\ Child Trends. Facts at A Glance, Washington, DC: Child Trends,
August 2001. The original data are from National Center for Health
Statistics, Centers for Disease Control and Prevention, Hyattsville,
MD.
---------------------------------------------------------------------------
Nearly half of all high school students and more
than two-thirds of graduating seniors in this country have had
sexual intercourse.\2\
---------------------------------------------------------------------------
\2\ Centers for Disease Control. ``Youth Risk Behavior
Surveillance--United States, 1999.'' CDC Mortality and Morbidity Weekly
Report Summaries, vol. 49, SS05, June 9, 2000 and vol. 47, no. 36,
September 18, 1998 (www.cdc.gov/mmwr/PDF/SS/SS4905.pdf and www.cdc.gov/
mmwr/PDF/wk/mm4736. pdf, respectively).
---------------------------------------------------------------------------
One in five high school seniors reports having had
sex with four or more partners.\2\
More than 40 percent of teens failed to use any
protection against STD infections during their last sexual
encounter.\2\
An estimated 25 percent of sexually active teens
will contract a sexually transmitted disease this year.
Nearly 500,000 babies are born each year to teens,
more than 80 percent of whom are not married.\3\
---------------------------------------------------------------------------
\3\ Child Trends. Facts at A Glance, Washington, DC: Child Trends,
August 2001.
The 1996 welfare reforms heightened the public's awareness of the
nature and extent of problems associated with teen sexual activity,
teen childbearing, and nonmarital childbearing. The reforms also
fostered targeted efforts to discourage sex among teenagers, to reduce
teen pregnancies and births, and to promote stronger family
---------------------------------------------------------------------------
relationships. Specifically, the reforms did the following:
Required state welfare plans to focus on out-of-
wedlock and teen childbearing and offered a total of $20
million in bonuses to states that were especially successful in
reducing their nonmarital birth ratio.
Increased the emphasis on statutory rape laws and
required minor parents to live in supervised settings.
Allowed use of federal Temporary Assistance to Needy
Families (TANF) funds to support family planning services.
Provided $50 million annually in federal support for
Title V abstinence education programs, which is matched by
roughly $38 million in state and local funds.
At this point, we have no definitive evidence linking any of these
provisions with favorable trends in teen pregnancies and births.
However, we have abundant evidence that the federal support of
abstinence education, in particular, has focused attention at the state
and local level on the problems of teenage sexual activity and
nonmarital childbearing, and that this focus has led to expansion in
the number and variety of abstinence education programs. An important
complement to these policy and program initiatives is the investment by
the U.S. Department of Health and Human Services in a rigorous research
study of Title V abstinence education programs. The study will fill a
small, but very important, portion of the knowledge gap by helping us
understand how best to design and implement abstinence programs that
are successful in reducing nonmarital sexual activity and childbearing.
Changes at the Local Level as a Result of Abstinence Education Funding
The federal government's commitment of $50 million annually to
support abstinence education through the Title V Block Grant Program
has had three major impacts. First, it has expanded and changed the
conversation about the role of abstinence education in local
communities and schools. Second, it has fostered the development of new
strategies for promoting abstinence among youth. Third, it has
increased significantly the number of abstinence education service
providers and the number of youth they serve.
One only needs to read the newspapers to be aware of the heightened
focus, at both the state and the local level, on health, sex education,
and abstinence education policies. However, the numbers provide more
concrete evidence of change. In 1988, only 2 percent of school
districts reported teaching abstinence as the sole way to prevent
pregnancy and sexually transmitted diseases; by 1999, 23 percent
reported such policies.\4\ Today, 23 states incorporate contraception
into their curricula, and 26 states teach abstinence.\5\ In part, this
increased emphasis on abstinence reflects the fact that, in many
communities, it is the only strategy for reducing teen pregnancies that
is consistent with local norms and values. In other cases, abstinence
education programs are viewed as important complements to other
existing strategies focused on curbing high rates of sexual activity,
pregnancies, and nonmarital births.
---------------------------------------------------------------------------
\4\ Darrroch, J.E., D.J. Landry, and S. Singh. ``Changing Emphases
in Sexuality Education in the U.S. Public Secondary Schools, 1988-
1999.'' Family Planning Perspectives, vol. 32, no.5, September/October
2000, pp. 204-211.
\5\ Wertheimer, R., J. Jager, and K. Moore. ``State Policy
Initiatives for Reducing Teen and Adult Nonmarital Childbearing: Family
Planning to Family Caps.'' New Federalism Issues and Options for
States, Series A, No. A-43. Washington, DC: Urban Institute, November
2000.
---------------------------------------------------------------------------
Title V funding has fostered the development of myriad new
strategies for promoting abstinence and expanded the concept of
abstinence education. The earliest grassroots abstinence education
programs tended to be more homogeneous, classroom-based programs
focusing on the benefits of abstinence and the negative consequences of
sex outside of marriage. In contrast, many of the current programs--
including Best Friends here in Washington, DC, and ReCapturing the
Vision in Miami, Florida--take a broader approach, linking abstinence
and other healthy behavioral choices for young people. The major
quality distinguishing them from many other youth development
initiatives in our country is their clear, consistent message that
abstinence is the healthiest choice and the only way to prevent
unintended pregnancies and sexually transmitted diseases.
Contrary to popular opinion, the vast majority of current Title V
abstinence education programs offer much more than a ``just say no''
message. As noted previously, many have extensive youth development and
mentoring components; they often include educational and cultural
enrichments; and they frequently incorporate curricula and experiences
designed to teach about healthy friendships and marital relationships.
The majority of the Title V abstinence education programs target
most of their services on identifiable groups of youth. The following
table illustrates the range of such programs:
TABLE 1: ILLUSTRATIVE TARGETED TITLE V ABSTINENCE EDUCATION PROGRAMS
------------------------------------------------------------------------
Entry grade/setting/curriculum/other
Program and location services/other features
------------------------------------------------------------------------
Teens in Control, Clarksdale, Grades 5 and 6. School-based. 30
MS. curricula sessions, possibly repeated
once. Minor peer mentor component.
Extremely poor, rural community.
ReCapturing the Vision, Grades 6-8 and 9-12. School-based. Daily,
Miami, FL. year-long curriculum. Monthly home
visits and referrals to other services;
school uniforms. Urban setting; diverse
student population.
Heritage Keepers Community Grade 6 and 7 and grades 9 and 10. School-
Services, Edgefield, SC. based. Character clubs added to a five-
session abstinence curriculum. 18 or
more sessions annually over multiple
years. Rural, middle- to lower-middle-
class population.
My Choice, My Future, Grade 8. School-based. 36-session
Powhatan, VA. curriculum. 9th and 11th grade boosters.
Lower- to middle-income community.
Families United to Prevent Grades 4-6. After school. Two hours daily
Teen Pregnancy, Milwaukee, throughout the school year for multiple
WI. years. Summer program; parent
involvement; peer mentors. Poor, inner-
city neighborhoods; mixed race/ethnic
groups.
------------------------------------------------------------------------
Other programs are using Title V monies to increase public
awareness, shape attitudes, and change behavior throughout the
community. Many community-wide programs also complement their public
education and messaging efforts with more targeted services to provide
particular groups of youth with the skills and values needed to remain
abstinent. The following are examples of such efforts:
TABLE 2: ILLUSTRATIVE TITLE V COMMUNITY-WIDE ABSTINENCE EDUCATION PROGRAMS
----------------------------------------------------------------------------------------------------------------
Principal program
Sponsoring agency components Target population
----------------------------------------------------------------------------------------------------------------
Cedar Rapids, IA................... Not-for-profit/ public Abstinence curriculum for All county youth;
school district 5th graders; Young Parent emphasis on middle
coalition. Network for abstinence school youth.
training; community
resource library; School
assemblies in middle and
high schools; workshops
for parents and educators;
support groups for
transition from middle
school; volunteer teens
writing and producing
messages; mentoring and
adult supervision; Baby
Think It Over dolls.
South Carolina \1\................. Heritage Keepers Abstinence education Grades 6-10; 11th and
Community Services. curriculum (450 minutes); 12th grade boosters.
weekly or biweekly
character clubs; parent
training; mentors;
assemblies; training of
medical providers.
Toole, UT.......................... Counth health Abstinence curriculum, with 9-18 year olds;
department. some Teen Aid et al. in strongest focus on 10-
family life classes at 14 year olds.
middle schools (typically
2 weeks or so); Love and
Logic parenting class (2
hours per week for 10
weeks); self-esteem ays
for 5th--8th graders; Baby
Think It Over dolls; FACT
student self-esteem
classes for high-risk
youth; peer educators;
school fairs; billboards
and newsletters; merchang
involvement; faith-based
linkages.
Waco, TX........................... Newly formed community- Abstinence curriculum (6 10-14 year olds, with
based organization. weeks as part of health a heavy emphasis on
class); Aim for Success 8th and 9th graders.
assemblies; Reality Check
(``I'm Worth Waiting
For''); character
education in elementary
schools; youth mentors;
medical provider training;
faith-based partners;
resource library; media
spots.
Fort Bend, TX...................... Newly formed community- Wings youth development for 9-18 year olds, with a
based organization. girls; ChangeMakers, heavy focus on middle
community training; peer school youth.
education (STARS);
GOLDCLUB, social group for
high school youth; parent
education programs; parent
resource center; propellor
group for boys (under
development); Aim for
Success Assemblies; school-
based abstinence
curriculum; community
events (e.g., fairs).
Monroe County, NY.................. County health Abstinence curriculum; Youth aged 9-14.
department and New parent guides; paid TV
York agency ads, radio spots, and
(advertising). posters; Kids Advisory
Panel for media efforts;
interactive web site for
parents, youth, and
community educators.
----------------------------------------------------------------------------------------------------------------
The $50 million annual federal investment in abstinence education
through Title V has been a huge boost to the abstinence-until-marriage
movement. Federal program funds have leveraged at least that much again
in local matching funds to support more than 700 programs nationwide.
And, funds for abstinence education through the Special Projects of
Regional and National Significance (SPRANS) grant program administered
by the Health Resources and Services Administration recently added
another $20 million to support 49 additional grantees operating a
similar range of programs.\6\
---------------------------------------------------------------------------
\6\ Lawler, Michele. ``Abstinence Education Grant Program, Health
Resources and Services Administration, U.S. Department of Health and
Human Services.'' Presentation at the Abstinence Clearinghouse
International Conference, Miami, FL, July 26, 2001.
---------------------------------------------------------------------------
If additional funds were available, it is clear that many current
programs would grow and that new programs would emerge. Particularly in
communities with the more intensive youth-development programs, demand
for abstinence programs frequently exceeds current capacity, as
evidenced by program waiting lists and requests for programs to expand
to new sites. Many communities with classroom-based programs are
interested in beginning them earlier and/or running them longer. One of
the biggest future challenges is knowing which models and delivery
strategies will work best for a particular community or with a
particular group of youth--issues that are central to the ongoing
evaluation of Title V abstinence education programs we are conducting.
What Will the National Evaluation of Title V Abstinence Education
Programs Contribute?
Congress identified the promotion of abstinence education as an
important strategy for preventing teen sexual activity, nonmarital
pregnancies and births, and sexually transmitted diseases. The central
focus of the Congressionally mandated study of the Title V programs is
to provide much-needed, scientifically rigorous evidence about which
program models are effective, for whom, and in what local contexts. The
study will measure the success of different program models in altering
youths' attitudes and intentions about nonmarital sex, reducing sexual
activity among teens, convincing youth who have had sex to become
abstinent, and lowering exposure to sexually transmitted diseases and
nonmarital births.
The Title V program evaluation findings should have much greater
credibility than findings from previous research, because of critical
features of the study design and implementation:
1. We are measuring program impacts using scientifically rigorous,
experimental design methods. This is the ONLY means of measuring with a
known degree of certainty how successful the programs are overall and
for key subgroups of youth. Findings based on any other evaluation
design could be readily dismissed for their weak study design and the
potential for ``selection bias.'' This would include results based
designs that relied on comparisons of pre- and post-program outcomes
for program youth; comparisons of outcomes for program youth with those
for youths in the program site who, for some reason, do not participate
in the program; and comparisons of outcomes for program youth with
those for youth in another school or district.
2. The impact evaluation is examining five quite different
programmatic strategies geared, in part, to the needs of the
communities in which they are operating. For example, the programs in
two sites serve mainly youth from single-parent households; these
programs are intensive and include strong components on relationship
development and maintenance, and appreciation of the institution of
marriage. In another site, many youth live in large, multi-generational
households often isolated from the broader community. The program in
this community is delivered through the schools and emphasizes both
basic knowledge development and peer pressure management components.
Youth in another two sites live in communities that mirror ``middle
America.'' The program in one of these sites is a low-cost, school-
based intervention, while that in the other site is a more
comprehensive and intensive youth development initiative. By measuring
impacts for a range of program models we promote the goal of
identifying and documenting effective abstinence education strategies
appropriate to varied local needs and contexts.
3. We have designed student surveys to ensure that program and
control youth apply common definitions when answering questions about
sexual activity and abstinence. Participation in abstinence education
programs sometimes leads youth to change their definitions of what
constitutes sexual activity and abstinence. Failure to address such
program-induced changes in definitions could result in a downward bias
in the reporting of abstinence by program youth relative to control
youth and thereby limit our ability to detect true program impacts. It
is, therefore, essential that we clearly ask about the specific
behaviors of interest.
4. We use interviewers who are independent of the programs to
collect all student survey data for the study. Research shows that
youth are especially likely to underreport sexual activity and other
risk-taking behaviors on surveys linked to or administered by program
staff. Reporting accuracy can be improved through carefully designed
surveys administered by independent professionals in neutral settings.
5. We are following youth for between 18 and 36 months after sample
enrollment. This follow-up permits the study to measure behavior
changes, not just changes in reported intentions. It also allows us to
observe more youth as they reach the age when they are at substantial
risk of engaging in sexual activity.
6. We have enrolled samples of 400 to 700 youth per site. Large
sample sizes protect against the possibility that we would fail to
detect true impacts of the programs, simply because the study lacked
statistical power. Small samples have a very high probability of
missing all but very large program impacts.
7. We are establishing a foundation for longer-term assessment of
systemic change resulting from community-wide programs. Changing
community norms and values is a cumulative process that takes time. As
part of the Title V program evaluation, we are documenting the
operational strategies of a select group of such programs. However, it
may take many years to reliably link operational success to changes in
community norms and youths' behaviors. Fortunately, some of these
projects have instituted indicator-tracking systems that will support
their ongoing efforts to gather evidence of cumulative changes in local
behaviors beyond the period when the national evaluation of Title V
programs is ongoing.
We are committed to conducting a scientifically rigorous,
responsible evaluation that will inform future decisions about
effective intervention strategies and policies to support and promote
them. Results based on only part of our study sample are susceptible to
missing all but very large program impacts. Thus, evidence on the
short-term effects of the various program strategies in changing norms,
attitudes, and behaviors will not be available until we have data for
the full study sample, early in 2003. The final impact findings will be
available early in 2005. Throughout the study period, we are monitoring
program operational experiences and the local community context, as
well as other related research that emerges.
The Title V program evaluation will generate some very important
information to guide future policy and program initiatives. It is
important, however, that there be other similarly rigorous studies to
fill other critical knowledge gaps about the causes of youths' risk-
taking behaviors, about ways we can promote healthier life choices
among youth, and about strategies to mitigate the adverse outcomes
youth encounter.
Chairman Herger. Thank you very much, Dr. Maynard. And now
Ms. RoseAnne Bilodeau, Greater New Britain Teenage Pregnancy
Prevention, Incorporate, New Britain, Connecticut. Ms.
Bilodeau.
STATEMENT OF ROSEANNE BILODEAU, EXECUTIVE DIRECTOR, GREATER NEW
BRITAIN TEEN PREGNANCY PREVENTION, INC., NEW BRITAIN,
CONNECTICUT
Ms. Bilodeau. Good morning, Mr. Chairman, and honorable
Committee Members. It is with a deep sense of honor that I
appear before you today to share our teen pregnancy prevention
findings from Connecticut's Sixth District, Congresswoman
Johnson's hometown of New Britain.
My name is RoseAnne Bilodeau, and I am the founder and
executive director of Greater New Britain Teen Pregnancy
Prevention, Incorporated, which is more commonly known as the
Pathways/Senderos Center.
We originated 8\1/2\ years ago as a neighborhood-based coed
teen pregnancy prevention youth and family center. We are an
independent private, non-for-profit organization. Our mission
is to eliminate teen pregnancy by addressing its root causes,
assuring high school graduation and promoting adult self-
sufficiency. We provide long-term comprehensive holistic
services by creating a parallel family structure with
neighborhood youth and parents. Our motto is ``diplomas before
diapers.''
Our board of directors is comprised mostly of successful
businessmen, bankers, lawyers and a few other community
stakeholders, such as the superintendent of the schools, the
director of Family Planning, local clergy and leadership from
both the Democrat and Republican parties. Almost 60 percent of
our board of directors are men.
Our annual evaluation, conducted by Philliber Research
Associates, documents that only two of our participants have
ever created a pregnancy, which 100 percent of our participants
remain in school, and only 25 percent of our kids have ever
been involved in a physical fight, only 4 percent have ever
carried a weapon, and only 8 percent have tried cigarette
smoking.
Our program population is 50 youth. They range in age from
10 to 18 years old, and as Congresswoman Johnson indicated, we
are one of New Britain's greater poverty-stricken areas. All of
our children are Latino, most are Puerto Rican, while the
others come from Peru, Colombia, Mexico, and Panama. For most,
English is a second language. At least 80 percent of our
preteens come from families that were started by teen parents.
Some of the children are being raised by their biological
parents, while others are raised by single grandmothers or
mothers who may be married to a stepfather, single or living
with a boyfriend.
Our TANF-dependent families were affected by the first wave
of Connecticut's welfare reform. All of our parents are
currently employed in low-paying entry-level jobs, many as
certified nursing assistants. Our families are Members of the
working poor, people who run out of food frequently while
trying to make ends meet. At Pathways/Senderos we provide
clothing and food pantries. We distribute at least a bag of
groceries a day.
Our program model and philosophy are based upon the work of
Dr. Michael Carrera and the Children's Aid Society, which was
recently identified as being an extremely effective
intervention by the National Campaign's ``Emerging Answers''
report. We believe that by participating in a safe environment
with a parallel family structure every day after school and
during the summer, that young vulnerable teens can develop the
skills and inner fortitude necessary to avoid negative, risk-
taking behaviors, and instead engage in activities that
encourage academic success, making the right choices, and
eventually attaining self-sufficient adulthood. We provide a
pathway of hope.
Ours is a child-focused family systems intervention which
involves us with families for years. Our primary service
components emphasize education, career, vocational exploration,
community service projects, family life and sex education, arts
and lifelong sporting activities. We have also started a
business of our own, titled Barcodes aRe Us, which is a bulk-
mailing service. We train and employ our age-eligible youth who
maintain at least a C average in school. Our business also
provides a source of revenue for our program.
Our board of directors is finalizing a year-long strategic
planning process which will identify an expansion of our scope
of services to include additional children from the elementary
grades. Currently we recruit from the sixth grade. Our intake
data, since welfare reform, indicates that the children now
spend less time with their parents and have greater exposure to
and involvement with risk-taking behaviors than did their peers
prior to welfare reform. We would like to reach out to these
younger children who might not be properly supervised when they
are out of school. We would like to involve children at an
earlier age with our philosophy of hard work, cooperation,
making the right choices and team effort.
Although we currently save the youth who are most likely to
fall between the cracks, we believe we could be so much more
successful in moving poverty-stricken children and their
families forward if we had the resources to serve more children
at an earlier age. Pathways/Senderos assists vulnerable
families by providing intensive long-term multi-faceted
services. Over time we have seen many families slowly overcome
the barriers created by undeveloped education, limited skill
training and lack of English language skills. With our daily
involvement the children flourish and prosper. As they grow in
this positive manner, the rest of the family follows, including
parents and extended family.
Pathways/Senderos is also credited by the local clergy with
contributing to the stabilization of our highly-transient inner
city neighborhood. When we first arrived local gangs controlled
the area and neighborhood teens either joined a gang for
protection or stayed in their apartments for safety. The police
cleaned out the gangs and Pathways/Senderos replaced them as an
option of choice for the neighborhood teens.
We have created a positive peer group which carries on when
we are not there on some of the weekends and during school
hours. Our youngsters bond as a family and strive together to
become responsible civic-minded self-sufficient citizens. It is
this long-term holistic approach which not only averts teen
pregnancy, but does so much more, that has persuaded our inner
city poverty-stricken children to make the right choices and
aspire to a life of success.
Thank you for your time and attention.
[The prepared statement of Ms. Bilodeau follows:]
Statement of RoseAnne Bilodeau, Executive Director, Greater New
Britain Teen Pregnancy Prevention, Inc., New Britain,
Connecticut
Good morning Mr. Chairman and honorable subcommittee members. It is
with a deep sense of honor that I appear before you today to share our
teen pregnancy prevention findings from Connecticut's Sixth District,
Congresswoman Johnson's home town of New Britain.
My name is RoseAnne Bilodeau. I am the founder and Executive
director of Greater New Britain Teen Pregnancy Prevention, Inc., more
commonly known as the Pathways/Senderos Center.
We originated eight and one half years ago, as a neighborhood-
based, coed, teen pregnancy prevention youth and family center. We are
an independent, private, non-profit organization dedicated strictly to
providing successfully evaluated, long-term, comprehensive, holistic
prevention services.
Our Board of Directors is comprised mostly of successful business
people, lawyers, bankers and a few other key community stakeholders
such as the Superintendent of Schools, Director of Family Planning, the
clergy and leadership from both the Democratic and Republican parties.
Our annual evaluation conducted by Philliber Research Associates of
Accord, New York, documents that only two of our participants have ever
created a pregnancy, while 100 percent remain in school; with only 25
percent have ever been involved in a physical fight; 4 percent have
ever carried a weapon; and only 8 percent have tried cigarette smoking.
Our program population is 50 10-18 year olds from one of New
Britain's poverty-stricken neighborhoods. All of our children are
Latino, most Puerto Rican, while the others come from Peru, Columbia,
Mexico and Panama. For most, English is a second language.
At least 80 percent of our (pre)teens come from families started by
teen parents. Some of the children are being raised by their biological
parents, while others are raised by their single grandmothers or
mothers who may be single, married to a stepfather or living with a
boyfriend. Our TANF-dependent families were affected by the first wave
of Connecticut's welfare reform. All are currently employed in low-
paying, entry-level jobs with many working as certified nursing
assistants. Our families are members of the working poor, people who
run out of food frequently while trying to make ends meet. At Pathways/
Senderos we also provide food and clothing pantries. We distribute at
least one bag of groceries a day.
Our program model and philosophy are based upon the work of Dr.
Michael Carrera and the New York's Children's Aid Society, which was
recently identified as being successful by the National Campaign's
``Emerging Answers'' report. We believe that by participating in a safe
environment with a parallel family structure every day after school and
during the summer that young vulnerable people can develop the skills
and inner fortitude necessary to avoid negative, risk-taking behaviors
and instead engage in activities that encourage academic success, and
where they can make the right choices to eventually attain self-
sufficient adulthoods.
Ours is a child-focused, family systems intervention, which
involves us with families for years. Our primary service components
emphasize education, career/vocational exploration, community service
projects, family life and sex education, arts and life-long sporting
activities. We have also started a business, Barcodes aRe Us, a bulk-
mailing service, which trains and employs our age-eligible youth who
maintain at least a ``C'' average in school. Our business also provides
a source of revenue for us.
Our Board of Directors is finalizing a year-long strategic planning
process which will identify an expansion of our scope of services to
include additional children from the elementary grades. Currently we
recruit sixth grade students. Since welfare reform, our data indicates
that the children now spend less time with their parent(s), and have
greater exposure to and involvement with risk-taking behaviors than did
their peers prior to welfare reform. We would like to reach out to
these younger children who may not be properly supervised when out of
school. We would like to involve children at an earlier age with our
philosophy of hard work, cooperation, making the right choices and team
effort.
Although we currently ``save'' the youth who are most likely to
fall between the cracks, we believe that we could be so much more
successful in moving poverty-stricken children and their families
forward if we had the resources to serve more children at an earlier
age. Pathways/Senderos assists vulnerable families by providing
intensive, long term, multi-faceted services. Over time, we have seen
so many families slowly overcome the barriers created by undeveloped
education, limited skill training and lack of English language skills.
With our daily involvement, the children flourish and prosper. As they
grow in this positive manner, the rest of the family follows, including
parents and extended family.
Pathways/Senderos is also credited by the local clergy with
contributing to the stabilization of our highly-transient, inner-city
neighborhood. When we first arrived, local gangs controlled the area
and neighborhood teens either joined a gang for protection or stayed in
their apartments. The police cleaned out the gangs and Pathways/
Senderos replaced them as the option of choice.
We have created a positive peer group, which carries on when we are
not there on some weekends and during school hours. Our youngsters bond
as a family and strive together to become responsible, civic-minded,
self-sufficient citizens.
Chairman Herger. Thank you very much, Ms. Bilodeau. What an
impressive program, and we thank you for coming and sharing
that with us.
And now Dr. Joe S. McIlhaney, Jr., M.D., president, Medical
Institute for Sexual Health, Austin, Texas. Dr. McIlhaney.
STATEMENT OF JOE S. McILHANEY, JR., M.D., PRESIDENT, MEDICAL
INSTITUTE FOR SEXUAL HEALTH, AUSTIN, TEXAS
Dr. McIlhaney. Thank you, Chairman Herger and other
distinguished members of the panel. I am a gynecologist and
actually am comfortable being on a panel with five wonderful
women.
I left a rewarding medical practice in 1995 to spend the
rest of my medical career helping women and men avoid the
problems I saw every day in my medical practice, sexually
transmitted disease (STD), non-marital pregnancy and emotional
damage of inappropriate sexual behavior.
You probably know that one-third of pregnancies in America
are born out-of-wedlock and that those drive much of the
problems that we see in this country, poverty, child health,
education, crime, much more that has been mentioned already. I
have some of those statistics in my written testimony.
We could go on and on with how dramatically these non-
marital pregnancies and the problems from them impact all of
America, every element of our society. We must dramatically
reduce its occurrence.
In the seventies and eighties the primary efforts were to
emphasize contraceptive use, but the pregnancy rates continued
to climb. The first governmental legislation to fund abstinence
promotion was the Title XX program initiated in the mid
eighties. There is some suggestion of success of these efforts
as they matured, in that teen sexual activity began declining
in 1990. A non-governmental abstinence program was proven to
work by the ADD Health, National Longitudinal Study on
Adolescent Health, Study, the biggest study ever done on
American adolescence. It showed that kids who took pledges of
abstinence, that those pledges were the biggest influence in
the lives of those children who were delaying the onset of
sexual activity. That ADD Health Study also showed that 10
percent of American boys and 15 percent of American girls in
their adolescent girls were taking those pledges. The pledges
were at first ridiculed by the scientific community. No more.
In addition to these efforts, there are studies
accumulating of specific abstinence programs which are showing
surprising success. You have already heard from Members of this
panel about some of them, and others of them are mentioned in
our written testimony. As a result of these efforts, teen
sexual activity has been decreasing since 1990. Today, as you
know, over 50 percent of students in high schools across the
country are still virgins, and during this same period of time
teen birth rates have been declining, as we have heard.
The chart I put here on out-of-wedlock birth rates from
1980 to 1999 clearly suggest that abstinence efforts have
played a major role in this healthy trend. Almost all efforts
to encourage sexual abstinence, particularly Title XX and Title
V, have been directed toward teens. And as the chart shows,
that red chart at the bottom, that it is the group, the teens
in which out-of-wedlock birth rates have fallen. If these
decreased birth rates were primarily due to increased
contraceptive rates, birth rates among unmarried women in their
twenties should also have fallen because they obviously had at
least equal access to contraceptives as the teens did. It was
only the age group in which abstinence efforts had been focused
that has experienced not only reduced pregnancy rates, but also
reduced rates of sexual activity.
[The chart follows:]
[GRAPHIC] [TIFF OMITTED] T7054.001
It is of great importance to note, however, there is a
major problem which is often disastrously overlooked in
discussing the problem of out-of-wedlock pregnancy, and that is
the epidemic of sexually transmitted disease. When I gave
testimony before this same Committee in 1996, I highlighted
those problems. They are still with us. Fifteen point five
Americans get a new sexually transmitted disease every year.
The result is that today 70 million Americans are living with a
sexually transmitted disease. Sixty-five million of those are
infected with incurable STDs because they are viral. One
specific example literally tears at our hearts, and that is
that 50 percent of women having sex, who are between the ages
of 18 and 22, right now half of them are infected with human
papillomavirus (HPV), the virus that causes 99 percent of
cervical cancer, a cancer which is killing between 4,000 and
5,000 American women a year, more than die of AIDS.
When I started practicing in 1968 there were only two STDs
you worried about. Today there are over 25 STDs we worry about,
and more people are infected today. In those days 1 in 47 teens
was infected with an STD. Today one in four teens is infected
with an STD.
The reason we must include the problem of sexually
transmitted disease when we talk about out-of-wedlock pregnancy
is that the contraceptive techniques more reliable for
preventing pregnancy, DepoProvera and oral contraceptives,
provide no protection from STD transmission, and this is the
reason it is so convenient to ignore the STD problem when
discussing out-of-wedlock pregnancy. To be honest about
physical problems that can result from out-of-wedlock sexual
activity, we must always discuss both of these problems.
The only technique that provides any protection from the
STDs are condoms. However, a major National Institute of Health
panel reviewed the world's data on this subject, and this
scientific panel this year reported that if condoms are used
100 percent of the time, they will reduce the risk of HIV and
gonorrhea, gonorrhea in men; they do not reduce the risk of
HPV, which is the most common STD and causes cancer, and we
don't know whether they reduce the risk of other STDs or not.
So this is information that we just must understand.
And unfortunately, sex is sexist. When people become
infected with diseases, it is the women that suffer. I am just
about through. And we all know that it is the women who suffer
from out-of-wedlock pregnancies. They are the ones, not the
men, that submit their bodies to the surgical procedure called
abortion. They are the ones that deliver the babies and then
often are left with those babies to raise as enormous personal,
educational and economic sacrifice. Many students of American
culture are of the opinion that these problems are the most
damaging on the American culture of all the problems we have,
and I agree.
Finally, for the health of individuals in all society, we
need to emphasize marriage as a core element of society and
emphasize its importance as the ultimate answer for these
health problems plaguing our country and other countries, by
the way, around the world. A major step in accomplishing this
is TANF reauthorization, and additional TANF funds being
earmarked for abstinence and marriage efforts, not just limited
to adolescence either.
And finally, Title V funds for abstinence education should
not only be continued but increased. If these steps are not
taken, there is significant danger that the promising trends
that we see over here, decreasing sexual activity and
decreasing teen pregnancy, will reverse. We need a cultural
transformation regarding sexual activity for the protection of
all society, and you as leaders can play a huge role in this
happening.
Thank you, sir.
[The prepared statement of Dr. McIlhaney follows:]
Statement of Joe S. McIlhaney, Jr., M.D., President, Medical Institute
for Sexual Health, Austin, Texas
Thank you, Chairman Herger and other distinguished members of this
committee. I am a gynecologist who practiced clinical medicine for
twenty-eight years. I had a rewarding practice of in-vitro
fertilization, surgery, and healthcare for women. However, I left that
practice in 1995 to spend the rest of my medical career helping women
and men avoid the problems I saw every day--problems that physicians
today are seeing even more often. Those problems are non-marital
pregnancy, sexually transmitted disease, and the emotional damage of
inappropriate sexual behavior.
First, births to unmarried women. There were approximately 4
million births in the United States in 1999.\1\ Approximately 1/3 of
those (1,300,000) were out-of-wedlock. Seventy percent of these were to
women twenty years of age and older, but 50 percent were to mothers who
were under age 20 when they bore their first child.\2\ These out-of-
wedlock births are often disastrous for the mothers, for the children,
and often for the fathers--but they are also disastrous for society.
They affect poverty, child health, education, and crime.
---------------------------------------------------------------------------
\1\ Ventura SJ, Martin JA, Curtin SC, Menacker F, Hamilton BE.
Births: Final data for 1999. National vital statistics reports; vol.
49, no. 1. Hyattsville, Maryland: National Center for Health
Statistics. 2001.
\2\ Ventura SJ, Bachrach CA. Non-marital childbearing in the United
States, 1940-99. National vital statistics reports; vol. 48, no. 16.
Hyattsville, Maryland: National Center for Health Statistics. 2000.
---------------------------------------------------------------------------
The specific facts I will now cite come from an insightful new
book, The Case for Marriage--Why Married People Are Happier, Healthier,
and Better Off Financially.\3\
---------------------------------------------------------------------------
\3\ Waite LJ, Gallagher M. The Case for Marriage: Why Married
People Are Happier, Healthier, and Better Off Financially. New York:
Doubleday, 2000.
---------------------------------------------------------------------------
Poverty: In 1996, for example, 11.5 percent of children younger
than 6 who lived in a married couple family were poor, compared to
almost 59 percent of those living with a single mother.
Child health: For college-educated white mothers, being unmarried
increases the risk that a baby will die by 50 percent.
Education: Living in a single-parent family approximately doubles
the risk that a child will become a high school dropout--29 percent vs.
13 percent.
Crime: Boys raised in single-parent homes are twice as likely to
have committed a crime that leads to incarceration by the time they
reach their early thirties than boys raised in the home of two biologic
parents.
I could go on and on to show how dramatically the non-marital
pregnancy problem has impacted almost every facet of society. We must
dramatically reduce its occurrence. And we have made some progress with
teen pregnancy. Prior to the government's first legislation funding
abstinence education, the Title XX program, teen pregnancy rates were
skyrocketing. As a result of Title XX funding, by 1990 approximately
200 abstinence programs had been founded and implemented. Subsequently,
in the early 1990s not just teen pregnancy rates, but also teen sexual
activity rates began falling--together. These trends continue for teens
and are most likely due in large part to abstinence promotion, which
received a big boost from Title V funds made available through the
welfare reform legislation of 1996.
The abstinence pledge movement is alive and well among teens and
has had a powerful influence in helping them maintain a healthier
lifestyle. Pledges by teens to remain abstinent have been proved by the
ADD Health Study to be one of the biggest influences in a young
person's decision to delay the onset of sexual activity. ADD Health
also shows that a surprisingly large number of adolescents have taken
such a pledge--10 percent of boys and 15 percent of girls. This
movement was begun as the Southern Baptist True Love Waits Campaign in
1993. It has now spread to both religious and secular environments
nationwide. Pledges were at first ridiculed by the scientific
community--no more!
In addition to these national statistics there are studies
accumulating of specific abstinence programs which are showing
surprising success. These are both published and unpublished. The best
known is Rowberry's study of Best Friends. The most recent has been a
report from the Monroe County, NY, Department of Health regarding the
success of its Not Me, Not Now program.\4\ A Title XX program performed
in rural South Carolina showed dramatic reduction in teen pregnancy in
the 1980s.\5\ A Cleveland study recently showed a 2/3 drop in the onset
of sexual activity of virgins and a return to abstinence by some
sexually experienced students (unpublished). There are others.
---------------------------------------------------------------------------
\4\ Doniger A, Adams E, Utter C, et al. Impact evaluation of the
Not Me, Not Now abstinence-oriented, adolescent pregnancy prevention
communications program, Monroe County, New York. J of Health Comm.
2001; 6:45-60.
\5\ Vincent ML, Clearie AF, Schluchter MD. Reducing adolescent
pregnancy through school and community-based education. JAMA.
1987;257:3382-3386.
\6\ Centers for Disease Control and Prevention. CDC Surveillance
Summaries, June 9, 2000. MMWR 2000;49 (No. SS-5).
\7\ Mann J, McIlhaney JS, Stine CS. Building Healthy Futures, The
Medical Institute for Sexual Health, 2000.
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Those who are attempting to discredit abstinence promotion efforts
emphasize the fact that there are only a small number of studies of
these programs. It is vital to remember two things about these efforts.
Implementation of abstinence education is still relatively new.
Additionally, it takes a lot of time, money, and expertise to evaluate
abstinence promotion programs--money not made available until recently.
Let's compare this to smoking. A brave Surgeon General in 1964 said
smoking was harmful and that Americans should not smoke. No study of
abstinence from smoking would have shown success in those early years.
Now, thirty-seven years later, we know that adult smoking has dropped
from 43 percent to 23 percent. We all praise this success. What we need
to also remember about this is that smoking hardly ever hurts a teen
while they are a teen--the cancer and emphysema do not usually happen
for years. Sexual activity, however, often hurts teens while they are
still teens with disease and/or pregnancy. We need to be as comfortable
and intentional in urging them to be abstinent from sex as we are in
urging their abstinence from cigarettes. And we need to be patient and
unrelenting so efforts can mature.
There has been some success. Teen sexual activity has been
decreasing since 1990. Today over 50 percent of students in high
schools across the country are still virgins. During this same period
of time teen birth rates have also declined to their lowest level in
recent memory.
The chart ``Out of Wedlock Birth Rates, 1980-1999'' clearly
suggests that abstinence efforts have played a major role in this
healthy trend. Almost all efforts to encourage sexual abstinence,
particularly Title XX and Title V, have been directed toward teens and,
as the chart shows, that is the group in which out-of-wedlock birth
rates have fallen. If these decreased birth rates were primarily due to
increased contraceptive use, birth rates among unmarried women in their
20s should also have fallen because undoubtedly these groups go to the
same healthcare providers and have equal access to contraceptives. It
was the only age group on which abstinence efforts have been focused
that has experienced not only reduced pregnancy rates, but also reduced
rates of sexual activity.
This information makes it clear that Congress was wise in including
Title V funding for abstinence promotion in its 1996 welfare reform
legislation. The success being shown by studies of abstinence efforts,
regardless of criticism of the strength of those studies, is the first
beam of light showing us the way out of the dark tunnel of not only
teen pregnancy, but also out-of-wedlock pregnancy for all age groups.
The goals of Title V legislation encourage adolescents to remain
abstinent until marriage and TANF legislation emphasizes marriage by
stating in three of its four goals, and I quote:
``2. To end the dependence of needy parents on government
benefits by promoting job preparation, work, and marriage.
3. To prevent and reduce the incidence of out-of-wedlock
pregnancies and establish numerical goals for preventing and
reducing the incidence of these pregnancies.
4. To encourage the formation and maintenance of two-parent
families.''
These messages from America's political leadership are powerful and
influential. I believe it is vital that Congress continue to help
America by reauthorizing TANF and Title V abstinence efforts and also
funding ongoing evaluation. Efforts to support, strengthen, and promote
marriage are evolving and efforts to encourage sexual activity in only
that environment are maturing. Evidence suggests these will result in
greater health for all. Studies are necessary to encourage continued
improvement of such efforts and to learn which are most effective for
different communities.
It is of great importance to note that there is a major problem
which is often conveniently and disastrously overlooked in discussions
about out-of-wedlock pregnancy. That is the epidemic of sexually
transmitted disease. When I gave testimony before this same committee
in 1996, I highlighted those problems, and they are still with us.
15.5 million Americans are infected with a new STD
every year \8\
---------------------------------------------------------------------------
\8\ American Social Health Association. Sexually Transmitted
Diseases in America: How Many Cases and at What Cost? Menlo Park, CA:
Kaiser Family Foundation; 1998.
---------------------------------------------------------------------------
It is estimated that over 70 million people are
currently infected with STD; 65 million of those are infected
with an incurable viral disease.\8\
Specific examples tear at our hearts.
1. In a recent study of women receiving routine gynecologic
care in New Mexico, 50 percent of sexually active women between
the ages of 18 and 22 were infected with human papillomavirus
(HPV), the virus that causes 99 percent of all cervical
cancer.\9\ Only a tiny fraction will get cancer, but will one
of these be your daughter? And, between 4,000 and 5,000
American women a year are dying from this disease--more than
die of AIDS.
---------------------------------------------------------------------------
\9\ Peyton CL, Gravitt PE, Hunt WC, Hundley RS, Zhao M, Apple RJ,
Wheeler CM. Determinants of genital human papillomavirus detection in a
US population. J Infect Dis. 2001;183:1554-64.
---------------------------------------------------------------------------
2. One in five Americans 12 years old and older is infected
with genital herpes,\10\ a disease from which many suffer
painful recurrences and emotional distress.
---------------------------------------------------------------------------
\10\ Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex
virus type 2 in the United States, 1976 to 1994. N Engl J Med.
1997;337:1105-1111.
---------------------------------------------------------------------------
3. Approximately 6 percent of teenaged females attending
family planning clinics are infected with chlamydia. Most have
no symptoms and yet this infection can cause them to become
sterile if untreated.\11\
---------------------------------------------------------------------------
\11\ Centers for Disease Control and Prevention. Sexually
Transmitted Disease Surveillance, 2000. Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention,
September 2001.
When I started practice in 1968, there were two major sexually
transmitted diseases that worried us. Now there are over twenty-five
such diseases and many more people infected. In the 1960s 1-in-47
sexually active teens was infected with an STD. Now it is 1-in-4.\12\
---------------------------------------------------------------------------
\12\ Institute of Medicine. The Hidden Epidemic, Confronting
Sexually Transmitted Diseases. Washington, D.C.: National Academy
Press, 1997.
---------------------------------------------------------------------------
The reason we must include the problem of sexually transmitted
disease when we talk about out-of-wedlock pregnancy is that the same
risky behaviors are responsible for both. But the contraceptive
techniques most reliable for preventing pregnancy, DepoProvera and oral
contraceptives, provide no protection from STD transmission. So we
therefore must not focus our efforts on reducing pregnancy alone. We
must include reducing STD also.
The obvious question then is ``Don't condoms make sex safe
enough?'' A major NIH panel considered the world's data about this
subject. The report was published this year. This scientific panel
found the following: If used 100 percent of the time, condoms reduce
the risk of HIV by 85 percent and of gonorrhea for men by 47 percent to
75 percent. However, for the most common STD (HPV) they provide no
protection from infection. For the other diseases there is just not
enough data to say whether protection is provided by condoms or not.
Unfortunately, sex is sexist. It hurts women far more than it does
men. I invite you to look at the diseases a moment.
The very common disease, HPV, causes persistent
warts, abnormal Pap smears, and cancer in women. Men rarely
have more than a tiny, almost undetectable bump.
Herpes is extremely common and can make a woman burn
so much she cannot have intercourse. It can also infect her
baby during birth resulting in severe damage or even death. It
hardly bothers a man.
Chlamydia causes huge numbers of women to become
sterile. Most men don't even know they are infected.
Then we all know that it is the women who suffer
from non-marital pregnancies. They are the ones--not the men--
that submit their bodies to the surgical procedure--abortion.
It is they who are usually left to give birth to and then raise
the children--often at terrible personal educational and
economic sacrifice.
In summary, all this information, in my opinion, provides credible
scientific evidence showing the wisdom of Congress in passing TANF
legislation and including its emphasis on two-parent families and
marriage. This information also provides data showing the wisdom of
including in Title V legislation funding for teaching adolescents that
they should reserve sex for marriage. This is not just a moral or
religious issue. Many aspects of marriage, including its very formation
and dissolution, are regulated as civil matters by secular government.
For the health of individuals and of all society we need to
emphasize marriage as the core issue for society and as the ultimate
answer for these health problems plaguing our country and other
countries around the world. A major step in accomplishing this is TANF
reauthorization with additional TANF funds being earmarked for
abstinence and marriage efforts which are not limited solely to the
adolescent age group. In addition, TANF bonus money for decreasing out-
of-wedlock pregnancies should be restricted to use for abstinence and
marriage promotion, the efforts by which those states obtained the
money in the first place.
Finally, Title V funds for abstinence education should not only be
continued but increased. If these steps are not taken, there is
significant danger that the promising trends of decreasing sexual
activity and decreasing teenage pregnancies will reverse. In addition,
if funds are not made available for promoting marriage and sexual
abstinence until marriage for single people in their 20s, that group
will continue to suffer. We need a cultural transformation regarding
sexual activity for the protection of all of society. You as leaders
can play a huge role in this happening.
Chairman Herger. And now to inquire, the gentlelady from
Connecticut, Mrs. Johnson.
Mrs. Johnson. Thank you very much, Mr. Chairman. And I
thank the panel for all of their information. It certainly is
helpful to be able to have the breadth of view that so many of
you have provided along with the concrete experiences from the
rest of you.
Elayne Bennett, I was interested that your program has so
many more female participants than male participants, and in
the long run, I hope that won't be true.
Mrs. Bennett. But that is because it was designed for
girls. We only target girls. Girls are our only Members.
Mrs. Johnson. I think that that is a cultural bias that was
unfortunate. Males are responsible for sexual behavior; it is
just as important as----
Mrs. Bennett. We now have a Best Men program.
Mrs. Johnson. Well, I do understand that, and I am glad you
are doing that, but I think this whole idea that women are
responsible and men don't have to be is terribly destructive in
our lives, and so I am glad you have a Best Friends. I
personally think it is better to have the boys and girls
together, because in the end, relational strength in America in
the long term of your life depends on being able to talk
intimately.
Mrs. Bennett. We did research on this, and we asked them.
The girls said they preferred to have their own session back in
1987 when we began at Langley High. And we did some sample
sessions, and the boys took over, and the girls said nothing,
and the boys ran the session.
Mrs. Johnson. Yes. I do appreciate that that is a problem
and remember that from those kinds of programs when I was that
age. But I think it is something we have to be challenged by
rather than comply with.
But I was wondering, what do you see as the barriers to
your program participating in an evaluation such as the one Dr.
Maynard is doing?
Mrs. Bennett. Well, we have an extensive evaluation, 15
years worth, and we just actually are publishing our comparison
study that compares our girls' behavior with the Youth Risk
Behavior Surveillance study----
Mrs. Johnson. I appreciate that. I just wonder why you
can't participate in Dr. Maynard's evaluation because it does
help us.
Mrs. Bennett. Okay, I will tell you.
Mrs. Johnson. It has been of concern to us.
Mrs. Bennett. Because the study that Mathematica proposed
wanted to do comparison of girls within the school, their
sexual activity behavior of girls in the same school. We wanted
a comparison school study because the Best Friends' philosophy,
we train all the teachers, all who are mentors in the school.
We have the principals attend two 2-day training conferences.
All the materials are in the schools. The whole philosophy is
reach out to your friend; help make your friend a better
person. The best kind of friend to have is that person who does
that.
The evaluation proposed by Rebecca Maynard--and we worked
for 2 years on this, and I am very sorry we could not
participate, actually. My academic board voted against it. I
was excited about it because I want a definitive study showing
how effective abstinence is, and how effective, frankly, we
have been. But we could not allow a comparison of girls within
the school who have been, you know, the ripple effect, who see
their friends who want to be in our program. We have a waiting
list in schools. So what you would be doing is asking girls in
a Best Friends' school where we have been 5 and 6 and 7 years,
where all the teachers have been trained, where the sexual
activity has declined because girls see what is happening with
the core group of Best Friends' girls. We wanted a matched
sample.
Mrs. Johnson. So you didn't want a comparison between the
girls who were participating in the program and those who were
on the waiting list basically.
Mrs. Bennett. Exactly. We wanted a comparison with girls
who had not had a Best Friends Program in their school so we
could get the clear dramatic benefit.
Mrs. Johnson. But they are different bodies of information
that could have been sought through those different
comparisons.
Mrs. Bennett. We were told there was no money to have a
comparison school survey, and that is what--actually, I wanted
to do both, the girls within the school and the matched sample,
the matched school comparison, and we were told there was no
money to do that and we could not do that. And that was why the
academic board voted it down.
Mrs. Johnson. I only have very little time, and I want to
get to Dr. Maynard, because I think this is an important issue.
Dr. Maynard.
Dr. Maynard. Well, I think reasonable people can differ. I
am very sad that we don't have Best Friends in the evaluation,
but will say that we have some wonderful programs in the
evaluation, and we will learn a lot from the evaluation that we
are doing, and there may be opportunities down the road to do
other similarly controlled evaluations of other programs.
Mrs. Johnson. What percentage of all the abstinence
programs have been evaluated either by you or other sort of
objective outsiders?
Dr. Maynard. I would say there are no really strong
evaluations of abstinence programs that have been done to date,
I mean where there are large samples, long-term follow-up,
external data collectors, et cetera. We have only five programs
in the evaluation that we are doing. They were carefully
selected because of the strengths of the programs, the
diversity of the programs, and the diversity of settings. So we
did as much as we could to build a broad information base from
the evaluation, given the resource constraints we had. We were
also constrained by going to those sites where we could do the
controlled comparison design. We felt strongly that in an area
as controversial as this, there is absolutely no point in
spending public dollars on an evaluation that will be
discredited by those who do not favor the results. That is not
a good use of public money. So we want to do this at the
highest standard.
Mrs. Johnson. Thank you.
Chairman Herger. Thank you very much for your testimony.
The gentleman from Maryland, Mr. Cardin, to inquire.
Mr. Cardin. Thank you, Mr. Chairman. Let me again thank all
the witnesses. This has certainly been extremely helpful to us.
Dr. Maynard, we really do look forward to the results of
your evaluation. The difficulty, as I see it, and it is not
your fault, is that we are not going to have good information
before Congress has to act on TANF reauthorization. We need to
act next year, and your work will not be completed until after
we have had to make decisions on reauthorization. So I guess I
would just ask for you to share as much information as you can
during this process, so that we can have the benefit of your
work as we move through this process.
I guess my concern, looking at the different statistics,
Dr. McIlhaney, I will just make one point about the chart that
you raise, and that is that the trend line on teenage pregnancy
started to drop before the Federal funds were available for the
target programs for abstinence programs. I mention that because
I am not sure we know why we have been successful. We know
there is multiple factors, as I indicated in my opening
statement. I just really want to raise the concern of
abstinence-only programs I and of itself, because I think it
does raise certain problems. I said in my opening statement
that I support abstinence, and I think it is a bipartisan
strong support in this Congress to support abstinence as the
first line of attack against teenage pregnancy and for values
that we believe are important. So I think there is no question
about it.
I am concerned that when you isolate, whether through
funding or through trying to determine how an abstinence
program in and of itself works, it is not reality. And I think
the public understands it.
And, Ms. Brown, I appreciate the work that your
organization has done, and one of the surveys that recently
came out--and let me just give this number. When it was asked,
given three choices, the choice that the overwhelming majority
of Americans think is the right choice, whether they be
teenagers or whether they be adults, is that teens should not
be sexually active. The teens who are should have access to
birth control or protection. That is where America is. That is
what most Americans believe, 73 percent of the adult
population, 56 percent of the teenage population, and the
teenage population is skewed more to believing sex is OK than
the adult population.
I mention that because I think we are denying reality when
we try to pigeonhole teenagers into a limited program and not
giving all the information. Abstinence should be combined with
sex education. Ms. Brown, you point out what we all know now to
be the case, that sex education doesn't increase sex. It should
be combined. Abstinence should be combined with constructive
activities for teenagers, so they don't get in trouble, whether
it is through sexual activities or through drugs or through
alcohol or violence, it should be combined with constructive
activities. Abstinence should be combined with other services
that are available to teenagers, and that is basically the
commitment we made to our States in 1996 through TANF, which
was flexibility. Don't pigeonhole how States have to respond.
Don't tell them they have to set up a program for a limited
purpose so that we can express our views. Let the States do
what they believe is correct in order to accomplish the overall
objectives. And I guess that is one of my major concerns.
And the last point, Ms. Brown, that you point out, the
realities of the situation. Two-thirds of our high school
seniors have engaged in sexual activities. That is the facts.
We would all like to see that number lower. We all would like
to see that number lower. We should work to get that number
lower. We know there is going to be a large number of teenagers
who are going to be involved in sexual activities, and to just
put our head in the sand and say that is not going to happen, I
think is naive.
So I guess my concern is that the Congress has expressed a
goal of reducing teenage pregnancies. That is our goal. We want
to be successful in doing that. And the best way to do it, is
to allow the States to be able to move forward with abstinence
education and contraceptive information and any other tool that
they can in order to try to reduce teenage births. And I think
sometimes it is counterproductive that we try to pigeonhole how
programs have to be developed at the local level to satisfy our
parochial favorite programs to reduce teenage pregnancy.
Thank you, Mr. Chairman.
Chairman Herger. Thank you, Mr. Cardin. Now the gentleman
from Louisiana, Mr. McCrery to inquire.
Mr. McCrery. Thank you, Mr. Chairman.
I don't disagree with what Mr. Cardin has said, and I agree
with him that reality today is that too many teenagers engage
in sexual activities, but I think what we would like to do is
create a different reality, and that is what these programs,
these abstinence programs are trying to do. In the meantime, I
don't disagree with you that we have to address what is before
us, but I think the purpose of these programs is to create a
different reality.
And Ms. Grant and Mrs. Bennett, why do you all believe that
teens should be taught abstinence as the primary way to avoid
the negative consequences of teen pregnancy. Ms. Grant.
Ms. Grant. Primarily, when I look at young people in sexual
activity, a lot of times we quote statistics and we merge a lot
of things together. But those young people who have not yet
engaged in sexual activity, we need to bring a message to them
and support skill building, education, that helps them postpone
sexual activity for as long as possible, which for me is
primary prevention. That is primary. Then there is early
intervention, and it goes on down the line toward treatment.
And I think earlier in the comments there was a statement
about how do we determine which kid needs what? I think as a
nation you bring the primary message first and foremost. There
are those young people--and they clearly surface--who will need
more intensive intervention on down that progression and that
continuum from prevention to intervention. And that then you
tailor messages to meet those sub-populations. But I think what
has happened historically, as I looked at this and worked in
this, is that for those kids who were not yet thinking about
engaging in sexual activity, who weren't there yet, we didn't
have anything for those young people. And I think abstinence-
until-marriage education gave a context for young people to
deal with sexuality education and issues around relationships,
negotiating relationships, that they didn't have before. So I
think that is primarily why we need it.
In the Virginia Health Department we have a continuum. We
work from abstinence-until-marriage education all the way up to
our family planning services, and so we have a continuum that
we look at, and we all work together. We are trying to have a
comprehensive model that this doesn't become a either/or. These
dollars for abstinence education did not displace the family
planning dollars. It did not displace other dollars. It was an
addition to, and I think it met a void and is meeting a void to
help us provide a continuum in terms of service delivery.
Mr. McCrery. Before Mrs. Bennett responds, I just want to
ask you about, I think you say in your testimony that you don't
have sufficient data really to give results on abstinence
education today, but can you give us some impressions that you
have from watching the program and other data that would lead
you to some conclusions as to the effectiveness of the program?
Ms. Grant. Right now what we see in our data, and what I
have prepared in my written package, is just looking at our
first-year data, and then moving on to our second-year follow
up. We started with seventh and eighth graders, so naturally,
knowing that the number of young people in our data set, in our
target population, report lower rates of sexual activity, we
are waiting to see, and hoping to be able to continue our
longitudinal study as these kids age into solo dating, pairing
off, what happens in those rates. We are hoping that we can
keep our transition rates low, but that is yet to be determined
as we look at this, so I really can't share.
What we see in short term right now looks good, but that is
very short term and we are talking about kids who don't engage
in the sexual activity that much, so that is why I am very
reserved about that, because we need time. We need time and
resources to be able to really critically look at this.
Mr. McCrery. Thank you. Mrs. Bennett, do you want to
respond to the first question?
Mrs. Bennett. Well, and I agree with Ms. Grant.
We have had time and we have had resources at Best Friends.
We have completed our comparison study that is going to be
published, as comparing the CDC data, the Youth Risk Behavior
Survey, which is given here in the D.C. Public Schools. We have
been in the D.C. Public Schools since 1987. CDC found that
17.8, nearly 18 percent of seventh grade girls in D.C. are
sexually active. That doubles to 32.8 percent of eighth grade
girls, so that is nearly a third of the girls here right down
the street, who are sexually active in eighth grade. We
compared those schools, in many cases same schools, but with
the girls from Best Friends. Four point 2 percent of our
seventh grade schools--and we began early in fourth or fifth
like you were talking about--4.2 are sexually active in the
seventh grade, 5.6 in the eighth grade. So we don't even have
that doubling. I mean we could expect, if we followed the
trend, that we would have 8 or 9 percent of our girls sexually
active by eighth grade. We have 5.6 percent. So we know we are
on to something that works. We know that with every fiber of
our being. Our teachers will tell you that. Our parents will
tell you that.
We have 1,000 girls here in D.C. Public Schools. We have
5,000 girls nationwide. And the reason is, it is not just about
abstinence from sex, you know, that is not the issue. The issue
is the larger picture. It is about self control. It is about
saying early on, what kind of life do you want?
And then we have a tremendous impact on drug and alcohol
use as well. These two issues can't be separated out from
sexual activity. If you are drinking at 12 and 13 and 14, you
are sexually active. We see that. I was just in a huge
conference in suburban Montgomery County. Girls are drinking.
They are binge drinking. They are sexually active at seventh
and eighth and ninth grade, and these are in our most
prestigious private schools. So this is not, first of all, it's
very clear to me, this is not an issue only that is pertinent
to the urban areas, it is not a socioeconomic issue. This is an
issue that transcends all families, no matter what their
socioeconomic status. It is about character. It is about what
we want for our children. It is about how we stand as a Nation,
what our standards are, and are we going to expect our children
to strive for some high aspirations. Low aspirations, you get
low performance. We know that as teachers. And if as adults, if
we give them our best, if we say, ``This is what we expect,''
children respond in kind. And we need to begin at 7 and 8 years
of age.
We also know, a thing that I discovered that I did not
anticipate when I began, is we have reduced sexual abuse by 66
percent among our girls. Many of our girls, and I am not just
talking inner city, Montgomery County, out of 25 fifth grade
girls, 5 had been sexually abused in the fifth grade, and we
were not even allowed in Montgomery County to discuss sex. We
came in and talked about friendship. We talked about self
respect, were not even allowed to use the three-letter word of
sex. By accident, a survey was given, have you ever been forced
to have--5 of the 20 girls in a middle class community in
Montgomery County. So we know there is something else going on
there, if we can get to our children early.
Also our little girls, look at the data, watch Brittney
Spears, look at what is happening, look at the message. I
chaperon for a seventh grade dance. I have a 12-year-old son.
The girls are dressing like street walkers. It is cool. That is
the way they think they should look. When they dress like
street walkers, what are the boys supposed to think?
Oral sex is going on at Catholic school dances. We have
been able--that has dropped, that activity seems to be
curtailing somewhat, but we have some real issues here. We have
to decide what we want our children to hear from us.
Mr. McCrery. Thank you, Mr. Chairman.
I applaud all of you who are working on this problem, and I
am glad that you are starting a program for boys because I
think boys need to be part of the solution as well.
Chairman Herger. I want to thank each of you. I have been
very liberal with the time, on both sides, and that is because
this issue is so, as a parent, as virtually all of us are
parents here, this is an issue and an area that is of great
concern to all of us, regardless of which way or combination
that we address this in our work of reauthorizing this
legislation next year. We want to come up with the programs
that are going to be the most effective, however that is.
With that, there are several who would like to go for a
second round of questions. So, Mr. Cardin, would you like to
inquire?
Mr. Cardin. Thank you, Mr. Chairman.
Ms. Brown, I just want to get focused on what this
Committee can do. We have TANF reauthorization next year. It
provides significant resources to our States. The philosophy
1996 was to provide most of that in basically a block grant
type of format with broad national goals, with maximum
flexibility to States to try to configure how they could
arrange use of these funds in order to get people off of cash
assistance, to get people self sufficient, and to reduce
teenage births, pregnancies.
I guess your focus is on reducing or preventing teen
pregnancy. How can we be constructive in TANF reauthorization
to assist in your efforts?
Ms. Brown. I am so glad you asked. There is some material
in my written statement on this, but let me just hit the high
points. We made several suggestions. First of all, obviously,
we need to maintain funding for TANF and not allow the net
resources to decline for any number of reasons, which you all
understand very well. We need to maintain the flexibility of
TANF as well. There are, unfortunately in my view, not enough
TANF dollars going to teen pregnancy prevention. The current
estimate is only about 1 percent. Those are still precious
monies in this field so we need to retain the flexibility that
allows stats to tap into that funding source in ways that suit
their culture and their citizens.
We need to get increased information to States and
communities about community-level programs that work.
Interestingly, the question we are most often asked at the
National Campaign is, ``What do I do?'' From the Pittsburgh
Health Department, from Cloverdale, California, from all over:
``What do I do?'' As you know, we try mightily to answer that
question and other credible groups do, too, but we need a much
larger more organized source to get this information out.
Of course the second question people always ask is, ``How
do I pay for what works?'' And I think that is back to the TANF
question in part.
We might even want to consider a block grant for teen
pregnancy prevention within the overall effort. There is some
justification for that. We can talk more with you about that in
the future if you would like to.
We also think that there is merit in asking the Federal
government to pay more attention to State level efforts to
prevent teen pregnancy. They are all required to have it in
their TANF plans, but I have yet to see a real hearing, or a
high-profile publication saying, ``What are States doing in
this area? What is working? What are they trying?'' Actually,
you asked these questions a lot this morning. ``What is going
on? How do you decide what to do?'' There is a way of getting
that information under the existing statute, and I think we
need to do more.
And then generally in the total body of the law, I think we
do need to retain a focus on a strong abstinence message, as
everybody has agreed this morning, but never at the expense of
family planning and good information about reproduction to
adolescents and to others, and all within a context of
flexibility and accountability.
Mr. Cardin. There are two approaches that we could take
aimed directly at reducing teen pregnancy, and that is we could
offer competitive funds to encourage States to come forward
with innovative programs and try to fund them in that way, or
we could use a bonus arrangement, which we have used, based
upon performance of States in accomplishing the goal.
Do you have preference as to, we have a limited amount of
dollars, which approach would be a better approach?
Ms. Brown. Well, there are merits in both approaches. On
balance, I would probably go for competitive proposals from
States, not just for innovative programs, although we certainly
need those, but to build on what we already know. There is, as
I said earlier, a lot of good news, and we need to take this
good news and say, ``Fine, we actually have some successful
programs we can point to.'' This program profiled in
Connecticut is an example of great success with very hard to
reach kids. It is quite expensive, of course, but there are
others for lower-risk kids that are less expensive and could be
applied to large numbers of youth. So I think, yes, we need
more innovation, but I really think we need to build on
successes.
We also need to find a way to work more with the media. You
know, I love programs and I love school programs, but if you
talk to the average teenager and say, ``What is shaping your
attitudes and views and the social script in your head?'' They
will often talk an enormous amount about the television shows,
Internet sites and magazines that they consume in huge
quantities. So part of this money also has to go, in my view,
to finding ways to influence popular culture through these
hugely influential institutions, which are the media, in order
to complement the efforts of individual community programs.
We need both. Doing just one without the other, I think, is
insufficient.
Mr. Cardin. That is very helpful, particularly on sharing
of information, and that is one of the things that I think all
of us would agree we have programs that work. We need to get
that information out, and we need to evaluate programs a lot
faster than the current system has been operating. I know it
started a new direction in 1996, but it is useful if we could
get information shared in a more expeditious way than we have
in the past.
Thank you, Mr. Chairman.
Chairman Herger. Thank you, Mr. Cardin.
I have a couple closing questions. Dr. McIlhaney, in your
testimony, you had some chilling, I believe, comments that
people simply don't talk about these very serious health
consequences, whether it be the venereal diseases or others, of
early sexual activities. Why do you suppose that we don't hear
more about these issues, and is there some way that we can
better spread this very important information?
Dr. McIlhaney. I think it is vital, as I said to include
the warnings and information and education about the sexually
transmitted diseases, along with the messages about out-of-
wedlock pregnancy.
I was just sitting here, I was just listening, and there
was not a word, as we talked about efforts to reduce teen
pregnancy, in talking about what at the same time we have the
problems of STD in those same people who have the pregnancies,
and the contraceptives just flat don't work, the ones commonly
used. And I think it is a disaster.
It is difficult to talk about sexual issue, I think, in our
society. As a matter of fact, the numbers I gave you, and so
many more I could give you, have been in the newspapers. They
just get dropped. And I think it is just absolutely vital that
we include that information as we talk about teen pregnancy
every time. And as a matter of fact, I strongly advocate that
any program that is having success in reducing pregnancy be
sure they are also testing for STD among their young people,
and older single people too, because they also are suffering
these problems.
I would like to just say one thing about the success of
programs. If our programs, who emphasize contraceptives, were
working or had been working, we wouldn't be here talking
because, because those rates that we see over there would not
have kept climbing during the 1980s, because it was during the
1980s that by far the dominant programs were those programs
that were strongly advocating contraceptive use. And we see
those pregnancy rates kept climbing. The STD rates did keep
climbing too. And so obviously, is that mandates that we make
some changes in what we are doing.
The one light in this tunnel of darkness of not just teen
pregnancy, but pregnancy among older people, younger adults,
the one light is the issue about sexual abstinence, because it
is beginning to show that there maybe is a way.
The problem with saying that there are programs that work,
and I am on the Research Task Force for the National Campaign
with Doug Kirby, that wrote ``Emerging Answers'', and he and I,
I keep arguing with him. I say, Doug, the other statistical
evidence of success, and that is a technical calculation, but
the actual dramatic drop in pregnancy rates, we are just not
seeing with the programs that are mixing the messages. Where we
are really seeing startling results sometimes, and there is not
enough of it yet, I totally agree with that, are the programs
that are good abstinence programs that are gradually beginning
to emerge, that is a new area, but those programs are gradually
beginning to emerge, and we are seeing some surprising
statistics with some of them, but I think that all of them must
start including education about STDs and testing.
As a matter of fact, Johns Hopkins, a couple of years ago,
said that every single sexually active adolescent must be
tested for chlamydia every 6 months. I mean, they are that
concerned about this problem. Are we doing that in all our
programs, you know? If we are not, then we are really not
giving the kind of care we should.
Chairman Herger. Thank you very much, doctor. And I think
the point is here, even with the protection, the diseases are
still being transmitted and I believe that is something that is
not being talked about enough.
Dr. McIlhaney. That is right. May I say one more thing,
sir?
Chairman Herger. Yes.
Dr. McIlhaney. Very briefly. I mentioned marriage in my
testimony, and that is three of the four goals of TANF funding
mentions marriage strongly. The reason is that the biggest risk
for a person becoming infected with a sexually transmitted
disease is how many sexual partners they have had in their
lifetime. We have good evidence that when people are single and
sexually active, they almost always continue to have more and
more sexual partners, which therefore dramatically increases a
risk of STD.
The biggest study on sexual practice in America came out of
the University of Chicago a few years ago, and it showed that
married rarely, few married people have sex outside of their
marriage. They usually have sex only with that one partner,
their marriage partner, which is a huge public and personal
health message, and that is why marriage I think is so wisely
including in TANF funding, and also why so many abstinence
programs, for example, do talk about marriage to you.
Chairman Herger. Thank you, doctor. Now, I will go to the
gentlelady from Connecticut, Mrs. Johnson.
Mrs. Johnson. Thank you, Mr. Chairman.
I just wanted to get your opinions, as you are sitting here
as a group, about the importance of the connectivity factor of
not just talking to kids about abstinence and sexuality and
sexually transmitted diseases, as important as all those things
are, but connecting them into doing well in school and why that
matters and career choices, connecting them into their
families, and their families into support services and into
their mothers' aspirations and so on.
I mean, I appreciate, of course, that the latter is nicer,
but I mean in terms of affecting the lives of these kids, what
should we be looking at, because after all, welfare reform is a
systems issue, and we have an opportunity to have a systems
focus. And I am asking your advice on how broadly we should try
to focus our effort to prevent teen pregnancy? We will just
take in order anyone who wants to comment. Ms. Grant. Keep it
brief so we can just run down the whole panel, anyone who wants
to.
Ms. Grant. I think your earlier statements about
connectivity really spoke to, really in answers to the question
I think, we cannot isolate young people or just parents and
say, ``We will have a program specifically for you,'' that even
the latest research around kids and risk behaviors and some of
the PSAs that we are seeing now, talk about that shift that we
have in society where young people want to hear from their
parents. They are not asking to hear from their peers on
critical issues. They want their parents to talk to them, and
they clearly state they are listening. So I think our efforts,
you know, we are always behind the ball trying to catch up with
it, and I think we really need to look at that and bring that
into the forefront, that then how do we structure strategies
that encourage that?
In Virginia, what we are doing through our initiative is we
are not just targeting young people, we are training medical
professionals to talk about these issues as kids come into
clinical settings. We are spending time educating parents
through radio while they are listening to the traffic report
and that kind of thing, to try to say, ``Hey, kids want to hear
from you'', and to tell kids, ``Go talk to your parents about
this'', and make those connections from a State-wide
perspective. That is what we are trying to do.
Mrs. Johnson. Let's keep it brief since we have so many to
hear from.
Mrs. Bennett. Goal setting, telling our young people that
they should have dreams, and how to kind of reach their dreams
with a plan. Our girls set goals starting in the fifth or sixth
grade, what they are going to have, what they want to achieve
academically, what they want in their lives. It is amazing how
many girls say they want to be married someday, and they want a
house, and they want a family.
What we, and you are exactly right, it is not just about
talking about STDs, it is not just about limiting at-risk
behavior. It is about the big picture, and we have discovered
that kids, children, no matter what their background, their own
home background, they have dreams and goals, and if we can,
which I think we do a very good job of in Best Friends, we have
the goal setting activities. We have the individual mentoring.
We have the community service. And then we have fun, the
singing and the dancing, fun dancing, fun singing, the jazz
choir, the jazz dance troupe, all of those kinds of things that
are fun. Kids want to have fun. Show them how to have fun
without negative behavior.
Ms. Brown. I think you are absolutely right, it is this
larger context that really makes the difference. We often say
it is not just about body parts, it is about values and
relationships and feelings and families.
We have four bodies of information now that shed light on
this youth development approach. The Adolescent Health Survey--
a Federally funded adolescent health survey--showed that strong
connections between teenagers and their schools and strong
connections between teenagers and their families were some of
the most highly protective factors against adolescent
pregnancy. That has gotten a lot of press.
We also now have all the information I summarized for you
today from ``Emerging Answers'' on youth development programs.
They get the biggest results in reducing teen pregnancy. Some
of them don't actually even address sex, but they give these
kids a lot to say yes to.
And finally, the National Academy of Sciences released a
report just last week on community-level programs for youth
that goes into a large number of databases about all these
different programs, what risk factors they address and what
their outcomes are, and it is very consistent, Mrs. Johnson,
with just the kind of thing you are saying.
Finally, the most popular publication that the Campaign has
released to this day--and we are moving 600,000 pieces this
year--is ``Ten Tips for Parents to Help Their Children Avoid
Teen Pregnancy.'' It offers very simple advice like: talk to
your kids; know what they are watching, reading and listening
to; be clear about your own values; and so on. This pamphlet
remains to this day the piece of information everybody most
wants from the National Campaign.
Dr. Maynard. I would just add to this that while I think
the evidence on connectivity is really out there, we have had
40 years of erosion of the American family and communities, I
think that, for some time to come, we need to be on a dual
track where we are working to promote connectivity and have
those more intensive youth development focused programs where
we can. But, we don't want to leave behind the kids who are
still living in communities and in families where we may not be
able to achieve all that we would like on the connectivity
front.
Ms. Bilodeau. Ours is a family systems program, and that is
where our greatest emphasis is, is on building strong families
and on encouraging children to gain educational skills. As I
indicated, at least 80 percent of our kids come from families
that were started by teen parents, and therefore you have
families that do not necessarily value education, do not have a
work ethic that combines education as a way of moving forward,
but rather people who tend to stay in low-paying jobs.
We believe that the key to teen pregnancy prevention is
education, and that the better a kid does in school, the more
likely it is that they are going to stay in school, and the
greater their reasons are going to be to avert early sexual
activity and teen pregnancy.
When we first started our program for the first couple of
years, at least 10 to 20 percent of incoming sixth graders did
not know the alphabet. That is where we put our emphasis. Now
we have an alphabet test as part of the intake process. We
receive our primary funding from the Connecticut Department of
Social Services, and so I tell the kids that the State makes us
do it, that is the only way we can get the money is if they do
the alphabet for us.
Recently, in the past couple of years, well, really in the
past year, we have not seen that happen. We have the
superintendent of schools on our board, and so that information
obviously did get passed back to the superintendent of schools.
But with poverty-stricken children, the children who are most
apt to become teen parents, they have to have the concrete,
tangible, every-day support that moves them from the bottom of
the class--you know schools do tracking, everybody tracks; our
kids are always tracked with the groups that is least likely to
succeed. You have to break that mentality for them and for the
schools and for the whole community, who expects our kids to be
the gang bangers, the pregnant teens, the drug addicts and the
drug runners. That is what our neighborhood has always been
about. We have to break people's perceptions, and not just the
kids and not just the parents, but the whole community has to
value those children who are most likely to fall through the
cracks. And then that is how you create a continuity and a
bonding, so that those children don't belong just to a family,
they belong to a larger community, and that they, our kids are
growing up believing that they too will be the Mayor.
When we go to visit Nancy's office, I always tell them,
``Look around because I expect in a few years to see one of you
here,'' and they look at it that way. Hope for the future, that
is the key.
Dr. McIlhaney. It is almost not necessary to add anything,
but I will. The health, hope and happiness of our society and
of so many people in this country are really being hurt. I
totally agree with you, Congresswoman Johnson, that the
connectivity, the environment that our kids live in, that we
all live in, really is the vital thing that must be
transformed, and the central element of that is the family and
marriage, because that is the core of our culture.
Unfortunately today, what I think all of us have found is
that parents often feel disempowered. They don't believe their
kids will listen to them. They really don't believe they have
that kind of influence, and we have some statistical
information that is really helpful, and we use it a lot, I
think all of us do. The ADD Health Study, the biggest study
ever done on adolescence showed that of all the risky
behaviors, drugs, sex, alcohol, running away from home, all of
them, that the kids that were doing the best were those kids
who had connectedness with their parents. We need to empower
parents.
And my belief, I think probably the belief of all of us, is
it is going to take leadership, and that is one thing at the
end of my testimony I said, you as leaders in this country can
make such an enormous difference. As Rebecca said, the whole
discussion in this area about sex changed when Congress
allocated money, and it really started in some sense back in
the eighties with the Title XX Program.
So how we all are in this together. We need to consider all
the risky behaviors because there is good evidence that impact
one of them. We have to impact all of them, and the one that
usually gets left out is sex. We need to include that in our
encouragement and guidance to young people.
And finally, Elayne mentioned the AAUW, American University
Women's report that those kids basically all said that no one
in their whole environment, not their parents, medical people,
their boyfriends or girlfriends--and these were girls--
encouraged them not to be involved in sexual activity. So we
have got to start at the top, and come and surround young
people with a world that supports them in avoiding these
problems so that they have hope for the future.
Chairman Herger. Thank you very much. I want to thank each
of our witnesses for their outstanding testimony. I trust that
the witnesses would respond to additional questions on these
issues for the record.
Again, it has been a very interesting hearing, one that is
very important not only to the Members of this Committee, but
certainly to the Nation, to the parents, and the young people
of this Nation.
With that, this Subcommittee stands adjourned. Thank you.
[Whereupon, at 12:07 p.m., the hearing was adjourned.]
[Questions submitted from Chairman Herger to the panel, and
their responses follow:]
Virginia Abstinence Education Initiative
Richmond, Virginia 23219
1. I understand from your testimony about the evaluations your
program is undergoing, but I'd like to know more abut the programs
themselves. Please describe the abstinence education programs in
Virginia. For example, how do teens come into your programs? Do you
involve parents of the teens in these programs? How about teens who
have already had kids--is part of your program preventing subsequent
births to teens who have already had one or more babies? Is your
program only about girls, or are boys involved, too? What is the source
of your funding?
VIRGINIA ABSTINENCE EDUCATION INITIATIVE
Program Descriptions
Reasons of the Heart
Organization: Alliance for Children & Families (Lynchburg,
VA)
Director: Maureen Duran
Localities: Fairfax County, Fauquier County, and Loudoun
County
Target Population: 7th graders **
Description: Utilizes original materials and classic film
clips to help youth (in school, after school, detention and
probation homes) examine the impact of character on sexual
decisionmaking and choosing abstinence until marriage. The
Reasonable Reasons to Wait curriculum will be implemented in
health classes teaching youth the value of abstaining until
marriage.
Individuals Abstaining `til Marriage
Organization: Alliance for Children & Families of Central
Virginia
Location: Lynchburg, VA
Director: Joan Foster
Localities: Pittsylvania County and City of Lynchburg
Target Population: 7th graders **
Description: Utilizes the Wait Training! curriculum and peer
mentors to promote the abstinence until marriage message in
both the school and after school settings. Community based
programming will be provided for participants during the
summer.
Very, Important, Person (VIP)
Organization: Horizons Unlimited Ministries, Inc. of Hampton,
VA
Location: Newport News, VA
Director: June Sullivan
Localities: Newport News (East End and Denbigh areas)
Target Population: 7th graders **
Description: Utilizes the Reasonable Reasons to Wait
curriculum to help youth appreciate their ability to abstain
from sexual activity until marriage because they have value and
can relate to others with integrity and purity.
I Can Abstain Now
Organization: Sussex Rural Abstinence Project with Social
Services Department County of Sussex, VA as lead agency and
fiscal agent.
Location: Sussex, VA
Director: Melody Walker
Locality: Sussex County
Target Population: 7th graders **
Description: Utilizes the Families United to Prevent Teen
Pregnancy and Managing Pressures Before Marriage curricula to
teach skills to resist the pressures to become sexually active
and remain abstinent until marriage. Peer mentors and adult
leaders will be trained and supported in modeling appropriate
behaviors for participants. Parent education and a community-
based resource center are additional components of the program.
My Choice, My Future!
Organization: Powhatan Partners In Prevention Coalition with
Powhatan County Health Department, of Powhatan, VA as the lead
agency and fiscal agent.
Location: Powhatan, VA
Director: Ginell Ampey-Thornhill
Locality: Powhatan County
Target Population: 7th graders **
---------------------------------------------------------------------------
** This is the initial point of contact with students. Students
receive abstinence educational sessions ranging from 12 to 18 weeks in
duration. All program participants are given a program booster in
subsequent grades. To date we have students receiving abstinence
education instruction in 7th through 11th grades.
---------------------------------------------------------------------------
Description: Utilizes the Reasonable Reasons to Wait and Wait
Training! curricula to motivating youth to choose and maintain
an abstinent lifestyle. The program will be implemented through
the health and physical education classes. This program is part
of a Federally funded evaluation.
Participants in the school-based programs are given consent to
participate by their parents. The abstinence educational sessions are
taught during the health education classes. All of the abstinence
education curricula have been reviewed for compliance with the
Standards of Learning guidelines established by the Virginia Dept. of
Education.
Parental involvement is limited in these programs, but Parent
Information Nights are offered at the beginning of the school year and
most of the programs have activities and events that are structured for
teen and parent attendance.
Because these programs are primarily school based there are
students who may be pregnant or parenting in the classes. These
students continue to participate in the classes and if necessary are
referred to school staff for additional services. The participants in
these programs are both male and female.
The Virginia Abstinence Education Initiative is funding through
Title V--Abstinence Only dollars. Virginia receives $828,619 in Federal
funds that is matched with $375,098 General Funds and in-kind dollars
from abstinence education program providers and added value generated
by our media campaign. Additional funds are provided through the
Department of Social Services TANF dollars in the amount of $211,000.
Gale Grant
Director
Best Friends Foundation
Washington, DC 20008
December 6, 2001
Hon. Wally Herger
Chairman
House Committee on Ways and Means
Subcommittee on Human Resources
Washington, D.C. 20515
Dear Chairman Herger:
Thank you for the opportunity to provide the subcommittee with
additional information about the programs of the Best Friends
Foundation and our efforts to prevent teenage pregnancies.
As you know, the Best Friends Foundation, a 501(c)(3) organization
incorporated in the District of Columbia, was founded in 1987 and now
reaches more than 5,500 girls through its Best Friends program and
about 500 boys through the recently created Best Men program. The
programs operate in 23 cities and 14 states, including the Virgin
Islands. Our message is very simple: Enjoy adolescence by abstaining
from sexual activity until high school, and illegal drugs, and alcohol.
While that message may not be new, the method in which it is
delivered is profoundly different. And we have had great successes.
Now, let me address the questions you raised in your letter of Nov.
19:
1. How do youths come into your program? Are other Members of their
family involved, such as the young person's parent(s) or
siblings?
Students may enter the Best Friends (girls) or Best Men (boys)
program beginning in the fifth or sixth grade. Every effort is made to
take an entire class of students. If that is not possible, a random
sampling is done. We work to make certain that the Best Friends program
is representative of the entire student body and there is no
stereotyping of the group (we have a carefully balanced mix of high
achievers, middle achievers and at risk students. Once they join the
program, each girl and boy is invited back to the program at the start
of the next school year. Indeed, experience has shown that a blend of
students consisting of high and average achievers, along with those who
fall below the mark, provides a productive learning environment.
The support of family is very important to the success of the
programs. Best Friends/Best Men parents give permission for their child
to participate. We are happy to report that we have received 100
percent parent permission. Each school holds a parent information
meeting at the beginning of the school year, which includes a video
about the Best Friends/Best Men program. Best Friends/Best Men staff
are on hand to answer any questions. At the end of each school year,
families celebrate the commitment of their children at the Family and
School Recognition Ceremony-about 80-90 percent of the parents attend
the event. Each Best Friends/Best Men participant acknowledges his/her
parents with a symbol of gratitude. In 15 years of operation, only two
parents did not allow their children to participate in the program, and
no parents ever have removed their children from the program.
2. What are the primary sources of funding for the Best Friends
program?
The Best Friends Foundation operates the Best Friends/Best Men
program in seven schools in D.C. and two in Maryland, paying for all of
their instruction and materials, field trips, and the annual Family and
School recognition ceremony with funds raised from the private sector.
Our funders include the Bradley Foundation. the Robert Wood Johnson
Foundation, the Case Foundation, the Kellogg Foundation, the Marriott
Foundation and American Standard. We also raise funds from our Annual
Donor Dinner. The cost of providing the Best Friends/Best Men program
is approximately $250--$600 per student. Additionally, a number of
schools and school systems around the country have replicated the Best
Friends/Best Men program, using their own funding. We have established
a National Training and Technical Assistance Center, which develops the
curriculum, monitors and evaluates the effectiveness of each program
and trains educators. We require that our model be followed and that
all educators providing instruction be trained by the Best Friends
Foundation. The replication sites' funding sources include local
education dollars; local and state grants, including money from state
``Drug Free Schools'' grants; Title V grants and grants from private
foundations and companies.
Because the programs take place during the school day, the Best
Friends/Best Men curriculum is taught by teachers who are, in most
cases, employed by the school system. Teachers and other school staff
Members volunteer to serve as mentors to participants.
3. How does your program address peer pressure so that young people
reinforce one another to abstain from sex? What do the young
people say about this?
The Best Friends/Best Men program's primary goal is to help
adolescents gain self-respect, make positive decisions, and support one
another in postponing sex and in rejecting illegal drug and alcohol
use. Our program works because participants become part of an intensive
peer support group based on friendship. We emphasize that friends must
help each other make good decisions and that friends sometimes must
intervene in each other's lives. We create a group within a school-
usually 30-40 students-that puts peer pressure on its Members not to
have sex. In an anonymous survey of Best Friends girls following the
1999-2000 school year, we found that 30 percent of our fourth- and
fifth-graders, 36 percent of our sixth-graders, 48 percent of our
seventh-graders, and 60 percent of our eighth-graders helped a friend
make a decision about sex. When we first started the Best Friends
program in 1987, testing the concept with 10th-graders at a Virginia
high school, more than 73 percent of the students surveyed said they
would like to belong to a group that supported one another in waiting
to have sex at least until after high school graduation. More recently,
one student commented: ``It was hard to say `no' until I became a Best
Friends girl. I have all these friends in Best Friends that check on me
and say, `How you doin'?' One time I was going to go with this guy who
had this great `line,' but they wouldn't let me. I'm glad. He got
another friend of mine pregnant and left her alone. She's sad. We watch
out for each other at Best Friends. I can say `no' in seven different
ways.''
The program also ``deglamorizes'' the barrage of sexual images that
come from popular culture. We present the students with an upbeat
message, one that emphasizes the joys of pre-teen and teenage years
free from the complications of sexual activity, and we give them
something to ``yes'' to: good grades, self-respect, and, for those who
stay in the program through high school, college scholarships. The
program is designed to reach children in early adolescence, when their
attitudes toward life are forming and when they need to discuss their
personal concerns with and receive support from friends and respected
adults.
The messages which are taught in the Friendship module include the
best kind of friend is the one that makes you a better person and
friends help each other make the right decisions
4. I think we have seen from Dr. McIlhaney's testimony, and most of us
know intuitively, that abstinence is the only way to prevent
the risk of pregnancy and the spreading of sexually transmitted
diseases. Yet, some people claim that the abstinence message
puts young people at risk. Is there any evidence of that? What
does your experience suggest?
There is no evidence that teaching-as the Best Friends/Best Men
program does-that abstinence from sex is the only 100 percent guarantee
against pregnancy and sexually transmitted diseases is putting young
people at risk. That claim cannot be made regarding teaching students
about various contraceptive devices and practices. Recent research
published by Child Trends data is showing there is a decrease in the
use of contraception and subsequent sexual activity. There is no
definitive research on sex-ed programs that focus on contraceptive
education. There has been a flurry of attempts by the contraception
advocates attempting to say that abstinence education results in
participants not using contraception once they have decided to become
sexually active. This is a flawed study and has been seized upon by
those who wish to see all abstinence funding eliminated. The
contraception lobby would do far better to focus their efforts on why,
after years of participation in their education programs, sexually
active students are not using contraceptives and why STDs are at
epidemic proportions. It is important to remember that since the advent
of sex education classes in schools in the sixties, the number of out-
of-wedlock births in the U.S. rose 450 percent by the early nineties.
Only since 1995, when there was a concerted push for abstinence
education, have teenage and out-of-wedlock births started to fall.
Our curriculum includes a section on AIDS and STDs, giving candid
information about the most common STDs, the symptoms, treatments, and
consequences. Young people are not put at risk through an abstinence-
only message but rather through confusing messages that say sex is OK
as long as you use a condom or birth control.
The experience of the Best Friends/Best Men program has been that
young people want to hear the abstinence message. When Emory
University's Marian Howard asked 1,000 teenage mothers what they wanted
to learn in sex education classes, 82 percent of them said ``how to say
`no' without hurting my boyfriend's feelings.'' A recent survey
conducted by the American Association of University Women Foundation of
2,000 11- to 17-year-old girls found that the vast majority said that
sex and how to say ``no'' in emotionally charged relationships was
their number one concern. And the National Campaign to Prevent Teen
Pregnancy found that 98 percent of teens said ``it is important for
teens to be given a strong message from society that they should
abstain from sex until they are at least out of high school.''
And we have proof of the success of our program. An independent
evaluation of data from a Centers for Disease Control survey of D.C.
public school students and data collected from Best Friends girls
attending D.C. public schools found that 18.5 percent of the seventh-
graders and nearly 35 percent of the eighth-graders in the CDC survey
were sexually active compared with 4.2 percent of seventh-graders and
5.6 percent of eighth-graders in the Best Friends program.
Additionally, in a spring 2000 survey of Best Friends participants, 92
percent of the girls said they want to wait until at least high school
graduation to have sex; 69 percent want to wait until marriage.
The Best Friends/Best Men program works because its message is
simple-abstain from sex, drugs, alcohol, and violence-and supported by
caring adults and fellow students. As Aristotle said: ``The best friend
to have is the one around whom you are a better person.'' We are
striving to mold young people into friends who make others better
people.
I refer to you once again; to look at the YRBS study which compares
the Best Friends sexual activity rates to children not in the program.
I implore that you please call us for accurate information on
abstinence education. Please understand this is a message that both our
teenage girls (boys and girls) need to hear. It is very difficult for
kids who do not want to be sexually active when all the efforts are
directed to contraception sex ed methodology. Please read Robert Blum
ADD health survey. It clearly demonstrated that parental disapproval
for teenagers is a protective factor in the onset of sexual activity.
This was a valid study and the contraceptive lobby has successfully
buried this information.
Thank you again, Mr. Chairman, for giving the Best Friends
Foundation this opportunity to contribute to the discussion on this
extremely important topic.
I am available for meetings or phone conferences at your
convenience.
Sincerely,
Elayne Bennett
Founder, President and CEO
National Campaign to Prevent Teen Pregnancy
Washington, DC 20036
November 29, 2001
Rep. Wally Herger
Chairman, Committee on Ways and Means
Subcommittee on Human Resources
Washington, DC
Dear Chairman Herger,
Thank you for the opportunity to testify about teen pregnancy
prevention before your Subcommittee. We commend the Subcommittee for
focusing on teen pregnancy which affects so many young people. As I
mentioned at the hearing, the National Campaign to Prevent Teen
Pregnancy strongly believes that reducing teen pregnancy is a highly
effective way to make progress on a number of related social issues:
child poverty, welfare dependency, out-of-wedlock childbearing, and
responsible fatherhood.
In a letter dated November 19, 2001, you asked me to respond to
several additional questions. Below, please find your questions and my
responses.
1. In your testimony, you mentioned that culture and family
environments of teens can be very powerful in determining their
behavior. What do you think we can do to affect these influences,
particularly with respect to the media and popular culture?
Teen pregnancy is rooted in broad social phenomena, including the
images portrayed in the entertainment media, the values articulated by
parents and other adults, and popular teen culture most of all. The
task of preventing teen pregnancy is often complicated by a culture
that too often sends young people messages that having sex at an early
age is just fine, that getting pregnant at a young age is no big deal,
that contraception is not all that important, that ``everybody is doing
it,'' and that parents have lost their children to peers and popular
culture.
With respect to parents, the primary challenge is to convince them
that they matter. Over two decades of research confirms that families--
and particularly parents--are an important influence on whether
teenagers become pregnant or cause a pregnancy. In a variety of ways,
parental behavior and the nature of parent/child relationships
influence teens' sexual activity and use of contraception. While
parents cannot necessarily determine whether their children have sex,
use contraception, or become pregnant, the quality of their
relationships with their children can make a real difference.
A recent National Campaign survey illustrates this challenge. Teens
cited parents more than any other source as having the most influence
over their sexual decisionmaking. But, adults believe that peers
influence teens' sexual decisionmaking more than parents. The
inescapable conclusion is that many parents do not recognize how
influential they are in this area or how many opportunities they have
to shape their children's behavior. Kids report to us time and time
again that they want to hear from their parents about sex, love, and
relationships but often do not. Adults need to be clear about their own
values and communicate them to young people.
Teen pregnancy prevention is as much about moral and religious
values as it is about public health. Teens, like adults, make decisions
about their sexual behavior based in part on their values about what is
right and wrong, what is proper and what is not. New research from the
National Campaign makes clear that religious faith is associated with
delayed sexual activity among some groups of teens. Survey data also
recently released by the National Campaign indicate that morals,
values, and/or religious beliefs affects teens decisions about whether
to have sex more than concern about STDs, fear of pregnancy, or other
reasons. And research from the nonprofit organization Child Trends
shows that the primary reason that virgin teen girls say they abstain
from sex is that having sex would be against their religious or moral
values.
Clearly, peers also shape teens' environment. Research and common
sense show that peer influence can play an important role in the sexual
behavior of teens. Accordingly, teens need accurate information about
what their peers are doing (or not doing) because what they think other
teens are doing has an impact on their behavior. Teens need to
understand that not everyone is ``doing it,'' and that many teens who
are sexually active wish they had waited longer.
Teens who are abstinent should speak about their choice, to the
extent they are comfortable, so that their peers will not so often
overestimate the level of sexual activity around them. Teens who are
careful users of contraception should also speak out so that the use of
contraception is not so mysterious or surrounded by so much
misinformation. Teen girls need to tell each other that sex doesn't
guarantee a loving relationship. Teen boys need to tell each other that
having sex is no way to prove manhood. Being a father too soon leads to
major financial burdens, legal risks, and a lifetime of personal
complexities. Teen parents need to speak to their peers about the
difficulties that early pregnancy and parenthood have posed for them.
As noted above, reducing teen pregnancy requires a change in social
values and popular culture. The entertainment media has a major
influence on popular culture and, therefore, working with this sector
is essential. According to a recent study by the Kaiser Family
Foundation, 99 percent of households in the United States have
televisions, and two-thirds of kids aged 8 and older have a television
in their own rooms. This study also reported that young people aged 8-
18 spend an average of 28 hours per week watching television--which is
twice as much time, over the course of a year, as they spend in school.
Given the extraordinary amount of time that young people spend
consuming media, it is clear that we cannot solve the problem of teen
pregnancy without the help of the media. Conveying responsible messages
through the entertainment media is both powerful and efficient. By
reaching millions every minute and shaping popular culture, the media
must be--and often is--a force for good.
We should encourage the media to show that sex has consequences.
Many teens say that although the media shows them a lot about sex, it
rarely portrays real consequences. For our part, the National Campaign
suggests that the media show teens doing the right thing--saying ``no''
to sex or saying ``no'' even if they've said ``yes'' before. Show teens
making the case to each other that postponing sexual involvement is
their best choice for many reasons, including emotional ones. Show
sexually active teens doing the right thing--using contraception and
dealing directly with the fears and myths surrounding it. Show parents
being parental, not passive--talking with their kids about sex, love,
and values from an early age; setting limits on early dating and on the
toxic older guy/younger girl combination; providing supervision and
setting curfews; and addressing the power of peer influence. And we
suggest the media show adults setting honorable examples in their own
sexual behavior if for no other reason than because it affects the
behavior of their children and teenagers.
How does the National Campaign get its messages before the
entertainment media? Since our inception, we have been working closely
with the writers and producers of TV shows, magazines, and websites,
focusing primarily on influencing the content of entertainment media.
To encourage media leaders to weave prevention messages into the
content of their work, we offer specially tailored face-to-face
briefings to key editors, scriptwriters, and producers about the
problem of teen pregnancy and its solutions. We discuss with them
various messages well suited to their shows or magazines, and talk
about different ways that these messages can be presented in their
media.
One final point about the current culture and teen pregnancy. We
have noted a distinct unwillingness among adults--and in the culture
generally--to take a clear stand on whether teen pregnancy is or is not
OK. In recent National Campaign polling fully one-third of adults said
they do not think that the kids in their communities are getting a
clear message from the adults in their lives that teen pregnancy is
wrong. This may be due to a reluctance of adults to take a stand that
has a values component, it may reflect a popular culture that is
increasingly tolerant of unwed pregnancy and childbearing, it may be
that some adults are fearful of offending those teens who are already
pregnant or parenting or that they might inadvertently stigmatize the
children of teen mothers, or it may simply be that many parents are
uncomfortable talking to their children about sex and values.
But if we can't even simply say that teen pregnancy and parenthood
is in no one's best interest, how can we be surprised at the high rates
of teen pregnancy in this country? Fundamentally, teen pregnancy is a
question of values, standards, social norms, and what a society
prescribes as the best pathway from childhood to adult life. If we are
to make continued and lasting progress in reducing teen pregnancy we
need to offer more straight talk to young people--and conversations
with them--about the critical need to postpone pregnancy and parenthood
until adulthood.
2. A report released by the National Institutes of Health shows
condoms are not necessarily effective in preventing most sexually
transmitted diseases. Is your organization sharing this important
information with teens? Do you believe that should become a key part of
any family planning curriculum?
Teens need to know that abstinence is their best choice for
preventing pregnancy and avoiding sexually transmitted diseases (STDs).
They also need to be given accurate information about the relative
effectiveness of various methods of contraception and the National
Campaign has been at the forefront of communicating both messages. The
recent report from the National Institutes of Health makes clear what
many of those concerned about the well being of youth have been saying
for some time--condoms are not 100 percent effective at preventing
pregnancy and that the jury is still out about their efficacy in
preventing many STDs. The clear national consensus--among adults and
teens alike--is that middle and high school kids, in particular, should
be given a clear message that abstinence from sexual intercourse is the
right thing to do because of the numerous important consequences.
Nonetheless, contraception is still a very important part of
reducing teen pregnancy. A sexually active teen who does not use
contraception at all has a 90 percent chance of getting pregnant within
one year. However, we must be careful to put this remedy into
perspective. Some teens, like many young adults, overestimate the
effectiveness of condoms and many have difficulty consistently using
the array of contraceptive methods currently available. For example,
among young women aged 15-19 relying on oral contraception as their
only form of birth control, only about 70 percent took a pill every day
during a 3-month period. Moreover, nearly one-third of teen girls were
completely unprotected the last time they had sex, and between 30 and
38 percent of teens who use contraception are not consistent users.
Despite the availability of the pill for more than three decades,
despite the fact that many teens now have access to copious amounts of
information about contraception from schools, magazine articles, and
websites, despite the availability of non-prescription methods in
virtually every drugstore, the vast majority (78 percent) of
pregnancies among teens are unintended. Improving the degree of access
that teens have to contraception might improve this statistic, but
there is no reason to think that this approach alone will be
sufficient. Increasing access that teens have to contraception is
important--to be sure, without sustained attention to contraception
over the past years, teen pregnancy rates today might be even higher--
but, again, this is still only one of many remedies required.
3. I appreciate your point about ``what works.'' However, the
prevailing wisdom used to be that 5 million families had to be on
welfare because they couldn't work. That logic proved to be flawed. As
Dr. McIlhaney mentioned, the prevailing wisdom also used to be that
smoking rates would never decline significantly because it was too
ingrained in our culture. That has certainly changed too. Given the
limited availability of abstinence education should we try to overturn
the prevailing wisdom once again by expanding the availability of
abstinence education?
As a general matter, the National Campaign strongly agrees with the
sentiment of this question. That is, abstinence is the first and best
choice for teens. Our polling data clearly indicate that the majority
of adults and teens support providing teens with a strong abstinence
message and research makes clear that abstinence has made a significant
contribution to declining teen pregnancy and birth rates during the
1990s. We offer our support for a strong abstinence message for teens,
however, with three important caveats:
While American adults and teens clearly feel that
young people should be given a strong abstinence message, the
research on the effectiveness of abstinence programs, is not as
clear. As Emerging Answers: Research Findings on Programs to
Reduce Teen Pregnancy, a comprehensive research review recently
published by the National Campaign makes clear, the jury is
still out on the effectiveness of specific programs or
curricula for conveying abstinence-only messages to young
people. All of this leads us to be cautious about massive
public funding of programs that do not yet have clear,
scientific evidence of their effectiveness.
It is also true that even when given strong advice
to remain abstinent, some young people will not do so: for
example, currently 65 percent of high school seniors have had
sex. More of these young people can--and should--be encouraged
to abstain from sex, but experience suggests that some (perhaps
most) will continue to be sexually active. For these young
people, the national consensus is that easily available
contraception can reduce the chances of pregnancy and STDs. Put
another way, American adults and teens clearly feel that
abstinence is better than contraception, but using
contraception is better than getting pregnant too soon. And,
importantly, whatever the level of support for abstinence, it
can never come at the expense of support and contraceptive
services for sexually active teens.
In the absence of good program evaluation data, and
given both the great sensitivity of teen sexuality issues and
the great diversity of American culture, the Federal government
should not dictate precisely what states and communities should
do to promote abstinence. While there is considerable consensus
about the importance of preventing teen pregnancy, there is
somewhat less consensus about how to go about it and the
answers may vary in different communities and for different
teens. Setting performance goals and expectations is a good
idea. Rigidly prescribing how to achieve these goals is not.
Consistent with the devolution philosophy underlying the 1996
welfare reform legislation, states and communities require
flexibility in designing strategies to reduce teen pregnancy in
order to accommodate differing local circumstances. In a
country as big and diverse as America, and on an issue as
complex and sensitive as teen pregnancy, it is important to
allow multiple approaches.
Sincerely,
Sarah S. Brown
Director
University of Pennsylvania
Philadelphia, Pennsylvania 19104
November 30, 2001
Mr. Wally Herger,
Chairman
Subcommittee on Human Resources
Committee on Ways and Means
House of Representatives
Washington, DC 20515
Via e-mail
Dear Mr. Herger:
I appreciate your offering me the opportunity to testify before
your Committee on November 15, 2001. The following are my responses to
your requests for clarification and additional information in support
of my testimony.
Request 1: Please elaborate on your statement that there need to be
more evaluations and funding for research on a variety of approaches to
deal with the problems of teen pregnancy and STD transmission.
The national evaluation of Title V abstinence education program is
the first major effort to gather scientifically rigorous evidence about
the efficacy of this particular approach to reducing teenage sexual
activity, exposure to STDs, and pregnancy. While there have been
studies of a wide range of particular programs directed in whole or
part at these same goals, the earlier research is of variable quality,
inconsistent in its coverage of program approaches, and therefore of
limited usefulness as a guide to designing effective national policies.
These shortcomings of past research were well documented in the
recent review of teen pregnancy program evaluation findings by Dr.
Douglas Kirby for the National Campaign to Prevent Teen Pregnancy. To
be sure, Kirby's review of the research identifies statistically
reliable evidence that several intervention strategies, tested in
particular settings, have reduced teen sexual activity and pregnancy
rates. However, this review identifies even more instances where
studies have been unableto find clear evidence that the interventions
favorably affected the key outcomes and some instances where the
programs had adverse impacts. The only way to generate the scientific
knowledge base needed to support smart policy development is to
systematically assess a range of policy relevant approaches to the
problems under varied implementation settings and using scientifically
rigorous study designs.
Request 2: Please elaborate on your statement: ``We have no definitive
evidence linking any of the TANF teen pregnancy and nonmarital birth
prevention provisions with favorable trends in teen pregnancy.''
The decline in teen birth rates and the leveling off of nonmarital
birth rates during the nineties could be related to those particular
policy changes directed specifically at addressing teen pregnancy and
nonmarital births. However, at the same time that these particular
policy changes were being made and the favorable trends emerging, other
potentially important factors were also shifting. Concurrent with the
decline in the teen birth rate, increasing numbers of states were
experimenting with other welfare reform elements now central to TANF
and its broader focus on responsible behavior--the institution of time
limits, the strengthening of child support enforcement, the stepping up
of work requirements and support, and the institution of family caps.
The 1990s also was a period of strong economic growth and changing
demographics among the teenage population. These myriad other changes
could also have had important effects on teen pregnancy trends. At this
point, there have been too many simultaneously changing factors to
establish definitive causal links between the teen pregnancy aspects of
welfare policy change and the trends in teen and nonmarital birth
rates, or to predict the relative contribution of particular policy
changes.
Request 3: Are the abstinence programs you have observed mandatory or
voluntary programs? Are family planning curricula typically offered on
a voluntary or mandatory basis? What are the implications of the manner
in which these programs are offered for your study findings?
Based on the observations my colleagues at Mathematica Policy
Research, Inc., and I have been making, I would say that both
abstinence programs and programs offering family planning curricula to
youth operate in one of two ways. Where services are provided through
community groups or as an extra-curricula activity within the school
setting, participation is usually entirely voluntary and generally the
parent must provide active consent. In contrast, in cases where the
programs are offered as a part of the core curricula within the school
setting, they generally use a passive consent process. For example,
parents will be notified about the program/class and informed about its
content and they will be given the opportunity to request that their
child not participate. However, in some cases, schools do require
active parental consent for students to participate in any type of
health or sex education curriculum.
The implication of this pattern of service delivery for our study
is simply that we need to be careful to document the nature of both the
abstinence programs we are studying and the counterfactual services
youths would be receiving if the Federally supported programs were not
available to them. This information provides the context for
interpreting the study findings and judging the extent to and
circumstances under which they can be generalized.
Request 4: Please provide more specifics regarding your statement that
``demand for abstinence programs frequently exceeds current capacity,
as evidenced by program waiting lists and requests for programs to
expand to new sites.'' Is there a demand by young people to become
involved in these programs? Are the programs voluntary?
Our experience suggests that abstinence education programs embedded
within well-run broader youth development and/or service programs, such
as mentoring programs, activity clubs, or after school programs, tend
to be very popular among youth and their parents. Such programs often
have limited capacity and as a result have waiting lists.
Some of the more dynamic, school-based programs also are in high
demand by school administrators. For example, principals in Miami,
Florida, have expressed a wish that ReCapturing the Vision could serve
more than the 20 to 30 girls per school it presently serves and the
program director has been asked to bring the program into more schools,
both within the district and throughout the state. This program is
among those where we have clear evidence that, not only are school
administrators eager to expand services, but that there are many more
youths who would participate in the program voluntarily if they were
offered the option.
Many schools where curriculum is offered in only one or two grade
levels have expressed interest in extending the curriculum to lower
and/or to older grade levels. School-based curricula programs tend to
be voluntary on the part of parents, not students. However, our
observation is that middle school youths generally are quite receptive
to the programs. The response of older youths to purely curriculum-
based programs is more mixed.
Request 5: Do you agree with Dr. McIlhaney's argument that it is too
early to have concrete evidence about the success of abstinence
education programs, but that ``as was the case with the effects of
smoking cessation initiatives, the data will come in time?''
It would be great if we had definitive evidence about the
effectiveness of the Title V abstinence education programs now.
However, Title V is delivering services largely to middle school
youths, and these services are geared to preventing behaviors
throughout the teenage years and even into young adulthood. For this
reason, it simply is not possible to know at this time how effective
these programs ultimately will prove to be. We need to wait and see how
successful they are in getting youths to abstain from sexual activity
as they move well into their teen years. The national Title V
evaluation being conducted by Mathematica Policy Research, Inc., under
contract to the U.S. Department of Health and Human Services will
provide strong evidence on this issue by 2005, when its final report is
due.
I hope these responses are helpful to you. Please let me know if I
can be of further assistance.
Sincerely,
Rebecca A. Maynard
University trustee Chair Professor
Medical Institute for Sexual Health
Austin, Texas 78716-2306
November 28, 2001
Hon. Wally Herger,
Chairman
House of Representatives
Committee on Ways and Means
Subcommittee on Human Resources
Washington, DC 20515
Attn: Ryan Work
Sent by e-mail
Dear Rep. Herger:
Thank you very much for your letter of November 19, 2001, and for
your kind words.
We are pleased to provide for the record the following answers to
the questions posed in your letter.
1. Do you have any recommendations about areas in the welfare reform
law we might improve to further our efforts to prevent teen pregnancy
and delay sexual activity among young people? What more can or should
we do?
A. While three of the four declared purposes of TANF relate to
promoting marriage, preventing and reducing the incidence of out-of-
wedlock pregnancies, and encouraging the formation and maintenance of
two-parent families, only a very small percentage of TANF funds have
been spent to date for these purposes. We recommend that a specified
percentage of TANF funding be designated for these issues, not just for
teens, but also for other affected groups which fall within the purview
of the enumerated goals of TANF. Furthermore, since the data, as
discussed in greater detail in my testimony dated November 15, 2001
submitted to this Committee, clearly shows that abstinence outside of
marriage is the healthiest behavior, and the only approach which
adequately confronts both the pregnancy and disease issues, we
recommend that at least half of the funding allocated for these three
purposes be reserved for furtherance of abstinence outside marriage as
the desired normative behavior. We are not advocating that sums
presently being funded for other worthy causes, if needed, be
diminished, but only that some significant TANF funding be designated
for these three purposes.
B. As to Title V funding, strong evidence supports the conclusion
that at least some of the programs being funded by the $50,000,000.00
per year allocation are beginning to realize very positive results. To
discontinue this program now, prior to the extensive evaluation
presently underway being completed, would not only severely hamper, if
not destroy, these programs, but might also negate the meaning and
usefulness of the pending evaluation. Clearly, these programs need to
be renewed, and, if available, additional spending made available for
abstinence programs through Title V, SPRANS, or other sources, so that
parity with other type programs is achieved. There were a number of
programs which were approved under both Title V and SPRANS, but which
did not receive requested funding due to the shortage of available
funds.
C. Since, as noted, abstinence is the only totally effective manner
to deal with both out-of-wedlock and disease issues, and constitutes
the only truly healthy behavior in this area, efforts should be made to
emphasize abstinence outside of marriage as the desired choice and
normative behavior for all legislation dealing with sexual behavior and
its effects, including health legislation.
2. We often hear about the link between teen sexual activity and
pregnancy and therefore welfare receipt. But clearly, there are serious
health consequences even if teens don't become pregnant. Can you
comment on some of the costs to individuals and society of that--both
in terms of the obvious personal costs to teens and the tangible costs
like increased Medicaid and other health care spending? Only abstinence
can effectively and completely address these sorts of issues, correct?
We agree that only abstinence can effectively and completely
address these sorts of issues.
The total costs to individuals and society, other than those
directly related to out-of-wedlock pregnancies, of teen and other out-
of-wedlock sexual activity, although difficult to accurately determine
or even estimate, are of enormous proportion. These expenditures fall
into several categories which include the following:
A. Direct medical and related costs
A 1997 report of the Institute of Medicine's Committee on
Prevention and Control of Sexually Transmitted Diseases, entitled The
Hidden Epidemic, Confronting Sexually Transmitted Diseases, states, in
the Introduction to its Summary;
``Of the top ten most frequently reported diseases in 1995 in the
United States, five are sexually transmitted diseases (STDs) (CC
1996c). With approximately 12 million new cases of STDs occurring
annually (CDC, DSTD/HIVP, 1993), rates of curable STDs in the United
States are the highest in the developed world. In 1995, STDs accounting
for 87 percent of all cases reported among the top ten most frequently
reported diseases in the United States (CDC, 1996c). Despite the
tremendous health and economic burden of STDs, the scope and impact of
the STD epidemic are under-appreciated and the STD epidemic largely
hidden from public discourse. Public awareness and knowledge regarding
STDs are dangerously low but there has not been a comprehensive
national public education campaign to address this deficiency. The
disproportionate impact of STDs on women has not been widely
recognized. Adolescents and young adults are at greatest risk of
acquiring an STD, but STD prevention efforts for adolescents remain
unfocused and controversial in the United States.''
As to the economic consequences of STDs, the report states, at page
7,
``The costs of a few STDs have been estimated . . . but no
comprehensive, current analysis of the direct and indirect costs of
STDs is available. . . . the Committee estimates that the total costs
for a selected group of major STDs and related syndromes, excluding HIV
infection, were approximately $10 billion in 1994. This rough,
conservative estimate does not capture the economic consequences of
several other common and costly STDs and associated syndromes such as
vaginal bacteriosis and trichomoniasis. The estimated annual cost of
sexually transmitted HIV infection in 1994 was approximately $6.7
billion. Including these costs raises the overall cost of STDs in the
United States to nearly $17 billion in 1994. These cost estimates
underscore the enormous burden of STDs on the U.S. economy. (emphasis
added).
In a report dated December, 1998 prepared for the Kaiser Family
Foundation by the American Social Health Association, entitled,
``Sexually Transmitted Diseases in America: How Many Cases and at What
Cost?, the panel calculated that the ``actual number of new cases of
STDs is approximately 15 million annually,'' and that this could be as
high as 20 million new cases per year. This report confirmed the very
high cost of STDs. An unpublished study by our office reaches the same
conclusion.
B. Other costs
As noted, there are many costs, monetary or other, in addition to
those related to pregnancies, which can be traced to or at least
associated with sexual activity outside marriage. These include:
1. Loss of work time and productivity due to having an STD.
2. Psychological and emotional damage and stress, including suicide
and other self-inflicted damage. For example, in a study entitled
Premature Sexual Activity as an Indicator of Psychological Risk
published in the February 1991 issue of the journal Pediatrics, non-
virgin girls in the teen group evaluated were 6.3 times more likely to
have attempted suicide (31.9 percent compared to 6.9 percent).
3. Involvement in other risky behavior--For example, non-virgin
boys and girls were more than six times as likely to have used alcohol,
were 3.8 (boys) to 7.2 (girls) times more likely to have smoked
cigarettes, and 4.8 (boys) and 10.4 (girls) times more likely to have
used marijuana. Premature Sexual Activity as an Indicator of
Psychological Risk, supra, p. 144.
4. Damaged relationships caused by one partner (married or
otherwise) having an STD. ``Sexually Transmitted Diseases in America:
How Many Cases and at What Cost?, supra, p. 23.
5. Pre-term labor.
6. Infertility. Between 30 and 40 percent of couples who require in
vitro fertilization because of the woman's infertility are required to
do so because of a prior STD infection. The cost of this procedure,
both monetarily and emotionally, is very high.
7. Miscellaneous others. As noted in ``Sexually Transmitted
Diseases in America: How Many Cases and at What Cost?, supra, p. 23.
``In addition to the economic impact of STDs, the panel noted that
STDs have a high human cost in terms of pain, suffering and grief.
Complications of chlamydia and gonorrhea can lead to chronic pain,
infertility and tubal pregnancies, which can affect a woman's health
and well-being throughout her lifetime. The harmful impact of STDs on
infants leads to long-term emotional suffering and stress for families
which cannot be captured in dollar terms. Unlike other diseases, STDs
often cause stigma and feelings of shame for patients diagnosed with
these infections.'' (emphasis added)
Thank you for including us among those testifying on this important
issue, and the opportunity to respond to the inquiries in your letter.
Please do not hesitate to let us know if we can be of further service.
Sincerely,
Joe S. McIlhaney, Jr., M.D.
President
[Submissions for the record follow:]
Statement of Melanie Howell, President, Abstinence Educators' Network,
Inc., Mason, Ohio
Thank you Honorable Chairman Herger and other distinguished members
of this committee to allow me to express my request for continued
funding of premarital abstinence education. I am president of
Abstinence Educators' Network, the only state-wide premarital
abstinence education network in Ohio. Our non-profit agency has
received Title V funding for 4\1/2\ years and this July received a
SPRANS implementation grant to expand efforts into more of the
underserved areas of Ohio.
I am a nurse, and since 1989, have worked in the trenches teaching
premarital abstinence education to parents, teens, teachers and other
professionals. I know first hand the value, importance, and results of
premarital abstinence education for the teens and communities in our
state. And, I know first hand the importance of state and federal
funding. Without government funding our organization would not be
reaching 10,000 people per year with the health and societal benefits
of abstinence and the necessary character development and refusal
skills to be successful with a premarital abstinent lifestyle.
More and more communities now desire the highest standard of sexual
health for their children. The approach is well received and makes good
sense to parents, teachers, and students. Every day, we hear comments
that they are tired of the old message and the mixed message approach.
Clear guidance is sought after in these difficult times.
Ohio's 29 Title V agencies have worked hard in the trenches over
the last four years to educate many more Ohioans about the importance
of such topics as: character development, healthy relationships, love
vs. infatuation, successful refusal skills, the importance of marriage
and family, the limitations and failure rates of contraceptives/condoms
for teens, and the short and long term devastation of over 25 Sexually
Transmitted Diseases.
We are thankful that three new SPRANS Ohio grantees can now reach
more who desire this approach for their children and students. Many of
these communities we have had to turn away in the past.
The need for abstinence dollars is obvious to anyone who works in
the field. It is what the common people are asking for. In some ways,
it reminds me of the war in Afghanistan. The common people are looking
for truth and liberation. Title V dollars are the army's foot soldiers,
who go in the caves and trenches to clean things up. The SPRANS dollars
are the heavy artillery, the big guns, to work the broad approach from
the top. Both work together to form the best strategy for increasing
the numbers of students to abstain from sexual activity. Both methods
of funding are needed desperately.
Please continue to move forward, not backward, for our children.
Continue to provide more funding for premarital abstinence education.
Its saves the lives of children and families.
Thank you.
______
THE AGENCY'S FOURTH YEAR ``TITLE V FOURTH YEAR EVALUATION SUMMARY''
By Dr. Raja Tanas, Whitworth College, Spokane, WA
This report is based on the fourth-year data generated from the
multi-faceted programs that Abstinence Educators' Network of Ohio
offered to students, peers, adult mentors, parents, social workers and
other professionals. The underlying objective of these programs was to
present information and give support to the development of skills
directed toward helping junior high and senior high school students
abstain from teen sex and develop healthy lifestyles.
Results reported in this study came from six sets of data. The
primary data set was obtained from 1505 students enrolled in grades
seven through twelve at nine schools in the State of Ohio during the
2000-2001 school year. The one-group pretest-posttest experimental
design was used to evaluate the impact of Lakita Garth's presentations
on promoting abstinence among teens. The other five sets of data were
obtained from other students, student peers, social workers, other
professionals, and parents who participated in mentoring, training
workshops and seminars designed to support teens in their decisions to
abstain from sex until marriage.
Similar to results reported in previous reports, Lakita Garth's
rallies continued to produce statistically significant impact on
students' attitudes and behavioral intentions supporting abstinence.
The pretest-posttest analysis using the t-test statistical technique
for independent samples yielded results showing that the rallies moved
the students toward a greater degree of agreement on each of the eight
variables targeted by the program. While this year's study replicated
the results of last year's study, one notices a greater impact on the
latter four items than was found in previous years. Specifically, after
attending Lakita Garth's presentations, students were more likely to
agree that:
they understood the advantages of abstinence (92
percent)
sexual urges are always controllable (64 percent)
it was possible for them to say no to sex (80
percent)
it was important for teens to stop having sex (70
percent)
having sex before marriage was against their
personal standards and values (56 percent)
they were currently practicing sexual abstinence (66
percent)
they intended to save sex from now on and until
marriage (56 percent)
they would like to have more support to say no to
sex (57 percent)
Participants in the other workshops and seminars equally found
their programs useful and effective in terms of providing information
and material; hands on training; effectiveness of presenters and
effectiveness of teaching methods; and relevancy of the material to the
stated objectives. The large majority of participants in each program
expressed their greatest degree of satisfaction with the organization
and administration of a respective program.
Many open-ended comments also reflected strong support to the
various facets of the programs and expressed their appreciation to AEN
for helping them develop new understanding of issues relative to teen
sex. It is no exaggeration to conclude that this year's results were
exceptional given the larger size of the student samples; the variety
of programs, activities, objectives, and locations; and the diversity
of audiences that AEN served during the academic year 2000-2001.
Alan Guttmacher Institute
New York, New York 10005
November 29, 2001
The Honorable Wally Herger
Chairman, Human Resources Subcommittee
House Ways and Means Committee
Room B-317, Rayburn House Office Building
Washington, DC 20515
Dear Chairman Herger:
The Alan Guttmacher Institute (AGI) applauds you for convening a
hearing on November 15 before the Human Resources Subcommittee designed
to shed light on the problem of teenage pregnancy. As you noted at the
hearing, accurately diagnosing why teen pregnancy rates are declining
in this country is extremely important to our ability to make further
progress in this area, particularly as legislators begin work on
welfare reauthorization.
AGI researchers in 1999 first set out to determine the extent to
which increased abstinence from sexual activity among teenagers and/or
other factors, such as changes in contraceptive behavior among sexually
experienced teenagers, contributed to recent declines in teenage
pregnancy. Due to the controversy inherent in the subject matter and
the various ways in which different people have examined and
interpreted the trends, AGI researchers went to extraordinary lengths
to make sure that their approach and methodology were the most
appropriate ones given existing data, and that their conclusions were
ones that they--and the Institute--could fully stand behind. This
included participation at a consensus meeting convened by the National
Institute of Child Health and Human Development to examine measurement
issues regarding sexual activity and contraceptive use of teenagers,
which involved researchers from AGI, the National Center for Health
Statistics, Urban Institute, Child Trends and the National Campaign to
Prevent Teenage Pregnancy. AGI's methodology for measuring factors
potentially contributing to pregnancy rate declines--sexual experience
and contraceptive use levels--follows the consensus of this group.
AGI's findings appeared in our publication ``Why Is Teenage
Pregnancy Declining? The Roles of Abstinence, Sexual Activity and
Contraceptive Use,'' \1\ which I have attached as an exhibit for your
review. Our analysis was based on calculations using the following data
sets:
---------------------------------------------------------------------------
\1\ Darroch JE and Sing S, Why Is Teenage Pregnancy Declining? The
Roles of Abstenence, Sexual Activity and Contraceptive Use, Occasional
Report, New York: The Alan Guttmacher Institute, 1999, No. 1.
Pregnancy rates--released by AGI in April 1999 in
``Teenage Pregnancy: Overall Trends and State-by-State
Information''--are based on birth rates from the National
Center for Health Statistics and abortion data from periodic
AGI Abortion Provider Surveys. Information on the proportions
of young women who have had sexual intercourse are from the
National Center for Health Statistics' 1988 and 1995 National
Surveys of Family Growth (NSFG).
Information on sexual activity and contraceptive use
is from 1988 and 1995 NSFG.
Overall contraceptive failure rates are based on
NSFG information on contraceptive use and from first-year
failure rates calculated from the 1995 NSFG and the 1994-1995
AGI Abortion Patient Survey.\2\
---------------------------------------------------------------------------
\2\ http://www.agi-usa.org/pubs/journals/3104669.html.
AGI's analyses showed that the teen pregnancy rate dropped
significantly--from 111.4 to 101.1 per 1,000 women aged 15-19--between
1988 and 1995, a decline of 9 percent.\3\ National survey data indicate
that during that time period there was a decline--or at least a
leveling off--in the proportion of teenagers who have ever had sexual
intercourse. The proportion of women aged 15-19 who report that they
have ever had sexual intercourse decreased 2 percent between 1988 and
1995.\4\ Analysis showed that about 25 percent of the decline in the
overall U.S. teen pregnancy rate was attributable to this increased
abstinence.
---------------------------------------------------------------------------
\3\ Darroch JE and Singh S, op. cit. (see reference 1), pages 8-9
and Table 1.
\4\ The percentage of 15-19 year old women who say they have ever
had sexual intercourse was 51.3 percent in 1995 and 52.6 percent in
1988. Ibid.
---------------------------------------------------------------------------
Of greater magnitude, AGI's analysis of the available data found
that approximately 75 percent of the decline in teen pregnancy between
1988 and 1995 was attributed to declines in pregnancy rates among
sexually experienced teenagers. Indeed, the drop in pregnancy rates
among sexually experienced teens has been marked--7 percent between
1988 and 1995.\5\
---------------------------------------------------------------------------
\5\ In 1988, the pregnancy rate among sexually experienced 15-19
year olds was 211.8 per 1,000; in 1995, it was 197.1 per 1,000. Ibid,
page 8.
---------------------------------------------------------------------------
Declining pregnancy rates among sexually experienced teens must be
attributable to one or more of the following three factors:
1) less frequent sexual activity;
2) an overall increase in contraceptive use (that is, an
increase in the proportion of sexually experienced teens using
a contraceptive); and/or
3) improved (in other words, more effective) contraceptive
use.
Government data do not bear out a decrease in levels of sexual
activity among sexually experienced teens.\6\ And, there is evidence
that only a slightly larger proportion of sexually active teens were
using contraceptives.\7\ More significantly, however, by 1995 teens
using contraceptives were choosing more effective methods. Most
notably, there has been a substantial shift among sexually active teens
toward the use of highly effective, long-acting contraceptive methods--
the contraceptive injectable (Depo Provera) and the contraceptive
implant (Norplant). These methods only hit the U.S. market in the early
1990s, but by 1995, over one in ten (13 percent) sexually active teen
women at risk of unintended pregnancy was using one of them.\8\ Because
these long-acting methods are so effective and so easy to use, they
made a big dent in the teenage pregnancy rate.
---------------------------------------------------------------------------
\6\ A somewhat lower proportion of sexually experienced young women
reported having had intercourse in the three months prior to the
National Survey of Family Growth in 1995 than in 1988 (79 percent vs.
81 percent); however, over the entire prior year, sexually experienced
young women reported having had intercourse during the same average
number of months in both the 1988 and the 1995 NSFG (8.6 months). Ibid,
page 10.
\7\ The proportion of sexually experienced teens reported currently
using a contraceptive--using one within the last month--was 80 percent
in 1995, compared with 78 percent in 1998. Ibid, page 10.
\8\ Ibid, page 11.
---------------------------------------------------------------------------
Use of Depo Provera and Norplant may have played a particularly
large role in reducing second pregnancies among teen mothers. Data
released by NCHS showed a dramatic 21 percent decline between 1991 and
1996 in the proportion of teen mothers giving birth a second time.\9\
During a corresponding time period, the proportion of teen mothers
using long-acting methods rose to one-quarter.\10\
---------------------------------------------------------------------------
\9\ Ventura SJ, Mathews TJ and Curtin SC, Declines in teenage birth
rates, 1991-1997: National and state patterns, National Vital
Statistics Reports,1998, Vol. 47, No. 12.
\10\ Using data from the 1995 National Survey of Family Growth,
NCHS researchers estimate that about one-fourth of teens who are
mothers are using Depo Provera or Norplant. NCHS, Unpublished
tabulations.
---------------------------------------------------------------------------
A recent analysis conducted by the National Campaign to Prevent
Teen Pregnancy found that 40-60 percent of the decline in teenage
pregnancy rates between 1990 and 1995 was probably due to fewer teens
having sex and 60-40 percent to lower pregnancy rates among sexually
experienced teens. (Looking at the years 1988-1995, the Campaign found
that 20-50 percent of the drop resulted from lower rates of sexual
experience and 50-80 percent from decreased pregnancy rates among
sexually experienced teens.) \11\ This analysis, however, contains
certain methodological flaws that hamper the reliability of its
findings. First, it places on equal footing data gathered in 1990
through telephone surveys with data collected in 1988 and 1995 through
in-person interviews, making it impossible to determine whether
differences between 1990 and 1988 or 1995 are due to an actual change
in behavior or the changes in survey methodology. Second, it uses
arbitrary and inconsistent measures of respondents' age in 1988 and
1995 (rather than the consistent point in time of when respondents were
interviewed), which produces biases in different directions in 1988 and
1995, and thus overstates changes in sexual activity. And third, it
measures sexual experience to include those young women who have had
sex before menarche, which is inappropriate for measuring teen
pregnancy since these women, by definition, are not at risk for
pregnancy. When this analysis is adjusted such that it is based on
comparable survey methodology and quality over time (1988 and 1995
NSFGs), unbiased measures of age (at the time respondents were
interviewed), and appropriate measures of sexual experience (ever had
sexual intercourse after menarche)--the most scientifically consistent
and rigorous approach--it yields a conclusion similar to AGI's findings
in Why is Teenage Pregnancy Declining?
---------------------------------------------------------------------------
\11\ Flanigan, C, What's behind the good news: The decline in teen
pregnancy rate during the 1990s, Washington, DC: The National Campaign
to Prevent Teen Pregnancy, 2001.
---------------------------------------------------------------------------
In summary, AGI's analysis found that approximately one-quarter of
the decline in teen pregnancy rates is due to increased abstinence;
about three-quarters is due to more successful pregnancy prevention
efforts among teens who are sexually active. Many questions still
remain around why teen contraceptive use has improved, why more teens
are remaining abstinent, and whether these trends have continued since
the mid-1990s. But the bottom line is that both phenomena are making a
difference in combating teen pregnancy. This strongly suggests that
even as abstinence is being promoted to our nation's young people,
accurate and reliable information about contraceptives, as well as
access to contraceptives for those teens who are sexually active--half
of all U.S. teens--is also vitally important to reducing teen
pregnancies, fully eight in 10 of which are unintended. Again, we
applaud your effort to devote attention to the critical issue of
teenage pregnancy, and strongly urge you to take this information into
account as you and members of your subcommittee move toward welfare
reauthorization next year.
Sincerely,
Jacqueline E. Darroch, Ph.D.
Senior Vice President
Vice President for Research
Center for Law and Social Policy
Washington, DC 20005
November 29, 2001
The Honorable Wally Herger
Chairman, Human Resources Subcommittee
House Ways and Means Committee
Room B-317, Rayburn House Office Building
Washington, DC 20515
Dear Chairman Herger:
The Center for Law and Social Policy (CLASP) appreciates the
opportunity to submit this statement for the record of the public
hearing on Teen Pregnancy Prevention that was held on Thursday,
November 15, 2001.
CLASP is grateful that you held a hearing on the topic of teen
pregnancy prevention in preparation for reauthorization of the
Temporary Assistance for Needy Families program in 2002. The importance
of the relationship of teen childbearing to poverty cannot be
overstated, yet, too often it is not given the attention it deserves.
Also up for reauthorization in 2002 is the separate abstinence
education program enacted in 1996, which received the most attention by
the witnesses who testified on November 15.
In this brief submission, CLASP will focus on the abstinence
education program. We have written and will continue to publish updated
materials on the full range of issues related to reauthorization and
teen pregnancy/reproductive health including such topics as: TANF
spending on teen pregnancy prevention, TANF spending on teen parent
services, the TANF teen parent living arrangement and education
requirements, the out-of-wedlock bonus, teen marriage, TANF teen
parents with disabilities, and ``family cap'' policies. Our materials
are all available free of charge on our web site: http://
www.clasp.org/.
The 1996 federal abstinence education program is often
misunderstood. In part this is because abstinence education can mean
different things to different people. For some, abstinence education
means information that asserts one should abstain from sex at every age
unless one is married; for others, abstinence education means programs
that promote abstinence as the only sure way to avoid pregnancy and
sexually transmitted illnesses and that when one stops abstaining it is
important to know how to contracept. Many are unaware that the statute
defines a program with the former approach, the most restrictive
approach--sometimes called abstinence-unless-married education.
The law's definition of a fundable program has eight points,
including that the program teach that ``sexual activity outside the
context of marriage is likely to have harmful psychological and
physical effects'' [Attachment A provides the full text of the law].
The program operates through the Maternal and Child Health (MCH) block
grant and provides $50 million in federal funds each year to support
abstinence programs that preclude education about contraception; a
state match of $3 for every $4 federal dollars is required.
The law was enacted without any research base suggesting that a
restrictive abstinence approach works at reducing teen pregnancy and
births. There still is none. As noted in a recent review of evaluations
of abstinence programs published by the National Campaign to Prevent
Teen Pregnancy, ``there do not currently exist any abstinence-only
programs with reasonably strong evidence that they actually delay the
initiation of sex or reduce its frequency.'' The author used strict
criteria in determining what studies of sexuality education programs to
include in his review of evaluations; only three such abstinence-only
studies met the criteria.\1\
---------------------------------------------------------------------------
\1\ ``The review examined the evidence available regarding studies
that met the following criteria: met the scientific standards requisite
for inclusion in professional journals or publications; published in
1980 or later; analyzed data collected from U.S. adolescents, most of
whom were 19 or younger; used a sample size of at least 100; measured
the relationship between the antecedents and one or more of the
following sexual behaviors: initiation of sex, frequency of sexual
intercourse, number of sexual partners, use of condoms, use of any type
of contraception, pregnancy, or childbearing. (Studies that measured
only out-of-wedlock pregnancy or childbearing were not included.)''
Douglas Kirby, Emerging Answers: Research Findings on Programs to
Reduce Teen Pregnancy, (Washington, DC: National Campaign to Prevent
Teen Pregnancy, 2001), p. 35.
---------------------------------------------------------------------------
Unfortunately, the federally funded evaluation of abstinence-
unless-married programs funded through the 1996 law will not be
finalized until 2003; thus, the 2002 reauthorization process will not
be able to benefit from any insights offered by the evaluation. While
the evaluation should help us learn more about some of the impacts of
the programs it will, nevertheless, not answer the question that needs
to be asked. That central question is ``How does a program of
abstinence-unless-married education compare to an abstinence program
that also provides contraceptive education?''
There is good reason to compare different types of approaches to
abstinence: available research raises concerns about an abstinence
education approach that does not provide contraceptive education. At
the same time, there is a bit of encouraging news that some abstinence
strategies may help delay the onset of sexual activity, particularly
among the youngest adolescents. But the abstinence-unless-married
approach can backfire when aimed at older teens.
A comparison of in-school youths who took a
``virginity pledge'' and those who did not found that some
virginity pledgers were at greater risk when they first engaged
in sexual intercourse. The pledge--to abstain from sex until
marriage--did delay first intercourse on average by nearly 18
months. However, pledging had no effect among teens who were 18
or older and also contributed to health risks for those who
became sexually active.\2\
---------------------------------------------------------------------------
\2\ The highlighted Kirby report above did not include these
community-based Virginity Pledge efforts.
---------------------------------------------------------------------------
According to researchers Peter Bearman and Hannah Brueckner,
who tracked those pledgers who had intercourse during the study
period, ``the estimated odds for contraceptive use for pledgers
are about one-third lower than for others.'' The researchers
noted that ``pledgers are less likely to be prepared for an
experience that they have promised to forego.'' They also found
that ``pledging does not work for adolescents at all ages'' and
that the efficacy of the pledge in some schools depended on its
being uncommon: ``Once the pledge becomes normative, it ceases
to have an effect.'' Thus ``policy makers should recognize that
the pledge works because not everyone is pledging.'' \3\
---------------------------------------------------------------------------
\3\ Peter Bearman and Hannah Brueckner, ``Virginity Pledges and the
Transition to First Intercourse'', Pregnancy Prevention for Youth: An
Interdisciplinary Newsletter, Vol. 3, No. 2, (June 2000); also,
``Virginity Pledges as they Affect the Transition to First
Intercourse'', American Journal of Sociology, Vol. 106, No. 4, (2001).
---------------------------------------------------------------------------
Another study compared an ``abstinence'' program
with a ``safer sex'' program that involved 659 African-American
middle-school adolescents and found that, among those who
already were sexually active when the courses began,
participants in the ``safer sex'' program reported less-
frequent sexual intercourse and less-frequent unprotected sex
one year after the program. Further, when the abstinence group
was compared with a control group, it reported less sexual
activity at three months following the intervention, but this
distinction evaporated over time.\4\
---------------------------------------------------------------------------
\4\ ``The abstinence intervention acknowledged that condoms can
reduce risks but emphasized abstinence to eliminate the risk of
pregnancy and STDs, including HIV. It was designed to . . . strengthen
behavioral beliefs supporting abstinence. . . . The safer-sex
intervention indicated that abstinence is the best choice but
emphasized the importance of using condoms to reduce the risk of
pregnancy and STDS, including HIV, if participants were to have sex. It
was designed to . . . increase skills and self-efficacy regarding [the]
ability to use condoms.'' John B. Jemmott III, Loretta Sweet Jemmott,
and Geoffrey T. Fong, ``Abstinence and Safer Sex HIV Risk-Reduction
Interventions for African American Adolescents, A Randomized Controlled
Trial'', Journal of the American Medical Association, Vol. 279, (May
20, 1998).
---------------------------------------------------------------------------
A study conducted by Edward J. Saunders and
colleagues at the University of Iowa School of Social Work
compared survey responses from participants in a comprehensive
sex-education program that promoted abstinence but allowed
contraceptive information with survey responses from
participants in an abstinence-unless-married program. The
authors found that the former program was more successful in
imparting knowledge about aids and other stds. In addition,
while the authors suggested that program comparisons should be
viewed cautiously because of differences in the age of the
participants, the length of the programs, and a range of other
variables, they noted that the program that offered
contraceptive information also appeared to be more successful
than the abstinence-unless-married program in ``promoting
communication between parents and youth about sex.'' \5\
---------------------------------------------------------------------------
\5\ Edward J Saunders, et al., ``Evaluation of Abstinence-Only
Education: Year One Report'', University of Iowa School of Social Work,
(October 1999).
Further, evaluations of programs that combine abstinence education
with contraceptive information find that they can help delay the onset
of intercourse without a concomitant concern about health risks, and
that they also reduce the frequency of intercourse and the number of
partners.\6\ If there are stronger approaches that further delay the
onset of intercourse by the too-young, those lessons should be adapted
by programs that combine abstinence education with contraceptive
information--in that way such programs will cause no health harm.
---------------------------------------------------------------------------
\6\ Douglas Kirby, Emerging Answers: Research Findings on Programs
to Reduce Teen Pregnancy, (Washington, DC: National Campaign to Prevent
Teen Pregnancy, 2001); Douglas Kirby, No Easy Answers: Research
Findings on Programs to Reduce Pregnancy, (Washington, DC: National
Campaign to Prevent Teen Pregnancy, March 1997).
---------------------------------------------------------------------------
Even in the absence of evidence that abstinence-unless-married
education reduces the risk of teen pregnancy and birth, and in spite of
the new research that the reduction in sexual activity is accompanied
by an increase in the health risk for some, funding for this approach
has expanded beyond the $50 million per year authorized in the 1996
welfare law. As of fiscal year 2002, at least $533 million will have
been earmarked in federal and state funds since 1996. Two other federal
sources, the Adolescent Family Life Act (AFLA) and Special Projects of
Regional and National Significance-Community-Based Abstinence Education
(SPRANS-CBAE) program, have made more money available. Under the SPRANS
grants, MCH can by-pass states and award grants directly to local
projects; grantees, however, may not provide contraceptive education,
even with separate funds. The House has increased its funds for SPRANS-
CBAE from $20 to $40 million (efforts to increase it to $73 million
failed); the Senate Appropriations committee would provide $30 million.
Any differences will be resolved shortly in Conference.
Proponents of increased funding for SPRANS-CBAE argue that funding
``parity'' is needed between abstinence-unless-married education and
family planning. This comparison, however, contrasts expenditures for
education against costs for medical services. Thus, this is a
comparison of ``apples'' and ``oranges'' and creates even greater
misunderstanding in the public debate.
The public supports abstinence education but wants contraceptive
education along with it. Virtually all of the parents of 7-12th graders
(97 percent) want their child's sexuality education program to cover
abstinence, according to a national study in 2000 by the Kaiser Family
Foundation.\7\ Notably, these parents also want lessons on how to use
condoms (85 percent) and on general birth control topics (90
percent).\8\ State and local surveys also have found strong support for
information about both abstinence and birth control.
---------------------------------------------------------------------------
\7\ ``Sex Education in America: A View from Inside the Nation's
Classrooms'', A Series of National Surveys of Students, Parents,
Teachers, and Principals, Kaiser Family Foundation Website, (September
26, 2000), (Accessed November 6, 2001), Available online: http://
www.kff.org/content/2000/3048/ Chartpack.pdf.
\8\ Ibid.
---------------------------------------------------------------------------
The Subcommittee on Human Resources hearing on teen pregnancy
revealed bi-partisan support for a more flexible approach to the
available federal abstinence education funds. Not only were a number of
attending Democratic members of the Subcommittee concerned that the
law's approach to abstinence education is too restrictive, so too was
Congresswoman Nancy Johnson (R-CN). This bi-partisan call for increased
flexibility as an issue for reauthorization is encouraging and
appropriate.
The Center for Law and Social Policy recommends further attention
to abstinence-only education funding during reauthorization and a
closer examination of how the research points to the importance of
greater flexibility in spending available funds.
Sincerely,
Jodie Levin-Epstein
Senior Policy Analyst
______
Attachment A
SEPARATE PROGRAM FOR ABSTINENCE EDUCATION
``SEC. 510. (a) For the purpose described in subsection (b), the
Secretary shall, for fiscal year 1998 and each subsequent fiscal year,
allot to each State which has transmitted an application for the fiscal
year under section 505(a) an amount equal to the product of--
``(1) the amount appropriated in subsection (d) for the fiscal
year; and
``(2) the percentage determined for the State under section
502(c)(1)(B)(ii).
``(b)(1) The purpose of an allotment under subsection (a) to a
State is to enable the State to provide abstinence education, and at
the option of the State, where appropriate, mentoring, counseling, and
adult supervision to promote abstinence from sexual activity, with a
focus on those groups which are most likely to bear children out-of-
wedlock.
``(2) For purposes of this section, the term `abstinence education'
means an educational or motivational program which--
``(A) has as its exclusive purpose, teaching the social,
psychological, and health gains to be realized by abstaining from
sexual activity;
``(B) teaches abstinence from sexual activity outside marriage as
the expected standard for all school age children;
``(C) teaches that abstinence from sexual activity is the only
certain way to avoid out-of-wedlock pregnancy, sexually transmitted
diseases, and other associated health problems;
``(D) teaches that a mutually faithful monogamous relationship in
context of marriage is the expected standard of human sexual activity;
``(E) teaches that sexual activity outside of the context of
marriage is likely to have harmful psychological and physical effects;
``(F) teaches that bearing children out-of-wedlock is likely to
have harmful consequences for the child, the child's parents, and
society;
``(G) teaches young people how to reject sexual advances and how
alcohol and drug use increases vulnerability to sexual advances; and
``(H) teaches the importance of attaining self-sufficiency before
engaging in sexual activity.
``(c)(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as such
sections apply to allotments under section 502(c).
``(2) Sections 505 and 506 apply to allotments under subsection (a)
to the extent determined by the Secretary to be appropriate.
``(d) For the purpose of allotments under subsection (a), there is
appropriated, out of any money in the Treasury not otherwise
appropriated, an additional $50,000,000 for each of the fiscal years
1998 through 2002. The appropriation under the preceding sentence for a
fiscal year is made on October 1 of the fiscal year.''.
Statement of Onalee McGraw, Director, Educational Guidance Institute,
Front Royal, Virginia
Evaluation of the effectiveness of Title V Programs must be consistent
with all of the A-H elements of Title V (Personal
Responsibility and Work Opportunity Reconciliation Act of 1996
P.L. 104-193)
Title V mandated a model for teaching about sexuality that
represented a major departure from the long established safer sex/risk
reduction approaches. Evaluation of Title V programs should be fully
consistent with the norm building, values formation core of the A-H
elements of Title V-not only in the programs themselves, but in the
methods of evaluation that are used.
The methodological assumption relied on by both the National Title
V Evaluation and state Title V evaluation efforts in various states,
e.g. Virginia, was grafted on to the abstinence-until-marriage model
from evaluation theories utilized for evaluating risk reduction and
HIV/AIDS prevention interventions. The theory of evaluation is that (1)
adolescents' sexual activity can be adequately and accurately measured
by their self-reported answers to survey questions and (2) statistical
analysis of these survey responses from subjects in intervention and
control (``no treatment'') groups can be utilized to answer the
question of whether or not the intervention programs thus measured are
effective in reducing the onset of sexual activity.
This methodology is not appropriate, however, for the norm-based,
values teaching, character education oriented goals and objectives of
the abstinence-until-marriage programs supported by Title V. This
positivist methodology will fail to establish a credible baseline of
sexual behavior change in the intervention and control/no treatment
groups. The question of whether such survey questions are ethically and
developmentally appropriate is a perennial issue in school settings.
School districts and parents are rightly opposed to their students
being asked intrusive questions about their sexual behavior.
Many of us in the abstinence education community desire a new
direction in evaluation, one that has an evaluation theory base and
methodology that is philosophically compatible with the mandated A-H
elements. Under the principle of ``do no harm'' no participant in
either an intervention or a so called ``control'' group should be
exposed to invasive questions about their own personal sexual
histories.
Existing methods of evaluating Title V programs through group
survey methods of measuring sexual behavior change involve serious
empirical and developmental problems.
(1) Empirically the establishment of the baseline is problematic
because our culture currently has subcultures of pre-teens and teens
engaging in oral sex play that they do not consider to be sexual. The
methodology of measuring sexual behavior change with group surveys will
fail to adequately establish a participant sexual behavior baseline for
determining whether programs reduce the onset of sexual activity.
Survey questions asking students if, when and how many times they
have had sexual intercourse will be answered ``no'' by students who
have not had sexual intercourse and who are not engaging in oral sex
play, and ``no'' by students who have not had sexual intercourse but
who have been engaging in oral sex play. In 1999, the national media
reported that subcultures of teens were engaging in behaviors they did
not consider to be sexual.\1\ For example, girls who reported engaging
in oral sex 50 or 60 times related in clinical settings that they were
``virgins and were going to wait to have intercourse until they meet
the man they will marry.'' \2\ The meanings of the words ``having sex''
or ``sexual activity'' have changed so that many respondents would
rightly answer ``no'' to the question, ``have you had sexual
intercourse?'' Leaders in the abstinence education community cautioned
supporters of the group survey methodology that survey questions
concerning ``sexual activity'' and ``sexual intercourse'' would not
produce empirically valid measurement, but these concerns were not
heeded when there was still an opportunity to address them.
---------------------------------------------------------------------------
\1\ The Washington Post, July 8, 1999, Talk Magazine, February,
2000.
\2\ Mona Charen, ``Sexual play as a preteen pastime,'' Washington
Times, April 13, 2000.
---------------------------------------------------------------------------
Another empirical problem is the contamination of the comparison
groups when the program evaluated is norm-based and value-laden. Many
of the same educational elements implemented in the intervention groups
are likely to be present in the comparison groups because more teachers
in the present cultural climate affirm the abstinence message; teachers
have a strong influence over learners in the values they impart.
(2) Developmentally, this positivist methodology fails to
adequately account for the emotional, social and moral domains of human
development that together fully integrate human sexuality.
Because human beings are whole persons, self-report responses to
survey questions about sexual behavior provide a flawed and incomplete
picture of each subject's genuine and holistic state of mind and heart.
Jerome Kagan, one of the nation's leading social scientists in the
field of human development, has said that the methods of social science
observation in studying human behavior will always be greatly limited
by the mode of observation chosen by the particular social scientist.
Contrary to the position taken by supporters of the group survey
methodology, operational principles of social science observation vary
greatly; they are not universally applied to all types of subject
matter. As Kagan, in the Nature of the Child observes, any given mode
of observation of human subjects can reveal only a portion of events
observed.\3\ That is, the responses given by adolescents to survey
questions about their sexual behavior provide only a ``snapshot in
time'' of what the respondent is truly experiencing and how he or she
has actually behaved.
---------------------------------------------------------------------------
\3\ Jerome Kagan, The Nature of the Child, Basic Books, 1994, p.
18.
---------------------------------------------------------------------------
Principles of Whole Person Development Require Respect for Every Human
Subject in K-12 Settings
The same developmental and age-appropriate assumptions that guide
abstinence-until-marriage model programming must apply to the survey
instruments that evaluate the effectiveness of these programs. The five
principles of age appropriate practice outlined below affirm the whole
person reality and integrity of human subjects in K-12 group evaluation
settings.
Principle #1: Human sexuality is strongly intertwined with social and
moral values
The authors of Sex in America: A Definitive Survey, describe the
erroneous concept of human sexuality that has dominated our culture for
so long as ``the belief that the individual is the sole actor on the
sexual stage'' The authors found instead that ``sexual behavior is
shaped by our social surroundings. We behave the way we do, we even
desire what we do, under the strong influence of the particular social
groups we belong to.'' \4\ The theory of behavior change that guides
the research base of the HIV/AIDS prevention establishment (and
inappropriately grafted onto Title V evaluation) is the very same
notion discredited by the Sex in America research. A review of HIV/AIDS
prevention research literature consistently reveals that the underlying
theoretical presupposition is to assist the individual conceived as
``the sole actor on the sexual stage'' to make autonomous and rational
decisions about sexual behavior.
---------------------------------------------------------------------------
\4\ Robert T. Michael, John H. Gagnon, Edward O. Laumann, and Gina
Kolata, Sex in America: A Definitive Survey, Little Brown and Co.,
1994, p. 16.
---------------------------------------------------------------------------
In light of the differences over proper methodology that shape the
Title V Evaluation debate, it is useful to review the methodology that
was followed by the researchers that produced Sex in America. Adult
subjects were interviewed by highly trained interviewers in their
homes. The Sex in America methodology recognized the whole person
nature of the subjects in these one-on-one interviews. By contrast, the
method used in state and national Title V evaluation efforts has been
to place in front of the adolescent respondent a hard copy survey or
computer program and to assume that the students will be able to
``report'' objectively and accurately on the subjective state of their
minds and hearts with regard to their sexuality.
Principle #2: Ethics in evaluation require treating respondents as
whole persons
The group survey method using self-report for explicit sexual
behavior questions places great reliance on confidentiality and
parental consent to frame its ethical requirements. The problem with
self-report in the survey method is that the emotional dispositions of
the person from whom the information is sought cannot be known. Because
of this unpredictable element of emotional response, especially when
the topic is sex, the aggregate results of respondents' self report are
likely to be ``inconclusive.'' By and large, adolescent respondents are
incapable of addressing their sexuality in the cognitive domain by
separating out through an act of the will (upon assurances of
confidentiality), the emotional, social and moral aspects that make
them whole persons.
The abstinence-until-marriage model's theoretical foundations,
learning theory, and principles for evaluation rely on a view of the
human person seen as a whole, not just in the part of the ``self'' that
involves sexual behavior. The complex interconnections of the moral,
emotional social and cognitive domains are at any moment in time an
unknowable result of the survey's psychological impact on not only the
mind, but the heart of the learner. As opposed to being a ``sole actor
on the sexual stage,'' each person has an inner core--a personal
dignity that must not be invaded except in a setting preceded by
personal or parental consent, as in one-on-one counseling or in a
therapeutic setting with licensed helping professionals.
Principle #3: Surveys containing personal questions about respondents'
sexuality are by that very fact psychologically invasive
The fact that the survey carries a ``guarantee'' by its
administrators of confidentiality is certainly an ethical imperative,
but it is not the only ethical imperative that must be followed.
Ethical considerations related to respecting research subjects as whole
persons are paramount because the survey instrument is not only a tool
for gathering data about sexual behavior, but it is also an
intervention that is educational and therapeutic in its potential
impact on the respondent. The survey that asks about sexual behavior is
therapeutic in that it reaches into the respondents' personal inner
core and alters it. It is educational in that it sends a message about
sexuality under the authority of the survey administrators. Such
interventions, whether educational or therapeutic in their impact, may
be harmful in some cases to the healthy emotional, moral and social
development of the adolescent.
Principle #4: The survey not only questions, it also teaches
A prominent educator in the abstinence movement has pointed out
that any survey that purports to measure sexual behavior change teaches
adolescents at the same time that it questions them. When the subject
is sex, school officials and parents have an instinctive sense of
boundaries being crossed. The survey teaches and asks questions about
personal sexual behavior to the adolescent in a value free context, and
in so doing sends a message that contradicts the norm building essence
of A-H in Title V. This is especially true for the respondents in the
``no treatment'' comparison groups.
Principle #5: The same ``whole person'' principles of age-
appropriateness apply to surveys as well as programs
A common assumption made by many persons committed to the
methodology of survey measurement of sexual behavior change is that the
content of the intervention and the instrument by which the
intervention is being evaluated exist on two totally separate tracks.
In fact, principles of sexual development apply to human subjects when
they are survey-takers just as they apply to these same whole persons
when they are in the classroom. The survey is a teaching instrument as
well as a research vehicle, and as such, must be subject to the same
principles of adolescent development and age-appropriateness that guide
the intervention being evaluated.
The intellectual error plaguing the National Title V Evaluation and
state evaluations is the concept that the programs that teach A-H and
the survey research conducted to determine Title V program
effectiveness exist in two separate realms. The assumption is that the
program has educational purposes and potential impact that is social,
psychological and cognitive, but the survey that is utilized as an
evaluation tool has merely cognitive impact as an instrument for
gathering data. The assumption that the subjects of the evaluation can,
in a dualistic fashion, separate their cognitive selves from the rest
of their whole personhood, is rooted in the empiricist/positivist
school of behavioral research that is inappropriate for norm-driven
programs that teach ``abstinence until marriage as the expected
standard for all school age children''
A Case Study Showing Emotional Harm to a Vulnerable 12-Year-Old
Participant in a State Title V Survey
By an unexpected set of circumstances, there is a documented case
of serious emotional harm that was done to a twelve year-old boy who
experienced a negative reaction as a result of participating in a state
level Title V survey that asked him questions about his personal sexual
behavior. This case is known to the officials in the state where the
incident occurred. Given the cloak of confidentiality in the evaluation
process, few events like the case described below are likely to be
reported outside the small circle of any state or national evaluation
effort. If such adverse emotional impacts are encountered, most school
officials, parents and teachers would have no knowledge of the event
(unless it was reported to them by students).
In 2000, a state sponsored Title V evaluation survey was being
administered in a cafeteria school setting to a number of students. The
incident grew out of the emotional response of a 12 year-old boy who
wrote the ``F'' word in letters so large on his survey booklet that it
caught the eye of the survey administrator who was passing near his
desk. The survey administrator was familiar with the school's policy
against writing obscenities, and took the boy to the principal's
office. The boy apologized to the survey administrator for his actions,
but stated that many of the other students felt the same way. The
principal made a decision to suspend the boy for 5 days from school.
The boy was in a home without a father and apparently grew upset when
he had to put down in the survey that his father was not in the home in
which he lived. Already in an agitated state, the boy reacted strongly
to the questions about his personal sexual life, and wrote the
offending word in big letters across the page of the survey.
Human beings develop sexually as whole persons
If we review again the findings of Sex in America, the response of
this 12-year-old boy is not that surprising. This young person, who is
now 13 or 14 years old, is a whole person who longs, as any young
person would, for his father. If he were, as the HIV/AIDS prevention
theorists and their predecessor, Alfred Kinsey, believe, a ``sole actor
on the sexual stage,'' the question of whether his father was in the
home or not should not have upset him so much. But whole persons have a
sense of who they are and who they are is deeply shaped by the family
structures in which they grow to maturity. This survey violated a young
boy's personal core where he was exceedingly vulnerable.
As whole persons, human beings think, feel and act simultaneously
as both agent and object. The methodology of measuring sexual behavior
change by self-reported student responses assumes that adolescents can,
with reasonable ease and assurances of confidentiality, transform
themselves into objective, self-therapists who through their cognitive
domain examine their sexuality in an objective manner. The Sex in
America findings confirmed that moral norms were key to how the adults
in their study formed their views of sexuality and their concepts of
who they were (Sex in America, p. 240). If we live as whole persons
with our sexual attitudes and behavior, how can we assume that
adolescents in their nature and sexual development are able to
compartmentalize their sexuality and turn themselves into a subject for
their own self study?
Albert Bandura, Stanford Professor and Former President of the
American Psychological Association, in his major book, Self-Efficacy:
The Exercise of Control, has this to say about the integrated nature of
our subjective and objective consciousness as human beings. Bandura
says that, ``The duality of self as agent and self as object pervades
much of the theorizing in the field of personality.'' We might also say
that viewing the self in the dualistic framework of agent and object
underlies the theoretical structure that pervades safer-sex/ HIV/AIDS
research and the same intellectual error supports evaluating Title V
through the use of surveys asking questions about sexual behavior.
Bandura comments as follows:
``Social cognitive theory rejects the dualistic view of self. . . .
It is one and the same person who does the strategic thinking about how
to manage the environment and later evaluates the adequacy of his or
her knowledge, thinking skills, capabilities, and action strategies.
The shift in perspective does not transform the person from an agent to
an object, as the dualist view of the self would lead one to believe.''
(Self-Efficacy: The Exercise of Control, p. 5.)
CONCLUSION
Under The Ethical Principle of ``Do No Harm'' No Group Surveys in K-12
Settings Should Include Personal Questions About Sexual Behavior
The concept that most survey-takers will go along with the survey
is not sufficient justification for this method The typical survey
asking questions about sexual behavior relies on the fact that most
students will probably conform to the expectations of the survey
administrators. Their emotions will prompt them to go along because the
survey administrators have authority over them. But under the ethical
principle of ``do no harm'' the concept that most survey-takers will go
along with the survey is not sufficient justification for this method.
The intrusive questions can do emotional harm to young people from any
walk of life but, as shown in the case study above, the emotional harm
can be serious when it affects young people who are already vulnerable
and who may not have involved parents to opt them out of intrusive
surveys. The vulnerable minority of students who are at risk in our
society are the most prone to risk taking in terms of drugs, sex and
alcohol, are clearly also the most vulnerable to questions that invade
their personal core.
The evaluation of Title V should be rooted in the abstinence-until-
marriage model's own distinctive theory base that supports programs
that teach the norm that abstaining from sex until marriage is the
accepted standard for all school age children.'' The fact that both
risk reduction and abstinence-until-marriage programs have similar
goals of pregnancy prevention and STD reduction does not mean that they
are rooted in the same theory of sexual behavior change. Using Albert
Bandura's social cognitive theory as the foundation, a credible
alternative approach can be utilized to evaluate Title V programs. This
new direction should not depend on measuring sexual behavior change by
asking pre-teens or teens invasive questions about their personal
sexual behavior. These questions invade respondents' personal inner
core and can therefore cause harm to some adolescents' emotional
development. Under the principle of ``do no harm'' no adolescent should
be placed at risk.
Friends First
Longmont, Colorado 80502-0356
November 28, 2001
Ways and Means Committee
To Whom It May Concern:
I am writing you in support of the Title V abstinence education
funding. As a former ``Safe Sex'' educator in Boulder Valley School
District, I have observed first hand the damage that occurs by
misleading adolescents to believe that sex outside of marriage is free
from consequences. I will always regret teaching that philosophy to
teens, but at the time I had no other choices or options.
Thanks to Title V, teachers and school districts now have choices
to consider in sexuality education. Since starting FRIENDS FIRST in
1993, I have seen incredible improvements with the type of sexuality
education offered to schools, families, and communities. I strongly
encourage you to reauthorize the good work that Title V has begun. We
need to offer communities this choice too. I am attaching some letters
of support for abstinence until marriage education that we have done
over the last five years.
Sincerely,
Lisa A. Rue
Certified Health Educator
President/CEO
[Attachments are being retained in the Committee files.]
Statement of Bob and Peggy Green, Cape Canaveral, Florida
We support this measure one hundred per cent as a way to teach our
children that the God given gift of sex should be preserved for the
marriage bed and that it is a healthy thing to remain chaste until
marriage. Giving condoms which cannot prevent all STDs is not the
answer. Thank you.
Statement of Leslee J. Unruh, President and Founder, National
Abstinence Clearinghouse, Sioux Falls, South Dakota
Background
As President and Founder of the National Abstinence Clearinghouse,
I have an innate understanding of the problem of unwedded pregnancy--
especially teen pregnancy--and the best, safest way to prevent
premarital pregnancies. I have been working with both sexually active
and virginal teens for over 17 years, convincing them that sex is best
when saved for marriage. They can decide not to have sex, no matter
what decisions they have made in the past.
I became interested in abstinence-until-marriage education after my
husband and I founded the Alpha Center, a crisis pregnancy center, and
The Omega Maternity Home, a home for pregnant girls and new moms,
located in Sioux Falls, South Dakota. Through counseling clients and
helping the mothers rebuild their lives, I came to realize that I was
only treating the symptoms not the problem.
The real problem is not premarital pregnancy. The problem is
premarital sex. Premarital pregnancy is a symptom of premarital sex.
Admittedly, there are problems solely associated with premarital
pregnancy and birth; for example mothers who have children outside of
marriage are much more likely to live in poverty. However, there are
also problems associated with promiscuity. The current worldwide HIV/
AIDS pandemic and sexually transmitted disease (STD) pandemics have
been caused by rampant sex outside of marriage. Premarital sex has also
been linked to higher divorce rates,\1\ teen depression and teen
suicide.\2\
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\1\ Joan R. Kahn and Kathryn A. London, ``Premarital Sex and the
Risk of Divorce,'' Journal of Marriage and the Family 53 (1991): 845-
855.
\2\ ``The Troubled Journey: A Profile of American Youth'' Search
Institute, 1993. p. 8.
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My call to work in abstinence-until-marriage education was further
strengthened while my son, Chase, was in 3rd grade. When he brought
home a textbook from his science class, I took the opportunity to
review the material he was being taught. The information in the text
and the pictures were far beyond what I as a parent and abstinence
educator deemed appropriate for his age and development level. The
graphics would have been considered pornography had they been in a
magazine. These pornographic pictures were being used to teach my son
about sex! In addition, the lessons supported the idea that everyone
was having sex and there were no consequences if the female was on
birth control. When children are given this lesson, it is no wonder
that they become sexually active before they are married.
I lobbied state legislators in South Dakota and surrounding states
to teach abstinence until marriage instead of comprehensive (condom)
sex education. I began to speak to teens at churches and schools on
taking charge of their lives. In my talks, I gave them a positive
message that they do not have to become sexually active. For those who
are already sexually active, I encourage them to make a change and to
become secondary virgins. Studies have shown that most sexually active
teens wish they had waited to have sex.\3\ I give the non-virgins a
message of hope for the future. For those who were raped or sexually
abused, I tell them that even if they had experienced these terrible
abuses, there is hope and they do not have to turn to sex to experience
love. Simple evaluation forms passed out after each of my presentations
showed that many who had been sexually active are choosing secondary
virginity, and those who are still virgins choose to remain so until
marriage. These evaluations are not longitudinal studies, but a review
of the 1997 teen pregnancy rates revealed that the four states where
our abstinence program had been presented had four of the five lowest
teen pregnancy rates in the nation.\4\
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\3\ ``Not Just Another Thing To Do: Teens Talk About Sex, Regret,
and the Influence of Their Parents'' National Campaign to Prevent Teen
Pregnancy. June 30, 2000.
\4\ ``National and State-Specific Pregnancy Rates Among
Adolescents--United States, 1995-1997'' CDC MMWR Weekly, July 14, 2000/
49 (27);605-611.
---------------------------------------------------------------------------
In 1993, I began to network with abstinence speakers around the
country through the Alliance of Chastity Educators (ACE). The goal of
ACE was to exchange and coordinate abstinence-related ideas, projects
and resources. As abstinence speakers, the other ACE members and I were
bombarded by requests for trusted abstinence resources. It was obvious
to all of us that a central location was needed where abstinence-until-
marriage materials could be easily evaluated, accessed and requests
processed. The ACE members all felt that we must be united in this
effort because the need for abstinence-until-marriage education was too
great for anyone to meet alone. I accepted leadership of the project,
and the Abstinence Clearinghouse became officially operational in 1997.
The Abstinence Clearinghouse is the central location where
materials and trainings are offered to effectively convey the
abstinence-until-marriage message. The mission of the Abstinence
Clearinghouse is to promote the appreciation for and practice of sexual
abstinence (purity) until marriage through distribution of age
appropriate, factual and medically-accurate materials. The
Clearinghouse has a National Advisory Council, consisting of more than
forty nationally known abstinence educators and supporters. In
addition, the Clearinghouse and the Medical Abstinence Council is
comprised of approximately 75 health professionals from across the
country who are dedicated to not promoting or prescribing
contraceptives to unmarried teens. We also have the Teen Abstinence
Advocates who are committed to remaining sexually pure until marriage
and an International Advisory Council consisting of individuals and
organizations from across the globe working to promote abstinence in
their own countries and communities.
Abstinence Defined
There has been much debate as to what the definition of abstinence
is. The members of the abstinence-until-marriage movement are not
confused about the definition of abstinence. In fact, to end any
confusion there may have been, the Abstinence Clearinghouse collected
hundreds of definitions of abstinence. A panel of leaders in the
abstinence-until-marriage field then decided on a definition. The
abstinence-until-marriage definition of ``abstinence'' is as follows:
``The commitment to not engage in any sexual activity prior
to marriage. This includes intercourse, oral sex, anal sex,
mutual masturbation and any genital contact or other contact
that is sexually arousing.'' \5\
---------------------------------------------------------------------------
\5\ Abstinence Survival Kit. Abstinence Clearinghouse, 2000. p. 13.
The true abstinence-until-marriage educators are not confused about
what abstinence means. Those who claim there is confusion probably
support so-called ``abstinence-based,'' ``abstinence-plus,''
``abstinence-focused'' or other non-abstinence-until-marriage programs.
Programs using these terms often include information about non-coital
sexual behavior, contraception, safe sex and risk reduction while also
mentioning not having sex as another option to avoid pregnancy and STD.
These programs give a mixed message and confuse adolescents about what
the best and expected behavior is.
Mixed Messages
As a leader in the national abstinence-until-marriage movement, I
always warn people to look out for ``wolves in sheep's clothing.''
These are programs which use the word ``abstinence'' in the title but
are really comprehensive sex education. They may also be programs that
support abstinence, but do not teach the children when it is socially
acceptable to be sexually active. True abstinence-until-marriage
programs follow the Title V A-H definition and teach adolescents that
sex is only healthy and socially acceptable in a committed marriage.
Programs that teach anything else give a fuzzy, mixed message.
Programs that give the ``abstinence until an adolescent is ready''
message do not work. Every 16-year-old girl who thinks she is in love
is ``ready.'' When programs explain that it is best to wait until an
adolescent is out of high school, students become pregnant outside of
marriage during their early twenties. The greatest number of premarital
pregnancies is currently in the 20- to 24-year-old age group, not the
15- to 19-year-old group.
Other programs say abstinence is best, but if you are going to do
it anyway, here is how to ``protect'' yourself. What this mixed message
actually does is lower the standard of expected behavior. This message
gives permission for adolescents to have sex.
Are Condoms Protection?
A National Institute of Health study released July 2001, reviewed
condom studies to determine the effectiveness of condoms against eight
STDs--HIV, genital herpes, syphillis, gonorrhea, human papilloma virus
(HPV), chlamydia, trichomonas and chancroid. The scientific panel found
that condoms are 87 percent effective in preventing HIV transmission,
and 40-76 percent effective against gonorrhea transmission from women
to men, but only when they are used perfectly, during every sexual
encounter. For every other STD there is no evidence that condoms slow
transmission rates.\6\
---------------------------------------------------------------------------
\6\ ``Workshop Summary: Scientific Evidence on Condom Effectiveness
for Sexually Transmitted Disease (STD) Prevention'' National Institute
of Allergy and Infectious Diseases, National Institutes of Health and
Human Services. July 20, 2001.
---------------------------------------------------------------------------
HPV can cause genital warts. Some strains cause no external
symptoms; with these strains, the carriers may never know they have it
and spread the disease. The strains that have no symptoms cause 90
percent or more cervical cancer cases. Approximately 15,000 women are
diagnosed with cervical cancer each year and 5,000 die. (Only 3,500
women in the United States die from HIV/AIDS each year.) HPV has also
been linked to cancer of the penis. It is estimated that 20 million
people have HPV, and 5.5 million more will contract the disease this
year. There is no cure for HPV. The disease is spread by skin-to-skin
contact anywhere from mid thigh to mid stomach. Condoms can not cover
all that area, but a wet suit will stop the spread of HPV.
Condoms also can not stop the body from releasing oxytocin during
sexual arousal. Oxytocin is a powerful hormone that creates permanent
chemical bonds linking the person to their sex partner. Oxytocin allows
men to vividly recall and mentally picture minute details of the sexual
experience. In women, it creates an unbreakable linkage and emotional
bond to their partner. Oxytocin explains why women will fight each
other on national talk shows to keep a boyfriend who is currently
sleeping with other women. It also explains why he is able to sit back,
grin and enjoy his memories while they fight. Condoms do not stop
oxytocin bonding.
Teens who are given condoms have a 20 percent pregnancy rate in
their first year of sexual activity. There is no evidence that they
will slow the spread of most STDs. Condoms cannot protect the heart
against heartache or stop teen depression and suicide linked to
teenaged sexual activity.\7\ If premarital sex causes all of these
problems and condoms do not stop many teens from becoming pregnant or
contracting diseases, why are we giving condoms away with ``safer'' sex
lessons? Why not tell the medically-accurate, factual truth that
abstinence until marriage is the best and premarital sex, even with
condoms is unhealthy?
---------------------------------------------------------------------------
\7\ ``The Troubled Journey: A Profile of American Youth'' Search
Institute, 1993. p. 8.
---------------------------------------------------------------------------
The Eighty Percent Contraception, Twenty Percent Abstinence Lie
The good news is that abstinence-until-marriage education does work
and it is being taught in more schools each year. According to the Alan
Guttmacher Institute, 35 percent of schools teach abstinence-until-
marriage programs.\8\ The children and adolescents in these programs
are not given destructive mixed messages or comprehensive sex
education, but are taught the skills necessary to remain pure until
marriage. Abstinence-until-marriage education was first given federal
money in the early 1990s. The introduction of abstinence funds and
abstinence education in schools coincided with the dramatic decreases
in the teen pregnancy and abortion rates. Some groups claim that the
decline of adolescent pregnancy and abortion was due 80 percent to
better contraceptive use and only 20 percent to abstinence. These
groups can not cite a source for these findings, as no factual,
scientific study was ever published. Instead, it appears as though the
numbers were made up and circulated on a ``talking points'' memo. A
study was done that supported abstinence as the sole cause of the
decline.
---------------------------------------------------------------------------
\8\ ``Can More Be Done? Teenage Sexual and Reproductive Behavior in
Developed Countries, Executive Summary'' The Alan Guttmacher Institute.
November 2001.
---------------------------------------------------------------------------
The Consortium of State Physicians Resource Council commissioned
the study, ``Declines in Adolescent Pregnancy, Birth and Abortion Rates
in the 1990s: What factors Are Responsible?''. The group of 11
practicing physicians reviewed studies on types and frequency of
contraceptive use by adolescents, sexual behaviors of adolescents and
adolescent pregnancy, abortion and birth rates. The papers they
reviewed came from a multitude of sources; a total of 45 articles were
cited from organizations and journals such as the CDC, JAMA and Family
Planning Perspectives.
The physicians concluded that ``the evidence points to sexual
abstinence, not increased contraceptive use, as the primary reason for
the decline in teenage pregnancy and birth rates throughout the
1990s.''\9\ Furthermore the authors found that there is a correlation
between increased condom use and higher out-of-wedlock pregnancy.
According to the studies they reviewed, abstinence-until-marriage
programs have a greater success at producing abstinence behavior than
do comprehensive sex education and mixed message programs.\9\
---------------------------------------------------------------------------
\9\ ``Declines in Adolescent Pregnancy, Birth and Abortion Rates in
the 1990s: What factors Are Responsible?'' The Consortium of State
Physicians Resource Council, January 1999.
---------------------------------------------------------------------------
Conclusion: Solve the Problem: Don't Feed It
Abstinence-until-marriage is the only 100 percent effective
protection we can give our children and adolescents against premarital
pregnancy and STDs. Let us not give them condoms and other
contraceptives, which lead to unplanned pregnancy, HIV, HPV,
heartbreak, depression and even future divorce. Let us give them a
strong, clear message that abstinence and sexual purity is what is not
only expected of them, but will also keep them healthy and happy. Let
us give them abstinence-until-marriage education.
[GRAPHIC] [TIFF OMITTED] T7054.004
National Organization on Adolescent Pregnancy,
Parenting and Prevention
Washington, DC 20037
November 28, 2001
House Ways and Means Subcommittee on Human Resources:
The National Organization on Adolescent Pregnancy, Parenting and
Prevention (NOAPPP) is a national membership nonprofit organization,
with over 20,000 constituents and members from all fifty states who
work in the field of adolescent pregnancy, parenting and prevention.
Our members are educators, health professionals, administrators, and
youth workers offering services to youth, parents and communities.
Services are offered in schools, churches, neighborhood centers,
hospitals, health facilities, and public institutions.
Our agency and our membership are dedicated to preventing teen
pregnancy, and to providing the best possible services for those
teenagers who become pregnant and who are parenting. Our goals are to
increase positive health and education outcomes for all youth so they
can reach their full potential, including those who are pregnant and
parenting, and their children.
NOAPPP's Board of Directors has recently adopted two national
policy statements that relate to Welfare Reform and Reauthorization and
specifically address the following:
1) the high correlation between childhood abuse,
interpersonal violence and teenage pregnancy, and
2) comprehensive sexuality education and abstinence
education.
Based on our experience with our constituents representing over
twenty years of work in the field of adolescent pregnancy, parenting
and prevention, NOAPPP strongly recommends that both policy statements
be considered as TANF reauthorization is being reviewed.
Thank you for the opportunity to respond.
Sincerely,
Mary Martha Wilson
Acting Executive Director
______
Policy Statement on Interpersonal Violence and Adolescent Pregnancy
Below is the policy statement of the National Organization on
Adolescent Pregnancy, Parenting and Prevention, Inc. (NOAPPP) on
interpersonal violence and adolescent pregnancy. The first section
provides broad recommendations applying to a number of different
fields. The third page has recommendations dealing solely with welfare
legislation. These recommendations emanate from NOAPPP's value
statements which, along with definitions, are described on page four.
The Policy
Interpersonal violence and adolescent pregnancy are intricately
intertwined. While no national data are available on all aspects of the
relationships between these two factors, evidence available from state
and other data suggest that:
Many adolescents are currently in violent or
coercive intimate relationships. This is particularly the case
for adolescents who become pregnant.\1\
---------------------------------------------------------------------------
\1\ Evidence from a variety of samples suggests that no fewer than
a quarter of adolescent mothers experience some form of interpersonal
violence in the year surrounding their pregnancy, with some studies
reporting rates of 50 to 80 percent (Leiderman S., Almo C.,
Interpersonal Violence and Adolescent Pregnancy. CAPD/NOAPPP, 2001).
---------------------------------------------------------------------------
Many women who become pregnant as adolescents were
violated or abused as children.\2\
---------------------------------------------------------------------------
\2\ For example, a study in the state of Washington suggests that
up to 66 percent of pregnant teens report histories of abuse (Boyer D.,
Fine D., ``Sexual Abuse as a Factor in Adolescent Pregnancy and Child
Maltreatment,'' Family Planning Perspectives, Vol. 24: 4-11, 19, 1992).
Due to the link between interpersonal violence and adolescent
pregnancy, NOAPPP makes the following recommendations.
1. NOAPPP recommends widespread efforts to inform, educate, and
train practitioners and policymakers about the nature, extent and
consequences of interpersonal violence and its links to adolescent
pregnancy.
2. NOAPPP recommends that community-wide supports and resources be
made available that incorporate links among the full range of relevant
fields (e.g., health, education, violence and violence prevention, law
enforcement and criminal justice, mental health, and child and youth
development). All supports need to be trauma-sensitive and provide non-
stigmatizing opportunities for adolescents who have experienced or are
experiencing interpersonal violence to identify themselves and seek
support.
3. NOAPPP recommends trauma-sensitive comprehensive sexuality
education that:
Includes information on the prevalence of
interpersonal violence in this country, and the different forms
that violence can take in relationships;
Includes a component on how to deal with coercive
behavior; and
Refrains from shame--and fear-based approaches as
well as abstinence-only-until-marriage for they run the risk of
re-traumatizing victims of violence.
4. NOAPPP recommends that abstinence-only-until-marriage as the
sole strategy for adolescent pregnancy prevention is inappropriate for
a number of reasons including the high levels of coercion and violence
in the lives of adolescents. Since teens' ability to choose abstinence
is often compromised, it is imperative that we give adolescents all of
the information and skills they may need to prevent pregnancy and
sexually transmitted infections.
5. NOAPPP recommends caution about promoting marriage among
adolescents because of the prevalence of interpersonal violence in the
lives of pregnant and parenting adolescents.
6. NOAPPP recommends that supports for adolescents who have
experienced interpersonal violence should balance strategies that build
on and reinforce their strengths and resiliency with strategies focused
on acknowledging and recovering from trauma and victimization.
7. NOAPPP recommends resources to reduce or eliminate interpersonal
violence in the lives of children and adolescents should be targeted to
both men and women. Further, we believe it is important to acknowledge
differences between the ways men and women experience violence in
targeted programming and practice.
8. NOAPPP recommends that changes be made in subsidized housing
programs and domestic and homeless shelters to ensure that adolescents
and their children can be placed in safe, stable and supportive
housing. Pregnant and parenting adolescents who experience
interpersonal violence need safe places to live, both in the short term
when they are in crisis and for the longer term as they parent their
children.
9. NOAPPP recommends that practitioners have access to relevant
best practices and receive training to identify typical consequences,
behaviors, and attitudes stemming from violence and abuse and link
adolescents with appropriate supports, programs, or treatment. They
will also need to have access to secondary trauma support to prevent
compassion fatigue.
Policy Recommendations Related to Welfare Reauthorization
1. NOAPPP recommends that the bonuses awarded to states that show
the greatest reductions in the rates of out-of-wedlock births should be
eliminated. This is consistent with our recommendation for caution when
promoting marriage among adolescents. Rather, we recommend these
resources be redirected to reducing rates of adolescent pregnancy
through researched-based pregnancy prevention programs, including
comprehensive sexuality education.
2. NOAPPP recommends that youth workers, eligibility workers, and
others who influence or inform teens about TANF regulations should
understand fully, publicize, and implement existing exemptions to the
minor parent living arrangement provisions in TANF. Further, NOAPPP
recommends transitional determinations of eligibility to give teens
time and opportunities to disclose information about interpersonal
violence in their lives. Safe housing must be provided that allows
parents and children to stay together (unless the minor parent is the
perpetrator of the violence).
3. NOAPPP recommends that each state and program review its
regulations and practices with respect to paternity establishment, to
make sure they are not putting adolescents at increased risk for
interpersonal violence.
4. NOAPPP recommends that states affirmatively identify pregnant
and parenting adolescents who have been victims of interpersonal
violence and may have difficulty meeting the applicable work, school,
or living arrangement requirements. For these adolescents, states need
to provide a qualified program that:
Re-establishes housing, income, transportation and
other supports;
Reinforces skills needed for school success that may
have been disrupted by interpersonal violence; and
Begins a process of healing and recovery.
NOAPPP's Related Value Statements and Definitions
NOAPPP's Board of Directors has adopted a set of seven value
statements, which articulate the core philosophical beliefs of the
organization. These value statements serve to inform the policies and
practices of the organization. Four of these seven statements have
particular relevance to the issues of interpersonal violence and
adolescent pregnancy. These four statements are as follows:
We believe that effective adolescent pregnancy,
prevention and parenting programs are comprehensive, utilize
research-based strategies, demonstrate an understanding and
respect for the rights and capabilities of adolescents, and
include a range of stakeholders in the decision-making,
implementation and evaluation processes. We further believe
that identification and evaluation of innovative strategies and
promising approaches will serve the field.
We believe that all children deserve to grow up in
safe, nurturing environments that promote their healthy
development. We further recognize the responsibility to address
the multiple needs of children of young parents. We believe
that individuals and organizations in the field must have
access to the most current information on research, best
practices, and fiscal resources, as well as professional growth
opportunities.
We believe that the involvement of families,
communities, practitioners, schools, religious institutions and
local, state, regional and national coalitions and networks is
essential in addressing the issues of adolescent pregnancy,
prevention and parenting.
Interpersonal violence (also called relationship or intimate
partner violence): while there is no standard definition, interpersonal
violence is usually defined as violent acts between individuals
including throwing an object at someone, pushing, slapping, kicking,
hitting, beating up, threatening with a weapon and using a weapon.
Interpersonal violence may also include sexual assault, sexual abuse,
stalking, psychological abuse, enforced social isolation, intimidation
and the deprivation of key resources such as food, clothing, money,
transportation or health care.\3\
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\3\ Technical Bulletin: Domestic Violence, No. 209, American
College of Obstetricians and Gynecologists.
---------------------------------------------------------------------------
Compassion fatigue: for a practitioner, cumulative feelings of
being overwhelmed, exhausted and/or unable or unwilling to continue
one's efforts to assist victims of maltreatment. Compassion fatigue is
particularly likely to occur when a practitioner cannot access the
resources to help everyone with whom he or she works, and/or when the
root causes of the maltreatment persist.
Secondary trauma: trauma experienced by a practitioner (or other
person) trying to support or treat an abuse victim. Secondary trauma
can be the result of repeated exposure to overwhelmingly painful or
graphic information (especially in high volumes) and/or from
resurfacing of one's own past abuse or trauma as a consequence of
working with others.
Trauma-sensitive: a condition of heightened awareness about the
nature, extent and consequences of violence or abuse reflected in, for
example, practitioner choices about how to work with young people,
curricula offered, incentives and sanctions built into eligibility
requirements and guidelines for programming, practitioner training, and
legislative and other policies affecting young people.
Policy Statement on Comprehensive Sexuality Education
Below is the policy statement of the National Organization on
Adolescent Pregnancy, Parenting and Prevention, Inc. (NOAPPP) on
comprehensive sexuality education. The first section provides broad
recommendations. The second section provides NOAPPP's value statements
that are related to the issues of comprehensive sexuality education,
and hence this policy statement. Definitions are provided at the end.
The Policy
With reference to NOAPPP's values, and based on currently available
evidence of the effectiveness of various strategies:
1. NOAPPP recommends and encourages the teaching of developmentally
and age-appropriate comprehensive sexuality education, as it holds the
greatest hope for reducing the risk of sexually transmitted infections
(STIs) and unintended pregnancy among adolescents.
NOAPPP believes the teaching of abstinence is an
integral part of comprehensive sexuality education.
NOAPPP supports comprehensive sexuality education
because it is research and evidenced-based, religiously
neutral, and free of fear-based and shame-based strategies.
2. NOAPPP recommends ongoing training and professional development
opportunities for those involved in teaching sexuality education
because we believe comprehensive sexuality education should be taught
by trained, qualified instructors.
3. NOAPPP encourages open communication between parents and teens
on the issues addressed by comprehensive sexuality education.
4. NOAPPP recommends that all children and youth have access to
information and clinical services that meet their age, developmental
and reproductive health needs. This is especially important for
sexually active adolescents and teen parents, for whom secondary
prevention is critical.
5. NOAPPP recommends that all adolescent pregnancy prevention
programs require high quality quantitative and qualitative evaluation
that is mandatory, not voluntary, and adequately funded at not less
than 10 percent of the project's total budget.
6. NOAPPP is concerned that many adolescents believe they are
abstinent even though they are participating in sexual behaviors which
could lead to STIs, HIV and pregnancy. For this reason, we encourage
the adoption of a common definition of abstinence which includes
refraining from the full range of sexual activity that can lead to
pregnancy, STIs or HIV transmission.
We encourage members and affiliates to use this policy to inform
the development of state, local and/or institutional policies and
standards.
NOAPPP's Related Value Statements and Definitions
The NOAPPP Board of Directors has adopted a set of seven value
statements which articulate the core philosophical beliefs of the
organization. These value statements serve to inform the policies and
practices of the organization. Five of these seven statements have
particular relevance to the issues of Comprehensive Sexuality
Education.
These five statements are as follows:
We believe youth can make responsible decisions
about sexuality, pregnancy and parenting, as well as be
effective parents when they have complete, accurate, culturally
relevant, age-, gender-, and-developmentally-appropriate
information, skills, resources and support.
We believe that effective adolescent pregnancy
prevention, pregnancy programs and parenting programs are
comprehensive, utilize research-based strategies, demonstrate
an understanding and respect for the rights and capabilities of
adolescents, and include a range of stakeholders in the
decision-making, implementation and evaluation processes. We
further believe that identification and evaluation of
innovative strategies and promising approaches will serve the
field.
We believe that both male and female partners are
equally responsible for preventing early pregnancy, as well as
supporting, nurturing and parenting their children.
We believe that individuals and organizations in the
field must have access to the most current information on
research, best practices, and fiscal resources, as well as,
professional growth opportunities.
We believe that the involvement of families,
communities, practitioners, schools, religious institutions and
local, state, regional and national coalitions and networks is
essential in addressing the issues of adolescent pregnancy,
prevention and parenting.
Comprehensive Sexuality Education: developmentally appropriate
sexuality education which provides complete, positive, accurate
information on human sexuality throughout a person's lifespan,
including, but not limited to: anatomy, human reproduction, intimate
sexual behaviors, healthy relationships, sexual risk reduction and
pregnancy prevention strategies (including abstinence and
contraception), gender roles and stereotypes.
Evidence-based: information that is supported by research,
recognized as accurate and objective by leading medical, psychological,
psychiatric, and public health organizations and agencies, and, where
relevant, published in peer-reviewed journals.
Abstinence: not engaging in any activity that puts one at risk for
sexually transmitted infections or pregnancy.
Religiously neutral: respecting all religious traditions while not
preferring or promoting any one over another.
Fear-based strategies: educational/motivational strategies that use
misinformation and exaggeration or present `worst case scenarios' as
the norm, for the purpose of scaring people from engaging in any
activity that might put one at risk for sexually transmitted infections
or pregnancy.
Shame-based strategies: educational/motivational strategies that
have the effect of shaming people for personal choices made relative to
sexual conduct and behaviors or the consequences of one's choices.
Approved by the NOAPPP Board of Directors, June 2, 2001.
New Mexico GRADS
Roswell, New Mexico 88203
November 29, 2002
To whom it may concern:
I realize there are many aspects to the re-authorization of TANF,
but I would like to address two issues that I am familiar with. I am
the pregnancy prevention coordinator for a teen parent program in New
Mexico that utilizes TANF funds to recruit teen parents who have
dropped out of school. We provide child care and services to ensure
that these teen parents graduate from High school. Our teen parents
have a much lower repeat pregnancy rate and a much higher graduation
rate than the national average for teen parents. We feel that the TANF
funds have been well utilized for these important goals, and encourage
re-authorization for these funds. I have reviewed TANF changes proposed
by Rep. Patsy Mink, and feel many changes will be beneficial EXCEPT for
the cut in incentives for pregnancy prevention.
Although non-federally funded abstinence programs began in some New
Mexico schools in 1989, The Title V program of 1996 has proven to be an
astonishing success in helping to reduce teen birth rates. After nearly
3 decades, (all through which the safe sex message prevailed) new
statistics from the National Center for Health Statistics show a 22
percent decrease in teen birth rates from 1991 to 2000! We are on the
right track and making significant progress in reducing the economic,
physical and emotional burdens of teen pregnancy. Please ensure that
these Title V funds continue this success.
Thank You,
Kathy Van Pelt
Pregnancy Prevention Coordinator
Statement of Pennsylvania Coalition to Prevent Teen Pregnancy,
Harrisburg, Pennsylvania
Supporting Documentation for Position Statements
I. Parents/guardians are the primary sexuality educators of their
children.
Strong parent/child relationships that promote open
communication about sexuality help prevent teen pregnancy.
Parents should be supported in obtaining the skills
and knowledge necessary to provide their children with clear,
accurate and developmentally appropriate information. They
should be encouraged to engage in an ongoing dialog with their
children to provide the information, skills and values they
need to grow into happy, healthy and sexually responsible
adults.
Children want their parents to talk with them about
values, relationships and sexuality.
Resources
Effects of a Parent-Child Communications Intervention on Young
Adolescents' Risk for Early Onset of Sexual Intercourse by Susan M.
Blake, Linda Simkin, Rebeccca Ledsky, Cheryl Perkins and Joseph M.
Calabrese.
Talking with Kids About Tough Issues, Children Now and the Kaiser
Family Foundation
Talking with Kids About Sex and Relationships, Children Now and the
Kaiser Family Foundation
Shop Talk, Volume 5, Issue 24, Parent-Teen Communication and the
Initiation of Sexual Intercourse, SIECUS
Ten Tips for Parents, National Campaign to Prevent Teen Pregnancy
II. Young people deserve comprehensive and accurate information about
sexuality and reproductive health.
Sexuality education is a lifelong process of acquiring information
and forming attitudes, beliefs, and values about identity,
relationships and intimacy. It encompasses sexual development,
reproductive health, interpersonal relationships, affection, intimacy,
body image and gender roles. Sexuality education addresses the
biological, sociocultural, psychological, and spiritual dimensions of
sexuality from the cognitive, affective and behavioral domain including
the skills to communicate effectively and make responsible decisions.
Sexuality education seeks to assist children in understanding a
positive view of sexuality, provide them with information and skills
about taking care of their sexual health and help them acquire skills
to make decisions now and in the future.
Sexuality education does not increase teen sexual
activity.
More than eight out of every 10 Americans believe
that, in addition to abstinence education, young people should
be given information about protecting themselves from unplanned
pregnancies and STI's.
Programs should begin early and encompass the entire
educational experience of the child.
Education should include information on both
abstinence and contraception that is medically accurate.
The most effective sexuality education programs will
increase a teen's capacity and motivation to prevent pregnancy.
Research indicates that effective curricula have the
following characteristics:
Clearly focus on reducing one or more sexual
behaviors that lead to unintended pregnancy or HIV/STI
infections
Behavioral goals, teaching methods, and
materials were appropriate to the age, sexual
experience, and culture of the students
Are base upon theoretical approaches that
have been demonstrated to be effective in influencing
other health related risky behaviors
Last a sufficient length of time to complete
important activities adequately
Employ a variety of teaching methods
designed to involve the participants had have them
personalize the information
Provide basic, accurate information about
the risks of unprotected intercourse and methods of
avoiding unprotected intercourse
Include activities that address social
pressures on sexual behaviors
Provide modeling and practice of
communication, negotiation, and refusal skills
Select teachers or peers who believe in the
program they are implementing and then provided
training for those individuals.
Resources
Effective, Comprehensive Sexuality Education by Anna Hoffman--
Advocates for Youth
Guidelines for Comprehensive Sexuality Education, National
Guidelines Task Force
Abstinence Based vs. Abstinence Only Sexuality Education, New
Mexico Teen Pregnancy Coalition
Support for Comprehensive Sexuality Education Reaches Highest
Level, Advocates for Youth & SIECUS
Abstinence Plus, Editorial, Philadelphia Inquirer, January 7, 2001
Sexuality Education: Our Current Status, and an Agenda for 2010 by
Susan Wilson, Family Planning Perspectives
Sex Education: Politicians, Parents, Teachers and Teens, The
Guttmacher Report on Public Policy
Changing Emphases in Sexuality Education in U.S. Public Secondary
Schools, 1988-1999 by Jacqueline E. Darroch, David J. Landry and
Susheela Singh, Family Planning Perspectives
9 of 10 Minnesotans Support Sexuality Education in Schools, Press
Release, MOAPPP
Tune In--New Mexico Attitudes on Sex Education, New Mexico Teen
Pregnancy Coalition
Teach Abstinence: Not IF, But HOW!, Family Life Matters, review of
conference by Network for Family Life Education
No Easy Answers by Douglas Kirby, Ph.D.
Consensus Statement on Adolescent Sexual Health, National
Commission on Adolescent Sexual Health
Fact Sheet: The Next Best Thing: Encouraging Contraceptive Use
Among Sexually Active Teens, National Campaign to Prevent Teen
Pregnancy
Teenage Sexual and Reproductive Behavior in the United States,
Kaiser Family Foundation
Myth or Fact? 1998 Kaiser Family Foundation Survey of Americans'
Knowledge on Teen Sexual Activity and Pregnancy
Abstinence Only Education: Why First Amendment Supporters Should
Oppose It, National Coalition Against Censorship
III. Policy and program development addressing teen pregnancy
prevention should be based on current research and proven
strategies.
The experiences of developing countries, the experience of the
United States during the mid-1950's to the mid-1970's, and the results
from a small number of evaluations of youth development programs all
suggest that programs that focus upon education, employment, and life
options for young people may markedly reduce adolescent pregnancy
rates. Pregnancy prevention initiatives must have multiple effective
components that address both adolescent sexual behavior as well as the
other contributors to teen pregnancy including poverty, lack of
opportunity, family dysfunction, as well as social disorganization.
Having a scientific basis for an approach shifts the
focus from opinions about the best way to prevent teen
pregnancy or about the consequences of taking a particular
action toward the firmer ground of facts and validated
experiences
We support gathering information about youth
behavior from the youth themselves with instruments such as the
Center for Disease Control's Youth Risk Behavior Survey
Research has shown that teens need a wide variety of
preventive strategies to choose healthy options to avoid
pregnancy
Research indicates that evaluated programs that have
been found effective have common characteristics:
Information about abstinence and
contraception
Theoretical basis that emphasizes skill
building
Focus on active learning through
experiential activities
Acknowledgment of social and media influence
on behavior
Age appropriate information and activities
Developmentally appropriate information and
activities
Culturally appropriate messages
Exploration of personal values and feelings
Training for those implementing programs
We can learn from other industrialized nations who
have been more successful in preventing pregnancies, abortions
and births among teens.
Resources
No Easy Answers by Douglas Kirby, Ph.D.
Effective Comprehensive Sexuality Education, by Anna Hoffman,
Advocates for Youth
Solutions: Getting Real About Teen Pregnancy, Communications
Sciences Group
Start Early, Stay Late: Linking Youth Development and Teen
Pregnancy Prevention, National Campaign to Prevent Teen Pregnancy
Fact Sheet: The Next Best Thing: Encouraging Contraceptive Use
Among Sexually Active Teens, National Campaign to Prevent Teen
Pregnancy
Teens on Sex: What They Say About the Media as an Information
Source
Adolescent Sexual Health in Europe and the U.S.--Why the
Difference? By Sue Alford and Ammie Feijoo, Advocates for Youth
Campaign Prospectus: Enlisting the Help of the Media to Reduce Teen
Pregnancy, National Campaign to Prevent Teen Pregnancy
Can the Mass Media be Healthy Sex Educators? By Jane D. Brown and
Sarah N. Keller
IV. Young people should have access to safe and confidential sexual and
reproductive health care.
Our first priority should always be to encourage
teens to delay sexual activity. However, no matter how much
encouragement we give to youth to say ``no'', many will still
become sexually active
We support the Pennsylvania law that ensures
confidentiality to teens seeking pregnancy testing,
contraceptive services and diagnosis and treatment of STI's
Between 85-95 percent of sexually active adolescent
females who use no birth control method become pregnant within
one year of initiating intercourse.
Resources
Adolescent Access to Confidential Health Services by John
Loxterman, J.D., Advocates for Youth
Family Planning/Population Reporter, Vol. 6 No. 4
Family Planning and Adolescent Services, Family Health Council of
Central Pennsylvania
Issues in Brief: Minors and the Right to Consent to Health Care,
Alan Guttmacher Institute
Contraception Counts: Pennsylvania Information, Alan Guttmacher
Institute
State Policies in Brief: Minors' Access to Contraceptive Services,
Alan Guttmacher Institute
Serving Minors: Legal Guidance for Family Planning Providers by
Susan Frietsche, M. Robin Maddox
Fact Sheet: The Next Best Thing: Encouraging Contraceptive Use
Among Sexually Active Teens, National Campaign to Prevent Teen
Pregnancy
The States in 1999: Actions on Major Reproductive Health Related
Issues by Adam Sonfield, Anjali Dalal and Elizabeth Nash
V. The promotion of a culture that recognizes sexuality as normal and
promotes respect and responsibility will lead to a reduction in
negative consequences of sexual behaviors.
Recognize that all persons are sexual and that
sexuality is a natural, healthy part of living
Model healthy sexual attitudes and behaviors
Take responsibility for our actions
Demonstrate respect and tolerance for others
Teach that sexual relationships should never be
coerced or exploitive
Reject stereotypes about the sexuality of diverse
populations
Promote the rights of all people to accurate
sexuality information
Promote the development of healthy, non-sexual
relationships.
Resources
Adolescent Sexual Health in Europe and the U.S.--Why the
Difference? By Sue Alford and Ammie Feijoo, Advocates for Youth
Talking with Kids About Sex and Relationships, Children Now and the
Kaiser Family Foundation
How to Talk To Your Kids About Anything, Children Now and the
Kaiser Family Foundation
Ten Tips for Parents, National Campaign to Prevent Teen Pregnancy
Consensus Statement on Adolescent Sexual Health, National
Commission on Adolescent Sexual Health
Reconceptualizing Adolescent Sexual Behavior: Beyond Did They or
Didn't They? By Daniel J. Whitaker, Kim S. Miller and Leslie F. Clark
VI. Pregnant and parenting teens should have access to quality health
care, education, and support services, with the main goal of
promoting health and preventing repeat teen pregnancies.
All new parents are tested both financially and emotionally when
their first child is born. For teen parents, the stresses are
proportionately greater because they have not had the time to become
fully independent adults. Teenage parents often experience inequity in
education and encounter discrimination when they seek housing and jobs.
Teenagers with children face a greater risk of not completing high
school or finding the resources to pursue a college degree. More often
than not, these young adults must nurture their children while living
in poverty or on the edge of poverty.
Repeat births to teenagers carry high individual and
societal costs
One-third of pregnant teens receive inadequate
prenatal care; babies born to young mothers are more likely to
be low birth weight, to have childhood health problems and to
be hospitalized than are those born to older mothers
In 1997, 1 of every 6 (17 percent) adolescents had
no health coverage
50 percent of adolescents who have a baby become
pregnant again within two years of the baby's birth
In 1996, 22 percent of all births to 15-19 year old
women in the U.S. were repeat births
Households begun by teens account for 44 percent of
the welfare caseload and over half of all welfare expenditures
go to families started by a teen birth
The federal government spends approximately $38
billion a year to families that began with a teen birth and
invests only $138 million a year in preventing teen pregnancy
Repeat childbearing is common in all race and ethnic
groups
Resources
Why Invest in Teen Parents, Alliance for Young Families
Sex and America's Teenagers, Alan Guttmacher Institute
Facts prepared by Dr. Marianne E. Felice, UMASS, for Campaign for
our Children, Inc.
Centers for Disease Control Fact Book 2000-2001
Births and Deaths in the United Sates, S. J. Ventura, K. D. Peters,
J. A. Martin & J. D. Maurer, National Center for Health Statistics
Teen Pregnancy and Parenting Issues in Pennsylvania by Anastasia
Snyder
Cost Study, Advocates for Youth
Statement of Kathleen M. Sullivan, Director, Project Reality, Glenview,
Illinois
Project Reality, a 501(c)(3) not-for-profit organization, though
not funded by any federal agency, is one of the largest abstinence
education providers in the country. The attached annual Illinois
Project Schools Report illustrates how we served 52,000 students in 350
schools in Illinois during the 2000-2001 school year. Our programs are
a remarkably cost-effective approach to teaching abstinence until
marriage as the healthiest lifestyle choice for adolescents, thus not
only addressing the teen out-of-wedlock pregnancy problem but the
emotional and medical problems associated with adolescent sexual
activity.
Our successful experience in Illinois over the last 16 years is now
beginning to be replicated in many other states as a result of the
funding provided by Title V block grants through The Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.
104-193). Reauthorization of this provision, and a substantial increase
in the appropriation for it, would be THE most cost effective approach
to ensuring the emotional and physical health of our young people
across the nation.
Statement of Project Reality, Glenview, Illinois
Illinois Project Schools Report 2000-2001
Project Reality, a 501(c)(3) not-for-profit organization, has been
a pioneer in the national field of adolescent health education,
developing, teaching and evaluating abstinence-centered programs in the
public schools since 1985. Project Reality has administered three
divisions for more than a decade under a grant funded by the State of
Illinois Department of Human Services. Two divisions have sites
throughout the state. The third is concentrated in the City of Chicago.
In addition to abstinence curricula and related materials, in-service
teacher training seminars are provided for all participating schools,
as well as a variety of motivational speakers for school assemblies.
During the 2000-2001 school year, Project Reality conducted five
REALITY CHECK rallies in four high schools in the Chicago area and 32
school assemblies and presentations throughout the state. These
inspiring and educating events reached 16,535 teens and 225 parents
with an exciting reinforcement of the instructional program we provide
in their schools.
In May 2001, Project Reality published and introduced an exciting
and innovative new abstinence text A. C. Green's GAME PLAN Abstinence
Program developed in conjunction with NBA ``Ironman'' A. C. Green.
The three divisions and a brief description are as follows:
Middle School Division, Statewide, Grades 6-10
Eight-unit series with strong medical emphasis. Values-based,
abstinence-focused curricula that gives teens the information and
training they need to discover for themselves that abstinence until
marriage is the ``best choice'' and helps them reduce at-risk sexual
behavior. Includes student workbooks and teacher manuals.
In 2000-2001, served 32,480 students in 217 schools
Senior High School Division, Statewide, Grades 10-12
A 15-unit program emphasizing the abstinence concept as the
healthiest way of living. By stressing the composite approach of saying
``No'' to pre-marital sexual activity, drugs and alcohol, young people
learn that maturity is learning how to think of others rather than self
and to set long-range goals instead of indulging in immediate pleasure.
Includes both a student workbook and a parent/teacher manual.
In 2000-2001, served 4,335 students in 33 schools
Chicago Division (Southwest Parents Committee), Grades 7-11
A two-part series presented by a seven-member team whose
credentials include medical, educational and bilingual training. The
presentations explain the emotional as well as physical benefits for
adolescents who choose abstinence until marriage as ``the healthiest
lifestyle.'' Each session includes lively discussions, role-playing,
and question and answer periods. Separate presentations for parents are
provided.
In 2000-2001, served 11,064 students and 961 parents in 99 schools
Statement of REACH (Responsibility Education for Abstinence, Character
& Health), Arcanum, Ohio
I am writing in support of the reauthorization of federal funding
for abstinence education under Title V of the Welfare Reform Act. I
write primarily as a concerned parent of two (soon to be 3) teenagers.
I want to protect our children from the heartache, regret, and physical
consequences of premarital sexual activity. As parents, we want to
inform and inspire our children to commit to sexual abstinence until
marriage and avoid risk behaviors in general.
That too, is the guiding principle for the organization I direct.
R.E.A.C.H. is a non-profit organization founded by a group of concerned
parents and professionals. We are also current recipients of Title V
Abstinence Education Funding in Ohio. Our purpose is two-fold--to help
parents, schools, and the community in promoting:
1) Character Education in children through education and the
practical application of such basic principles as honesty, self-
discipline, patience and respect for self and others. Strong character
is the foundation for ethical and wise behavior. Our society has
changed--even since we were young. Too often, self-sacrifice has been
replaced by self-absorption, patience for immediate gratification,
honesty for deception. We are experiencing a crisis of character in our
nation, which is showing itself in a variety of irresponsible acts
(violence, inappropriate sex, drug/alcohol abuse, etc). It is our
character that determines our behavior. It's who we are when no one is
looking. Character is the internal motivation demonstrated by our
outward conduct. Character education says ``You do not have the right
to do wrong''. It places personal responsibility and self control
within the definition of freedom. It teaches and reinforces universal
core ethical virtues within the context of family and community.
2) Character-Based Abstinence Until Marriage Education as the only
safe and wise choice--physically, emotionally and socially. With the
incidence of sexually transmitted diseases among teens reaching
epidemic proportion, contraceptive education is NOT a medically safe
solution to the problem. We must challenge youth to the higher standard
of risk elimination (abstinence), not merely risk reduction
(contraceptive education). R.E.A.CH is committed to help teens choose
the healthy choice of character-based pre-marital abstinence. With the
onslaught of messages from our sex-saturated society, youth often
believe the lie that ``everybody's doing it'', when in actuality,
everybody is NOT doing it. Recent research shows that teens want to
hear a clear message of abstinence from parents and adults. Abstinence-
until-marriage education gives youth the skills, knowledge, and
motivation to say ``no'' to risky behavior, guilt, STDs and instant
gratification and ``yes'' to future goals, self-control, self respect,
and faithfulness within marriage.
REACH is in the midst of its third year of program services to
Ohio. Funded under Title V, with the Darke County Educational Service
Center as our fiscal agent, we serve both Darke & Preble Counties in
Ohio. The community collaboration has increased each year as citizens,
schools, and agencies recognize the value of character-based abstinence
education. Until funding under Title V was approved, the rural counties
we serve did not receive any comprehensive abstinence education. Today,
however, we provide valuable services to every school in these two
counties. REACH seeks to saturate both counties with the motivational
and educational components of character and abstinence until marriage
education, involving those sectors of society that exert the greatest
influence over youth's lives: parents, schools, churches, peers, health
care providers, and the media. Utilizing both knowledge and ideas of
traditional and grassroots innovations, the goal remains to reduce
sexual activity, pregnancy and birth rates among unmarried teens. This
past year (2000-01), REACH served 21,465 students and adults.
As is true of all risk behaviors, premarital sexual activity is a
symptom of a much deeper concern involving the character choices of
that individual. Learning and internalizing the character strengths of
self-control greatly decrease the onset of sexual activity. Primary and
secondary risk prevention focus on skills and character asset building.
Schools teach character based abstinence education in an age
appropriate manner. Grades K-6 focus on foundational character
education, with grades 7-12 building on character foundations for
abstinence education. Character education, coupled with the social,
psychological, economic and medical benefits for choosing premarital
abstinence, help teens avoid risk behavior in favor of self sufficiency
and the attainment of life goals. The choice of renewed virginity is
discussed and offered as a valid choice for those who are already
sexually active. Stress is given to the fact that, while we can't
change what happened yesterday, we can decide what we do tomorrow.
Additionally, abstinence commitment cards are used as an integral part
of the REACH program. Studies confirm that those teens who make a
pledge to abstinence until marriage--are much more likely to wait
before becoming sexually active.
Professional training seminars give teachers, social workers,
medical professionals, community youth advisors, peer leaders and
parents workable strategies for steering youth toward a new or renewed
commitment for abstinence.
Parent proficiency is a vital component of all REACH services. We
focus on providing parenting information related to character training
and abstinence education for parents to use with their own children.
Media awareness sets the stage for requests for services and for
raising the awareness of the need for parent involvement in developing
assets in youth.
Each component is statistically evaluated using pre/post testing,
exit surveys, and process evaluations. Special effort is made to
appraise the success in reaching those members of the community who
most need the character based abstinence message. Analysis of teen
birth rates and STD rates are be used to measure project success. Since
REACH began service provision, birth rates have decreased in the
counties we serve.
Abstinence funding under Title V has made the difference in the
quality of the message and the content of the teaching in our schools.
In addition to the process results measured in terms of increased
exposure to character-based abstinence content, children and youth in
Darke and Preble counties in Ohio are sharing measurable changes in
attitudes and reported behavior. We hired an independent team to
evaluate the success of the REACH program for character based
abstinence education. Consider these results:
50 percent of students surveyed made new abstinence
until marriage pledges as a result of REACH services.
The percentage of students seeing lots of benefits
to waiting for sex until marriage increased significantly,
girls feeling more strongly than boys in pre/post testing (54.5
percent to 62 percent) (p. 01)
The percentage of students disagreeing that sex is
okay if the partners agreed increased significantly, girls
being influenced more than boys, and younger students believing
more strongly in abstinence (55.7 percent to 63.8 percent
girls)
Both males and females said they will wait for
marriage to have sex, girls and younger students believing more
strongly
The majority of students stated positive reactions
to the REACH program (56 percent rated excellent or good) (58
percent claimed it helped in their commitment to abstinence)
Parents in our service area almost universally
support the ``abstinence until marriage'' practice for their
children (phone survey--90 percent)
Responses to motivational speakers supporting
abstinence until marriage was overwhelmingly positive. Over
sixty (60) percent stated commitment for abstinence, forty-five
(45) percent indicated that as a result of REACH services, they
were going to make positive changes in their personal lives,
and over thirty (30) percent said they would start respecting
those they date. Once again, females and younger students
responded more positively.
The charts that follow visually demonstrate the positive results of
abstinence until marriage education:
[GRAPHIC] [TIFF OMITTED] T7054.003
A COMPARISON OF STRATEGIES FOR ADDRESSING TEENAGE SEXUAL ACTIVITY
----------------------------------------------------------------------------------------------------------------
Risk elimination Risk reduction
----------------------------------------------------------------------------------------------------------------
Common name.......................... ``Abstinence Until Marriage''.... ``Safer Sex''.
Success indicator.................... Reserve sexual activity for Increase usage of condoms.
marriage.
Effectiveness in the reduction of out 100 percent effectiveness (no Up to 24 percent of teens relying on
of wedlock pregnancy/birth. sexual activity=no pregnancy). condoms become pregnant in the first
``Abstinence and decreased year of use.\2\
sexual activity among sexually Furthermore, ``out of wedlock
active adolescents are primarily birthrate among sexually experienced
responsible for he decline and sexually active female teens has
during the 1990's in adolescent increased since 1988, despite a
pregnancy, birth and abortion significant increase in condom use by
rates.'' \1\. this cohort''.\3\
Effectiveness in the prevention of If two virgins marry each other Condom usage provides no risk
STDs (sexually transmitted diseases). and remain faithful, no STDs elimination for any sexually
will be transmitted.\4\. transmitted disease. There is,
however, an 85 percent risk reduction
for HIV, as well as some risk
reduction for gonorrhea for men. This
effectiveness however is only noted
when condoms are used correctly and
consistently--100 percent of the
time. There is no condom protection
for the sexual transmission of HPV,
one of the most common STDs and the
cause of 99 percent of cervical
cancer, a cancer causing the death of
almost 5000 American women a year
(more women than die of AIDS). No
effectiveness has been demonstrated
in the effectiveness of condoms
against five other STDs (chlamydia;
syphilis, chancroid, trichomoniasis,
genital herpes).\5\
Effectiveness in the delay of onset Those who made a pledge for Earlier sexual debut translates into
of sexual activity before marriage. abstinence delayed sex 1 to 2 more lifetime sexual partners and a
years longer than their consequential increased risk of
peers.\6\ Teens who personally acquiring an STD Students in Sweden
commit to abstinence until (a country held as a model for
marriage delay sex significantly comprehensive sex education) are
compared to those who don't.\7\. beginning sexual activity at earlier
and earlier ages, even though
contraceptives are easily accessible
to all.. Although these findings
can't necessarily be generalized, the
results are noteworthy.\8\
Funding for each strategy............ $50 million per yr for 5 years $700 million per year.\10\
\9\.
----------------------------------------------------------------------------------------------------------------
\1\ ``The Declines in Adolescent Pregnancy, Birth and Abortion Rates in the 1990s: What Factors Are
Responsible'', Consortium of State Physicians Resource Councils, January 1999. \2\ Fu H, Darroch JE, Haas T
and N Ranjit N. ``Contraceptive Failure Rates: New Estimates from the 1995 National Survey of Family Growth''
Family Planning Perspectives, 1999, 31 (2):56-63. \3\ ``The Declines in Adolescent Pregnancy, Birth and
Abortion Rates in the 1990s: What Factors Are Responsible'', Consortium of State Physicians Resource Councils,
January 1999. \4\ C. Everett Koop, MD, former US Surgeon General: ``When you have sex with someone, you are
having sex with everyone they have had sex with for the last ten years, and everyone they and their partners
have had sex with for the last ten years.'' \5\ (National Institutes of Health report: ``Scientific
Evidence on Condom Effectiveness for STD Prevention'', June 12,13, 2000). \6\ Beerman, P., Bruckner, H..
''Promising the Future: Virginity Pledges as they affect the Transition toFirst Intercourse'' American Journal
of Sociology, Jan. 2001. \7\ National Institutes of Health News Release, ``Virginity Pledge Helps Teens
Delay Sexual Activity'' January 4, 2001. \8\ Forsberg, Margareta, ``Adolescent Sexuality in Sweden--A
research review 2000'', Swedish National Institute of Public Health). \9\ Section 510 of Title V,
Abstinence Education Funding of the Welfare Reform Act of 1996. \10\ Scott Evertz.
Abstinence education raises the bar of expectations for young
people by challenging them to choose abstinence until marriage, while
other programs only focus on pregnancy prevention and reducing the teen
birth rate. Far from being a `just say no' model, abstinence education
focuses on the whole person--physically, emotionally, socially--
encouraging them to set future goals and make good decisions related to
all life choices, not the least of which is a commitment to abstinence.
A choice for abstinence is really about saying, ``yes'' to the rest of
your life. Any successful society relies on the very strengths that are
built in abstinence education, for life achievements are gained by
exchanging self gratification for consideration of others; instant
satisfaction for self control. Strengthening and developing character
is an integral component, since responsibility, respect, and self worth
are all tied to the choice of premarital abstinence. Abstinence
education teaches resistance skills, resiliency strengths and asset
building techniques. It encourages and equips parents to take an active
role in teaching their children the value of abstinence, since the
abstinence paradigm believes that parents should be the primary sex
educators of their children. The wisest usage of taxpayer money
includes abstinence education. Abstinence education only costs about
$25 per person. Each teen who chooses abstinence rather than sexual
activity will save taxpayers much more than that 25-dollar investment.
Every teen who doesn't get pregnant--because they choose abstinence,
saves taxpayers a minimum of $14,000 each year. Each teen that doesn't
get an STD because they choose abstinence saves taxpayers a minimum of
$400 in basic STD treatment each year. That's quite a return on
investment! $25 investment for a savings of about $15,000 per student!
Beyond a strictly financial savings, however, don't we want to
encourage our next generation to choose the best future for themselves,
and their children? Study after study agrees that children born within
marriage stand a better chance for future success and parents who are
married are more financially secure--allowing them to build a good nest
for their babies--and reducing the burden on taxpayers for financial
support.
For too long, we adults have not believed that teens have the self
control and character strength to wait on sex. We have encouraged
behavior that is not safe, adding, ``make sure you use a condom.''
Abstinence education raises the bar of expectations for our youth.
Abstinence education says, ``You have value; you have potential; you
have the capacity to make the healthiest decisions for your life--
saving sex for marriage'' and then we provide the skills and
encouragement to do just that.
Abstinence Education isn't ``just say no'' education. It's so much
more comprehensive and positive than that. It helps children develop
character so they have the inner strength and drive to make good
choices, not only in the area of sexual activity, but in many life
decisions. Abstinence Education is effective. Consider sample comments
we received after being in schools in Darke & Preble Counties: ``Before
(you came), I was thinking of committing suicide . . . but after
(wards), I realized that I have a whole life ahead of me,'' and
another, ``You were an inspiration. You made me think twice about my
future decisions. I'm glad you came'' and yet another, ``I thought
about sex and doing it, but now I'm going to save myself'', and
finally, ``I found it the most impacting presentation I've seen since I
began attending school''.
For the many reasons stated above, I encourage you to continue
funding for abstinence education. Compared to the numerous federal
dollars going toward family planning, the funding for abstinence
education is negligible. In the interest of health for our children, I
encourage funding reauthorization for abstinence education at an amount
that reaches parity with family planning dollars. If you desire any
additional information about the success of abstinence education in our
state, I would be happy to supply it.
Please help us impact the next generation for health, and success
by funding abstinence education, Thank you.
Statement of William (Bill) Wood, Charlotte, North Carolina
In my spare time, I volunteer to help families and children in the
State of North Carolina and around the country. I am a principal
custodian of a 10 year-old girl and this statement does not necessarily
represent the views, or the opinions of any other group or individual
other than me.
Forward
For the first time in American History, we stand at the edge of a
cliff, facing the almost certain possibility of falling off the edge if
we do not act swiftly, decidedly, and with certainty. This precarious
position is not from outside terrorist attacks, though certainly the
infamy of the horrible atrocity of September 11th will never be
forgotten; this precarious position is one where we stand directly at
the crossroads of creating the self-sustained internal destruction of
our country by the rising tide of illegitimacy, now exceeding ONE-THIRD
of all child births \1\ coupled with the directly related problem of
divorces affecting 50 percent of marriages.
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\1\ National Center for Health Statistics, 1999.
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It is imperative that our legislators and all Federal and State
elected representatives take swift, decisive, and certain actions to
shore up marriage, and to immediately stem the tide of divorce.
Otherwise, just as the Titanic sunk to the bottom of the ocean with a
relatively small breach in its hull, so America faces the very real
possibility of becoming a footnote to a once great Nation in future
history books.
This paper is for the millions of voiceless children represented by
this issue who are not able to offer their own testimony. It is not
meant to be more child centered propaganda by special interests
claiming to represent children. Yet these special interests somehow
routinely miss the mountains and volumes of social studies data proving
that their ``deadbeat'' special interest policies joined with
``deadbeat'' government actions are the direct cause of the suffering
of those children. Both the unwed teen mothers, and the children of
those mothers alike suffer from these ``deadbeat'' special interests.
Introduction--Roots must be identified
I am particularly partial to a quote by American Author Henry David
Thoreau (1817-1862), where he says;
There are a thousand hacking at the branches of evil to one
who is striking at the root.
We can easily spend a lifetime ``hacking at the branches'' of
illegitimacy, but until we begin to ``strik[e] at the root,'' the
problem will persist and will continue to grow worse. Getting close to
``the root'' requires that we look at what illegitimacy is in order to
understand how to change it.
illegitimacy--The state or condition of a child born outside
a lawful marriage.--Also termed bastardy.\2\
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\2\ Black's Law Dictionary. Abridged Seventh Edition, pg 598. West
Group (2000)
Illegitimacy by its very definition and meaning is narrowly defined
as a condition of childbirth outside of marriage. Therefore, any
discussion, program, and issue that is intended to deal with
illegitimacy must address marriage (and conversely divorce) or it does
not deal with the roots of illegitimacy. For some special interests,
the subjects of marriage and divorce are particularly charged with a
tremendous amount of acrimony and hatred for anyone daring to suggest
that marriage must be promoted and divorce must be curtailed.
The Tide on Teen Pregnancy--our modern mess
Single motherhood, once lauded by the feminist icon ``Murphy
Brown,'' has thoroughly produced its cultural ``poisoned fruit''
(Candace Bergen and the feminists attacked then Vice President Dan
Quayle for his support of the traditional family.\3\ Though Dan
Quayle's support of the traditional family was derided, his warning was
quite prophetic in hindsight. Recently this issue was revisited by The
Wall Street Journal;
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\3\ June 1992, Vice President Dan Quayle criticized the TV show
Murphy Brown for promoting single motherhood. Chaos ensued and he was
incessantly ridiculed by Hollywood and the media. Candace Bergen wins
an Emmy for her portrayal of Murphy Brown and begins another career
giving commencement speeches on University campuses. [Author
commentary] With the complete absorption of feminist, anti-family,
anti-father philosophy so deeply entrenched in Hollywood, the media,
and gaining a stranglehold over the courts, is it any wonder that
families are being destroyed, children are suffering, and our culture
is decaying?
[I]n the years since Mr. Quayle first raised the issue in his
``Murphy Brown'' speech, the number of single-mother families
has grown by 25 percent, to 7.5 million. And though there has
been some good news--teen pregnancies have leveled off, as has
the African-American illegitimacy rate--the levels remain quite
high.
Indeed, by almost any measure (the likelihood of teenage
pregnancy, of going to prison, of dropping out of school, of
taking drugs) the risks escalate dramatically for those who
grow up without a biological father in the home.
National Center for Health Statistics reports that today nearly
seven out of 10 African-American children are illegitimate--
with the rates for Hispanics and non-Hispanic whites having
risen, respectively, to 42 percent and 22 percent. Clearly this
problem crosses racial barriers.\4\
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\4\ The Dad Deficit. Dan Quayle was still right. June 15, 2001. The
Wall Street Journal.
Putting those numbers in human terms, we are approaching 7 out of
10 African-American children being born outside of marriage, just over
2 out of 5 Hispanics, and just over 1 out of 5 Caucasians. The raw
numbers and huge percentage of illegitimate births is frightening. For
---------------------------------------------------------------------------
example, according the a recent Washington Times article;
A record 1.3 million babies were born out of wedlock in 1999,
marking the first time that a full one-third of all U.S. births
were to unwed mothers, the federal government said yesterday.
The greatest failure of welfare reform is that the governors
have grievously neglected the issue of marriage[,]. . . adding
that only four governors, including President Bush during his
the governorship of Texas, have promoted marriage in any way.
The sole reason that welfare exists is the collapse of
marriage--it is a huge national tragedy that this country
spends $1,000 subsidizing single parenthood for every $1 it
spends trying to promote marriage and prevent illegitimacy.\5\
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\5\ Unwed mothers set a record for births by Cheryl Wetzstein. The
Washington Times. April 18, 2001.
With Illegitimacy rates around 70 percent in the African-American
community, where is the outrage, the demands, and the demonstrations by
the Black Caucus or its leaders? If they will not represent the
African-American Community then who will? What of the Hispanic
leadership? The consequences of continued silence on these issues is
frightening and devastating for their constituency.
What Social Science tells us about some of the causes of Illegitimacy
White teenage girls in 1988, without fathers at home, were 72
percent more likely than their father-present peers to become single
mothers, while there was a 100 percent increase for black teenage
girls,\6\ other studies also reported up to a 600 percent increase in
teenage illegitimate births.\7\ In contrast, more involved fathers
protect girls from engaging in first sex, lower the risk of using
illicit substances, and also reduce the risk of violent behavior.'' \8\
This protection ``from engaging in first sex,'' or promoting
abstinence, is the most certain way to reduce teenage pregnancy.
Father-absence in teenage boys creates a 77 percent \9\ to 100 percent
\10\ increase in the overall likelihood of fathering an illegitimate
child and therefore, as the research has shown, perpetuating the
father-absence cycle for another generation (or generations to come).
Father-absence causes difficulty for girls in building a stable family
in adulthood.\11\ Teenage girls run a 92 percent greater risk of
continuing the divorce cycle.\12\ Fast forward to 1999 data and 71
percent of pregnant teenagers lack a father.\13\
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\6\ S. McLanahan. Demography 25, Feb. 1988, p. 1-16.
\7\ Y. Matsuhashi et al. (1988). J Adolescent Health Care 10, 409-
412.
\8\ K. Harris et al. Paternal involvement with adolescents in
intact families: The influence of fathers over the life course,
presented at the annual meeting of the Am. Sociol. Assoc., New York,
N.Y., August 16-20, 1996; Univ. of North Carolina at Chapel Hill,
Chapel Hill, N.C., 27516, p. 28.
\9\ W. Marsiglio Family Planning Perspective 19 Nov/Dec, 1987, 240-
251.
\10\ B. Christensen. The Family in America. Vol 3, no. 4 [April
1989], p.3.
\11\ S McLanahan, L Bumpass. (July, 1988). Am J Sociol, 4, 130-152.
\12\ Warren Farrell presentation at NCMC conference, 1992
\13\ U.S. Dept. of Health & Human Services press release, Friday,
March 26, 1999
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How can the tide of illegitimacy be stemmed without addressing
underlying issues such as ``[d]aughters in single mother homes hav[ing]
more negative attitudes toward men in general and their fathers in
particular.'' \14\ Or, ``girls whose parents divorce may grow up
without the day to day experience of interacting with a man who is
attentive, caring and loving. The continuous sense of being valued and
loved as a female seems an especially key element in the development of
the conviction that one is indeed femininely lovable. Without this
regular source of nourishment, a girl's sense of being valued as a
female does not seem to thrive.'' \15\ And another study ``suggest[s]
that father loss through divorce is associated with diminished self-
concepts in children . . . at least for this sample of children from
the midwestern United States.'' \16\
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\14\ Brody and Forehand, Journal of Applied Psychology, 1990
\15\ Kalter, American Journal of Orthopsychiatry, 1987
\16\ Children's Self Concepts: Are They Affected by Parental
Divorce and Remarriage Thomas S. Parish, Journal of Social Behavior and
Personality, 1987
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The trend of illegitimacy requires the presence of a father in the
daily lives of children. It is not just ``participation'' of a father
in the lives of children. It is primarily the ``presence'' of a father:
``The decline of fatherhood is a major force behind many of
the most disturbing problems that plague America: crime and
juvenile delinquency; premature sexuality and out-of-wedlock
births to teenagers; deteriorating educational achievement;
depression, substance abuse, and alienation among adolescents;
and the growing number of women and children in poverty . . .
Fathers are the first and most important men in the lives of
girls. They provide role models, accustoming their daughters to
male-female relationships. Engaged and responsive fathers play
with their daughters and guide them into challenging
activities. They protect them, providing them with a sense of
physical and emotional security. Girls with adequate fathering
are more able, as they grow older, to develop constructive
heterosexual relationships based on trust and intimacy. . .
Why does living without a father pose such hazards for
children? Two explanations are usually given: The children
receive less supervision and protection from men mothers bring
home, and they are also more emotionally deprived, which leaves
them vulnerable to sexual abusers . . . Even a diligent absent
father can't supervise or protect his children the way a live-
in father can. Nor is he likely to have the kind of
relationship with his daughter that is usually needed to give
her a foundation of emotional security and a model for
nonsexual relationships with men . . . \17\
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\17\ D. Popenoe. ``Life without father.'' In: C. Daniels, ed. Lost
fathers: The Politics of Fatherlessness in America. (New York: St.
Martin's Press, 1998).
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``Fathers who actively engage in joint activities and
interaction with adolescents promote their educational and
economic achievement and fathers who maintain a close stable
emotional bond with adolescents over time protect adolescents
from engaging in delinquent behaviors.'' \18\
---------------------------------------------------------------------------
\18\ H. Biller, Paternal Deprivation: Family, School, Sexuality,
and Society (Lexington, Mass.: D.C. Heath, 1974), p.114.
Additional information about the impact of father involvement shows
they ``play a significant role in terms of adolescent functioning''
\19\ ``teach them values,'' \20\ and ``[enhance] their career
development, moral development, and sex role identification.'' \21\
``The continuing involvement of divorced fathers in families where
mothers maintain physical custody has become recognized as an important
mediating factor in the adjustment and well-being of children of
divorce'' \22\ and ``frequent contact with the father is associated
with positive adjustment of the children.'' \23\ ``[A fathers]
involvement with children diminishes some of the negative consequences
of living with a single mother''.\24\
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\19\ Thomas and Forehand, American Journal of Othopsychiatry, 1994
\20\ Seltzer, Journal of Marriage and the Family, 1991
\21\ Dudley, Family Relations, 1991
\22\ Ahrons, and Miller, American Journal of Orthopsychiatry, 1993
\23\ Ibid. Ahrons and Miller
\24\ Seltzer, Shaeffer & Charing, Journal of Marriage & the Family,
1989
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Jonetta Rose Barras, a Washington D.C. columnist, in her recent
book,\25\ describes the lasting impact of fatherlessness on her and
other women.
---------------------------------------------------------------------------
\25\Jonetta Rose Barras. Whatever Happened to Daddy's Little Girl?:
The Impact of Fatherlessness on Black Women. One World Ballantine
(2000). As noted by the author of ``http:// wheres-daddy.com/
index.html'' ``Where's Daddy? The Mythologies behind Custody-Access-
Support.''
``Promiscuous fatherless women are desperately seeking love.
Or we are terrified that if we give love, it will not be
returned. So we pull away from it, refusing to permit it to
enter our houses, our beds, or our hearts. To fill the void
that our fathers created, we only make the hole larger and
deeper.
``If it is true that a father helps to develop his daughter's
confidence in herself and in her femininity; that he helps her
to shape her style and understanding of male-female bonding;
and that he introduces her to the external world, plotting
navigational courses for her success, then surely it is an
indisputable conclusion that the absence of these lessons can
produce a severely wounded and disabled woman.''
What about blended or ``re-constituted'' families?
While not a substantial portion of the problem, increases of child
sexual abuse is certainly a contributing factor.\26\ Child abuse occurs
most frequently within stepfamilies, and, in fact, most sexual abuse
occurs in stepfamilies.\27\ Sexual abuse of girls by their stepfathers
can be at a minimum six or seven times higher,\28\ and may be up to 40
times \29\ that of sexual abuse by biological fathers in intact
families. There seems to be little substitute for the presence of a
caring biological father. Children living with a mother and stepfather
fared poorly on most indicators.\30\ When it comes to the risk of abuse
with unrelated males, Barbara Dafoe Whitehead explains:
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\26\ A Sedlak (August 30, 1991). ``Supplementary Analyses of Data
on the National Incidence of Child Abuse and Neglect'' (Rockville, Md.:
Westat) table 6-2, p. 6-5. see also, Gomes-Schwartz, Horowitz, and
Cardarelli, Child Sexual Abuse Victims and their Treatment, 1988 (69
percent of victims of child sexual abuse came from homes where the
biological father was absent)
\27\ David M. Fergusson, Michael T. Lynskey, and L. John Horwood,
(1996). ``Childhood Sexual Abuse and Psychiatric Disorders in Young
Adulthood: I. Prevalence of Sexual Abuse and Factors Associated with
Sexual Abuse,'' Journal of the American Academy of Child and Adolescent
Psychiatry, Vol. 34, pp. 1355-1364.
\28\ Diana E. H. Russell, (1984). ``The Prevalence and Seriousness
of Incestuous Abuse: Stepfathers vs. Biological Fathers,'' Child Abuse
and Neglect, Vol. 8, pp. 15-22.
\29\ See Wilson and Daly, ``The Risk of Maltreatment of Children
Living with Stepparents,'' p. 228.
\30\ National Center for Health Statistics, June 1991.
``Stepfathers also pose a sexual risk to children, especially
stepdaughters. They are more likely than biological fathers to
commit acts of sexual abuse, and are less likely to protect
daughters from other male predators. According to a Canadian
study, children in stepfamilies are forty times as likely to
suffer physical or sexual abuse as children in intact
families.'' \31\
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\31\ M Daly, M Wilson. Homicide (N.Y.: Aldine de Gruyter, 1988),
p.89.
It is worth noting that stepfathers cannot make up for the lack of
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a biological father. In fact, Maggie Gallagher notes:
``Children in stepfamilies do no better on average than
children in single-parent homes . . .Failing to understand the
erotic relations that are at the heart of family life, they
[sociologists] failed to predict what, sadly and surprisingly,
later research strongly suggested: Remarriage is not only not
necessarily a cure; it is often one of the risks children of
divorce face.'' \32\
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\32\ M. Gallagher, (1996). The abolition of Marriage: How We
Destroy Lasting Love. DC., Regnery Pub, Chapter 6.
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Between the years of 1975 and 1990, welfare incentives and feminist
marriage hatred served to severely damage the foundations of American
families. During this period, as entrenched feminist experiments
denigrating marriage and fatherhood have excluded fathers from their
children's lives, we find the marriage rate falling and the divorce
rate rising. SAT scores had even fallen to all-time lows while teen
births and the crime rate exploded. The divorce rate, teen birth rate,
and the crime rate each doubled between 1975 and 1990. SAT scores fell
in 1975 and then dipped below 900 for the first time in 1980. They have
remained at that low level.\33\
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\33\ Index of Leading Indicators, Washington Times, 1994
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Congress recently passed a program calling it a ``Fatherhood''
program, giving 150 Million dollars for the central focus and purpose
of turning fatherhood into a paycheck. In reading the Testimony by
Robert Rector of the Heritage Foundation,\34\ it would appear that lip
service was paid to the issue of fatherhood, but apparently a father-
child relationship is completely useless. The only ``counting'' done in
the ``Fathers Count Act'' is the counting of the amount of money that
can be extracted from men. This in spite of the studies showing
``[r]eceipt of child support does not appear to make a significant
difference'' and ``the presence of a step-parent does not significantly
improve a child's situation.'' \35\ Or what about, 90 percent of
fathers with joint custody pay the ordered child support. 79.1 percent
of fathers with visitation rights pay the ordered child support. 44.5
percent of fathers with no visitation rights pay the ordered child
support.\36\ One must wonder, why the focus on increasing child support
compliance when it is not the crisis that illegitimacy and
fatherlessness is. It is both fascinating and bewildering that this
appears to be the Congressional view of Fatherhood. What is funded in
the ``Fathers Count Act'' to create father-child involvement? Who is
the real deadbeat? Why is Congress so enmeshed in its support of anti-
marriage, anti-father special interests, and government programs that
uselessly expend BILLIONS of taxpayer dollars \37\ each year that no
one wants to ``rock the boat?''
---------------------------------------------------------------------------
\34\ THE FATHERS COUNT ACT OF 1999. Testimony by Robert Rector of
the Heritage Foundation before the Ways and Means committee. October 5,
1999. available online at; http:// www.heritage.org/library/testimony/
test100599 . html
\35\ K. Harris. Reuters. Fathers' Care Benefits Children. N.Y.,
August 25, 1998.
\36\ Census Bureau report. Series P-23, No. 173
\37\ The Office of Child Support Enforcement expends taxpayer funds
of nearly 5 BILLION dollars per year to continue a government run
system that is essentially a ``mess'' based on garbage data, draconian,
and arguably unconstitutional tactics as elaborated in previous
testimony that I have submitted. Serial No. 106-107--H.R. 1488, The
``Hyde-Woolsey'' Child Support Bill, March 16, 2000, beginning on Page
94. Can be viewed online at; http://frwebgate.access.gpo.gov/cgi-bin/
getdoc.cgi?dbname=106__house__hearings&docid=f:71291.pdf
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For more extensive information on the issue of the current
fatherlessness problem, please see my recently submitted
Congressional Testimony on the US House of Representatives web
site, Serial Number 107-38, June 28, 2001, regarding Fatherhood
proposals;
http://waysandmeans.house.gov/humres/107cong/6-28-01/record/
chillegalfound.htm.
Also, please see the companion legal brief raising Constitutional
issues related to fatherlessness that was submitted for the
record in this same hearing, but ended up excluded from the
official printed record at;
http://personal.clt.bellsouth.net/woodb01/Custody/
Equal__custody__statement__ of__william__wood.htm
Excerpts from California Governor Wilson's Focus On Fathers Summit
(1995), sheds some light on the issues:
Wade Horn, National Fatherhood Initiative: Our 3 decade experiment
with fatherlessness has failed. 23 million children will be sleeping in
fatherless homes tonight. The divorce rate tripled between 1960 and
1980. 40 out of 100 families divorce now compared to 16 out of 100 in
1960. Illegitimacy has followed a geometric progression from 10.7
percent in 1970 to 33 percent today. 40 percent of children in
fatherless homes have not seen their fathers for more than 1 year. 58
percent have never been in their fathers homes. 75 percent of single
parent families live in poverty versus 20 percent of 2-parent families.
Single-parent households produce: 60 percent of repeat rapists, 72
percent of murderers and 70 percent of long-term imprisoned. This is
not an attack on mother-headed households. Fathers just do things
differently and this can't be replaced with AFDC, Welfare, etc. Divorce
has severe consequences on children. We must change the way we look at
it. We are running out of time because soon the majority of children
will be raised in single-parent families. The issue is father contact,
not money.
In reviewing this commentary by the current Secretary of the Health
and Human Services Organization, is it any wonder that anti-marriage,
anti-family, and anti-father factions were so adamantly opposed to his
appointment? In the face of all of the social studies data
demonstrating the complete and utter destruction of children, families,
and our future (our Constitutional ``posterity''); Who was the
opposition to his appointment really supporting?'' When will someone
actually speak for the children; the teenage mothers and their
offspring, rather than supporting such culturally corrosive, completely
failed, anti-father/anti-marriage programs and interests? Who is the
real ``deadbeat'' here?
Hogan Hillings: We must promote father presence. Fatherlessness
is a problem which feeds itself--a fatherless child grows up
without a male role model and then has difficulty being a
father to his own children. Fatherlessness is not a passing
fancy that will go away. Human costs are larger than the dollar
costs and the dollar costs are enormous. [Look at the] enormous
size of the welfare and prison budgets.
1. Teen pregnancy must be stigmatized through education
and responsible media.
2. Families must be strengthened because families are
the best environment for children.
3. Policies must be developed to encourage and permit
parenting by fathers.
4. Strengthen laws holding parents responsible for
children's actions.
5. Develop male role models for the children of mother-
headed households.
From the same summit, in the section ``Causes and Cures for
Fatherless Children'' reveals an interesting view of our current
``divorce-promotion'' system (we call it ``no-fault'');
Several public policies have been criticized by father's rights
lobbyists as harming the crucial father-child relationship.
Some public policies that exacerbate fatherlessness and
abnormal childhood development are:
1. The use of so called ``no-fault'' divorce laws. This
has made divorce easy and typically results in children
having less time with their fathers.\38\ Marvin
Mitchelson, a famous lawyer who specializes in man and
woman relations, has been quoted as saying ``The
(present) easy grounds (for divorce) and no-fault
system of divorce (in some states) mean that anyone can
go to court and get a divorce with very little
effort.'' . . . Some states still don't have no-fault
laws, and those that do might consider repealing them
for the childrens' sake.
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\38\ 67 to 75 percent of all divorces are initiated by the female
partner: 74 to 80 percent of unilateral (non-mutual) divorces--Maggie
Gallagher, The Abolition of Marriage: How We Destroy Lasting Love,
Washington, DC: Regnery, 1996, who cites Frank F. Furstenberg, Jr. and
Andrew J. Cherlin, Divided Families: What Happens to Children When
Parents Part, Harvard University Press, 1991, p. 22. Ilene Wolcott and
Jody Hughes, ``Towards Understanding the Reasons for Divorce,''
Melbourne: Australian Institute of Family Studies, Working Paper No.
20, June 1999, as quoted in The Australian, 5 July 1999. Beuhler,
``Whose Decision Was It?'' Journal of Marriage and the Family, Vol. 48,
pp 587--595, 1987. Braver & O'Connell, Divorced Dads, Tarcher Putnam,
1998, p. 34. Lynn Gigy & Joan Kelly, ``Reasons for Divorce:
Perspectives of Divorcing Men and Women,'' Journal of Divorce and
Remarriage, Vol. 18, 1992. Braver, Whitley, Ng, ``Who Divorced Whom?
Methodological and Theoretical Issues,'' Journal of Divorce and
Remarriage, Vol. 20, 1993.
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2. Awarding sole physical custody of children after
divorce to one parent instead of joint physical
custody. Several states have tried to make joint
custody the default, and some states, like Washington,
even permit joint custody over one parent's objection.
Joint physical custody helps children get the fathering
they need to develop normally.\39\
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\39\ Please see my previously submitted legal brief on the
Constitutional issues related to this. It was submitted for the June
28, 2001 Fatherhood proposal hearings but was excluded from the printed
record. It can be seen online here; http://personal.clt.bellsouth.net/
woodb01/Custody/Equal__custody__statement__of__william__wood.htm
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3. The non-enforcement of visitation agreements. This
permits bitter ex-spouses to deny children visits with
their fathers. Encouragingly, Arizona, Colorado and
Illinois have passed laws that enforce visitation.
4. The immunity enjoyed by bitter divorcing spouses who
file contrived restraining orders to separate children
from their fathers. For example, a Massachusetts
``2090A'' restraining order prohibits children from
having reasonable visitation and adequate fathering,
and this is routinely justified by unproven
allegations. California has recently passed a law, SB
558, which will hopefully allow more fathering in that
state. It makes false convictions of child abuse a
justification for change of custody.
5. The practice of putting children in day-care when
divorced fathers are willing to care for them. Some
states, like Virginia and California, have introduced
legislation dubbed ``Mrs. Doubtfire'' bills that
encourage children to be cared for by their fathers
instead of sending them to day care facilities.
Conclusion
We are at a fork in the road in American History, we have been
attacked from outside by terrorist forces bent on destroying our
country, our culture, and our way of life. Yet inside, special
interests who routinely use intentionally deceptive child-centered
propaganda are causing little lives to be destroyed and are
destabilizing our culture and our nation for generations to come. Only
History will tell which forces, those external, or from within our own
shores, will have more devastating or far-reaching consequences. Will
we win the culture war that has been quietly escalating for decades
with children and families as their ultimate casualties?
We can no longer afford to tolerate the special interest advocates
of culturally corrosive and child destroying ideologies, promoting
their anti-marriage, anti-father, ``promiscuous free-for-all''. No
longer can we turn a ``blind-eye'' to single-parenthood, and engage in
``Hollywood-esque'' ridicule of those who would see the tragedy of
single-parenthood for what it is.\40\ Nor can we turn a blind-eye to
the continuing carnage of generation after generation of failed welfare
policies, failed ``no-fault'' divorce \41\ experiments, and the social
studies data showing the causal links to the destruction of children.
Our Constitution and the oaths that all elected officials take mandate
that we must take a hard look at these issues, and make hard decisions
for the ``posterity'' of our Nation. That posterity is our children and
their children for generations to come. What examples and life-lessons
will they pass on?
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\40\ See earlier notes on Dan Quayle and the ``Murphy Brown''
incident.
\41\ In fact, if one seriously considers the idea of ``no-fault''
it is a complete logical fallacy as practiced. ``No-fault'' simply
means that the individual who is willing to shred the marriage contract
bears absolutely no consequences for its destruction, or the attendant
negative consequences for all of the parties. ``No-fault'' is an
absolute guarantee that the ``fault'' will be transferred to the party
who does not desire or seek the destruction of the social contract of
marriage. Because in ``no-fault'' the non-moving, non-divorcing party
who often is TRULY NOT AT FAULT is crushed by the state divorce machine
that guarantees the divorcing party in the action that they will
receive that divorce with the full force and weight of the state
divorce machinery in the courts.
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This Congress must also consider very seriously its place in
History. Every administration and every Congress holds some place in
the History books. Looking back some 50, 100, or more years from now,
what will be the historical judgment and verdict of this Congress? With
so great a resource of detailed social studies data available
universally pointing to signs that we are taking our children in the
wrong direction, what will you do? How will you stand up and support
your constituent's children, and their children? How will the history
books show your grandchildren you dealt with this hidden internal
crisis?
Recommendations (several of them extracted from, or adapted from
Governor Wilson's Focus on Father's Summit)
1. Make supporting marriage--not just marriage neutrality--the
goal. Healthy marriages benefit the whole community. Conversely, when
marriages fail, huge personal and public costs are generated. If we can
help more marriages to succeed, it would be foolish and wrong-headed to
settle for policies that are merely neutral about marriage. There is no
neutrality with a state ensuring the end of the marriage contract
through a ``no-fault'' fiction when one party objects to the end of a
marriage.
2. Respect the special status of marriage. Do not extend the
benefits of marriage to couples who could marry, but choose not to.
Offering the social and legal benefits of marriage to cohabiting
couples unfairly and unwisely weakens the special option of marriage.
3. Reconnect marriage and childbearing. Do not discourage married
couples from having children as they choose, and encourage young men
and women to wait to have children until they have made good marriages,
not just until they have high school diplomas or turn twenty-one.
4. Do not discourage marital interdependence by penalizing unpaid
work in homes and communities. Couples should be free to divide up
labor however they choose without pressure from policies that
discriminate against at-home parenting and other activities that serve
civil society.
5. Promote both the ideal of marital permanence and the aspiration
couples today have for more satisfying marriage relationships.
Require a portion of the TANF funds to be used to promote marriages
and father involvement.\42\ Award special ``bonus grants'' of TANF
funds to foster marriage promotion ideas such as when, in 1999, then
Texas Governor George W. Bush signed a bill increasing the marriage
licensing fee by $5.00 to create a premarital education manual for
distribution to all marrying couples and to fund new premarital and
marital education research. In addition, then Governor Bush's bill
directed county clerks to keep a register of premarital educators for
supply to potential spouses and outlines suggested course content for
premarital education.
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\42\ 5 Wm. & Mary J. Women & L. 1 (1998)--HOW JUDGES USE THE
PRIMARY CARETAKER STANDARD TO MAKE A CUSTODY DETERMINATION. Page 37.
``Compared with those [children] raised in intact two-parent families,
adults who experienced a parental divorce had lower psychological well-
being, more behavioral problems, less education, lower job status, a
lower standard of living, lower marital satisfaction, a heightened risk
of divorce, a heightened risk of being a single parent, and poorer
physical health.'' (as cited from Paul R. Amato, Life-span Adjustment
of Children to Their Parents' Divorce, in 4 The Future of Children page
146. (1994))
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Find ways to encourage states to enact pro-marriage and anti-
divorce programs. In 1998 and 1999, governors in three states--
Louisiana, Utah, and North Carolina--signed marriage proclamations,
recognizing the importance of marriage to the public good. Sign a
Federal Marriage proclamation and a Congressional Resolution
recognizing the importance of marriage.
Reward those states that are successful in reducing divorce and
encouraging marriage with additional TANF Fund block grants or other
incentives. To successfully stem the tide of family instability could
save the taxpayers untold BILLIONS AND BILLIONS of dollars in chemical
dependency programs, welfare programs, child support collection
programs, prison and jail construction, courthouse construction (and
their additional staffing), and other assorted costs in productivity
and generational dependency.
Federal and State governments have an obligation of promoting ``a
more perfect union . . . establish[ing] justice . . . insur[ing]
domestic tranquility . . . promot[ing] the general welfare . . . and
secur[ing] the blessings of liberty to ourselves and our
posterity''.\43\ What better way to make good on this Constitutional
principle for our children and grandchildren than to strengthen and
promote marriage and family while reducing divorce.
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\43\ As excerpted from the preamble of the US Constitution. This
preamble sets these principles forth as the GUIDING PRINCIPLES FOR ALL
CONSTITUTIONAL INTERPRETATION.
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