Generally, state health departments lead state TPP efforts. States’ Teen Pregnancy Prevention Strategies Target Different Groups and Are Implemented at the Local Level

In their efforts to address the problem of teen pregnancy, the states that we visited developed prevention strategies with multiple components that included a variety of programs and services. Although each state generally had all of these components in their TPP strategies, the emphasis placed on the components and the types of services and programs included in their strategies varied. Program Implementation Varied at the Local Level

While TPP strategies were applicable statewide, the states we visited typically gave communities flexibility in selecting and implementing programs to meet local needs and preferences. Although not a part of the states’ strategies, all eight states received federal funding from CDC to support school HIV prevention education programs. States Began Requiring Teen Parents to Stay in School and Live at Home Before Federal Welfare Reform

The eight states in our review had already begun requiring teen parents receiving welfare to live at home or in supervised living arrangements and stay in school or job training to receive assistance—requirements that were subsequently included in federal welfare reform. Not All Study States Plan to Seek Bonus for Reducing Out-of-Wedlock Births

Federal welfare reform legislation provides a financial incentive for reducing the ratio of out-of-wedlock births to all births within the state. Some say they will likely not be competitive for the bonus because they are focusing their prevention efforts on teens rather than adult women, who have most out-of-wedlock births; other states say they may not be eligible to compete because they do not have available the abortion data needed to compete. Some States Concerned About the Prescriptive Nature of Abstinence-Only Education Programs

Welfare reform also included a provision to enhance efforts to provide sexual abstinence education and authorized $50 million annually for 5 years in grants to states that choose to develop programs for this purpose. Despite these concerns, all the states we visited applied for and received the federal funding to either initiate new programs or expand existing abstinence efforts. As of June 1998, six of the eight states we visited had begun to implement their abstinence-only initiatives. Although HHS could not isolate all of the funding specifically for TPP efforts, it was able to identify at least $164 million in fiscal year 1997. HHS recently began program evaluation efforts for two of its TPP programs—the multisite Community Coalition Partnership Program and the new Abstinence Education Program—that will measure the programs’ effects on behavior outcomes closely related to teen pregnancy. Because block grants—a source of funding used by the eight states to support their TPP strategies—give states flexibility in using funds, specific program evaluations are not typically required. Objectives, Scope, and Methodology

In response to congressional concern about teen pregnancy, we were asked to identify the strategies states have been implementing to prevent teen pregnancy and how states fund these strategies, determine if federal welfare reform had an effect on these strategies, identify these states’ efforts to evaluate their pregnancy prevention efforts, and describe the federal government role in supporting state efforts to prevent teen pregnancy.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on: (1) state strategies to reduce teen pregnancy and how states fund these efforts; (2) how welfare reform affected states' strategies; (3) the extent to which programs that are part of states' prevention strategies are evaluated; and (4) what teen pregnancy prevention activities the federal government supports.

What GAO Found

GAO noted that: (1) the eight states in GAO's review have, over time, developed teenage pregnancy prevention (TPP) strategies involving numerous programs that fall into six areas; (2) in general, these states targeted high-risk populations and communities and tailored programs to three different groups of teens; (3) while strategies were applicable statewide, states typically relied on local communities to select and implement specific programs from an array of alternatives; (4) states generally gave localities the flexibility to choose the type and mix of programs they wanted to put in place; (5) some communities chose not to implement programs that the state strategy encouraged; (6) all of the states GAO visited relied on federal funding to support their strategies and in many of the states, federal funding exceeded state funding for TPP; (7) the 1996 federal welfare reform legislation had a limited effect overall on these states' TPP strategies, in part, because the states in GAO's review already required that teen parents live at home and stay in school to receive assistance--two key provisions now mandatory under federal welfare reform; (8) only two of the eight states plan to compete for the bonus provided by the law to states that show the greatest success in reducing out-of-wedlock births; (9) the other states are unlikely to compete because they lack the data needed to show reductions or because their prevention efforts focus on teens who account for a relatively small proportion of out-of-wedlock births; (10) although the eight states initially had concerns about the prescriptive nature and administrative requirements of the new law's grant program for sexual abstinence education, the eight states applied for the grants, received funding, and plan to either initiate new abstinence education programs or expand programs that they had already included as part of their strategies to prevent teen pregnancy; (11) although all eight states are tracking changes in teen births, few are evaluating the effect of their TPP programs on teen pregnancy; (12) only four states are attempting to link some of their TPP efforts to changes in teen pregnancies, births, or other closely related outcomes; (13) for fiscal year 1997, the Department of Health and Human Services identified at least $164 million for TPP programs or services; and (14) however, funding specifically for TPP activities could not be isolated at the federal level, primarily because of the flexibility on spending decisions given to states.