Teen Pregnancy Researchers Regroup After Trump's HHS Pulls Funding
Back in May, when Jennifer Hettema first saw the Trump administration’s proposed budget, it took her a while to find the bad news. But buried in a Health and Human Services appendix, there it was: a $100 million line through the nation’s teen pregnancy prevention program. A psychologist and public health researcher at the University of New Mexico Health Sciences Center, Hettema is studying how doctors can best talk to Native American and Latino teens about avoiding unwanted pregnancies. Her work is funded by the Obama-era program, which gives out five-year grants for evidence-based intervention evaluations.
That left Hettema with three years left on her grant, but she figured it wasn’t too soon to worry about the future. She started to talking to her local representatives in Congress, who assured her there was bipartisan support for science and reproductive health—the budget was just a proposal, after all. She went back to work recruiting patients for her trial study.
But last week, when her annual grant award letter arrived from the Office of Adolescent Health, the HHS arm that administers the teen pregnancy prevention program, she found one gut-sinking sentence: “This award also shortens the project period to end June 30, 2018, and the end of this budget year.” The grants were supposed to last through 2020.
As recipients at 81 institutions around the country found out last week, the Trump administration decided to cancel them early—cutting off $213.6 million in promised funds and disrupting ambitious research projects aimed at unwanted pregnancies in teens. The unusual move, circumventing the traditional congressional budgetary process, has scientists and public health officials scrambling to figure out how to save work already in progress. But for most, the outlook is bleak.
“Our study can’t be salvaged,” says Lisa Masinter, who leads a Chicago Department of Public Health project to test the efficacy of a school-based education and STI screening program. Started as a pilot in 2009, the program had so much demand that CDPH wanted to make sure it actually worked. So they applied for a federal grant and began collecting baseline data last year. They were planning to start testing the intervention on ninth graders next year, and follow them through their entire high school career. Now, they can maybe collect six months of follow-up data. Which, if you know anything about human gestation, isn’t long enough to evaluate the most relevant metric: births. “Even if we find other funding, the framework of the evaluation has been totally altered,” says Masinter.
Many grantees WIRED spoke with indicated that their project officers at the Office of Adolescent Health were just as surprised by the grant disruptions as they were. According to a Reveal report that broke the news last week, the decision to eliminate funding likely came from the office of the assistant secretary of health. Last month, President Trump appointed Valerie Huber, an outspoken advocate of abstinence-only education, as the office’s new chief of staff. On Monday, a spokesperson from the office of the assistant secretary for health confirmed eliminating the final two years of funding, but when asked where the directive came from, responded in an email that “the President’s FY 2018 Budget eliminated funding for the Teen Pregnancy Prevention Program, so our grants office informed the grantees of their June 30, 2018 end date, to give them an opportunity to adjust their programs and plan for an orderly closeout.”
It should be pointed out here that the President’s proposed 2018 budget is not a legally binding document meant to guide any immediate agency funding decisions. Until Congress approves the budget, it should only be a White House wish list.
Before coming to HHS, Huber was the president of Ascend, formerly known as the National Abstinence Education Association. In a March editorial in The Hill, Huber wrote that the time had arrived for evidence-based pregnancy prevention programs to yield to an abstinence-only sex-ed stance. And indeed, evidence of that thinking was on display in the Trump administration’s rationale for eliminating the program. In the HHS appendix, which outlines budget justifications, the stated reason was that while the teen pregnancy rate has declined significantly over recent years, “it does not appear this program has been a major driver in that reduction.”
Trump’s budget did leave in place $277 million for abstinence-only sex-ed, stating that the program exclusively “supports an evidence-based approach defined as voluntarily refraining from non-marital sexual activity.” Not having heterosexual sex, whether you’re married or not, is the best way to not get pregnant in your teen years. But researchers know this, of course, which is why the programs being evaluated with these grants include abstinence education in addition to information about contraception and sexual decision making.
Pat Paluzzi, a public health researcher at the Healthy Teen Network in Baltimore, says one of the biggest determinants for whether or not people get pregnant during their teen years is the age at which they start having sex. That’s why the smartphone apps she has designed, which give teens information about having healthy sexual relationships, focus largely on helping them decide to hold off on having sex. But she’s also a realist. “Forty percent of teens, no matter what kind of education they receive, are having sex,” she says. “And ignoring the 40 percent who are either making that choice willingly or unwillingly is harmful to these young people. We have to also teach them how to stay safe.”
Paluzzi was using her grant to conduct a randomized clinical trial—the gold standard for testing whether or not an intervention works—on an app tailored to 18 and 19-year old African American and Latino girls. But without the promised funds, she’s going to have to cut recruitment short, from 1,500 down to only 800 participants. And without enough people to make her results statistically significant, she won’t be able to actually prove whether or not the app is effective. She’s started to look around for additional funds, either from non-profit or commercial partners, but she’s not overly optimistic.
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When Paluzzi first started working with the Healthy Teen Network, it was under President Bush’s abstinence-only administration. Back then, there was reliable non-profit funding from sources like the Ford Foundation and the Edna McConnell Clark Foundation to support research for evidence-based interventions. But these days, private endowments are still recovering from the Great Recession. And they’re stretched thinner, as they support other fields whose government dollars are drying up, like climate change research and opioid addiction treatments. “Foundations aren’t spending as they once were,” says Paluzzi. “I’m not sure we’re going to be able to rebound in the same way.”
So far, there doesn’t seem to be one white knight emerging to fill in the fiduciary gap. Some researchers, like Masinter in Chicago, are working with local authorities and citywide initiatives to make up for the loss of federal dollars. Others, like Hettema, are even entertaining the idea of partnerships in the pharmaceutical and medical device industry. All of them hold out a sliver of hope that the decision may yet get reversed, or the money reinstated by Congress. But researchers can’t just push the pause button while they wait and see. Kids have already been recruited, baselines already measured. Which means they’re all forging ahead with whatever they think they can cobble together.
The biggest loser in all of this, researchers say, is the American taxpayer. “To put $3 million into a powerful, randomized clinical study with more than 1,000 people and then stop it before we can really deliver?” says Hettema. “It’s so wasteful.” She points out that these grants in particular had a unique requirement. They specifically set aside time and money for dissemination of results in year five, so that researchers actually put effort into making their findings widely available to educators, physicians, and teens. Now, even if anything valuable can still come out of these 81 projects, it’s unlikely that information will get where it most needs to go.
The teen birth rate in the US has indeed been declining over the past two decades, but not as quickly for minorities and low-income communities (or in states that only only offer abstinence education). And it’s still the highest among other developed nations: 57 births for every 1,000 teenagers between 15 and 19. Switzerland, where only eight out of 1,000 teens give birth every year, starts sex-ed in kindergarten. And it covers a lot more than abstinence.