Failure to Launch: Obama’s New Teen Initiative Can Be Fixed, and Here’s How

William Smith and James Wagoner

Preventing teen pregnancy is incredibly important. But unintended pregnancy among teens is not the only sexual and reproductive health issue facing our nation's youth.

President Obama’s Fiscal Year 2010 budget is to be
applauded.  The President has proposed an
end to abstinence-only-until-marriage funding as we have known it for the
better part of the last decade.  This marks
a significant change in direction, one that finally brings science and evidence
back into government policy. His leadership on this new direction will be
essential in the coming negotiations with Congress.

He has also offered up a new initiative that has become the
source of much discussion among advocates and between these same groups and the
White House.  The President seeks to
reallocate the funding previously spent on abstinence-only-until-marriage to teen
pregnancy prevention in a "silo-ed" approach that will inhibit the comprehensive
approaches needed to address the challenges facing teens today. 

Preventing teen pregnancy is incredibly important.  But unintended pregnancy among teens is not
the only sexual and reproductive health issue facing our nation’s youth.  We also have an epidemic of sexually
transmitted diseases among youth and every hour, at least one young person
acquires HIV in our country.  These and
other adverse outcomes of unprotected sexual activity among youth–outcomes that may result simultaneously in one act of intercourse–are the
consequences of a complex set of circumstances representing the failure of our
nation to strategically and systemically provide the education and information
young people need to make responsible decisions about their sexual health. This
is why our organizations, Advocates for Youth and the Sexuality Information and
Education Council of the United States (SIECUS), have been staunch advocates
for a much broader approach to these and other issues, through efforts that empower
young people to make good and healthy decisions now and throughout their
lifetimes. 

From a sexual and reproductive health perspective, vertical
or silo-ed programs don’t work.  In fact,
if persistently high teen pregnancy and sexually transmitted disease rates,
including HIV, prove anything, it is that addressing these outcomes separately
has consistently failed.

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SIECUS and Advocates for Youth, along with nearly 200 of our
nation’s leading health organizations, are seeking change that breaks from this
mold. That is why, during the 2008 election and subsequent transition, for
example, this large and informal coalition strongly advocated for deep
investments by the new Administration in comprehensive sex education, rather
than solely on one aspect of a broader problem. 
Comprehensive sex ed provides teens with information and life-skills
training that will reduce teen pregnancy and sexually transmitted infections while
addressing other aspects of sex and sexuality, such as responsibility, respect,
mutual consent, identification of abusive or controlling relationships, and
other critical skills. 

Comprehensive
sex ed is an approach that has been shown to be effective, for which Americans have consistently shown
support in poll after poll, and which promotes prevention and good health across a range of outcomes rather than only one outcome.  So while
the proposed new initiative is a step in the right direction, there is a great
deal of consensus among the groups who have been working on these issues for
decades that some changes are necessary to achieve maximum benefits in regard
to improving reproductive and sexual health, which in turn will contribute to
reduced health care and social costs. 

This week, more than 175 organizations reiterated the need
to do better and sent letters to the White House and Congressional
appropriators
toward this end.  These
letters underscored that just a few simple modifications to the President’s proposed
initiative can achieve what is needed.

First, expand the scope of the program.  The current teen pregnancy
prevention language must be expanded to include other proven interventions that
address sexually transmitted diseases and HIV/AIDS.   To do otherwise hamstrings this initiative
before it even gets off the ground.  By
supporting language that is inclusive of additional approaches, we can bring to
scale comprehensive programs that meet the diverse needs of all young people in
all communities, including lesbian, gay, bisexual, transgender, and questioning
youth whose needs fall wholly outside of the narrow teen pregnancy prevention
framework.  Admittedly, this step alone hardly
gets us out of the "disaster aversion" silos, but we have to work with what has
been so far advanced by the White House and these few additional words can at
least ensure that broader interventions are supported.

Second, make schools a priority.  By prioritizing schools, the new initiative
can help ensure smart and multi-faceted investments toward a sustainable legacy
to improve the health of our nation.

Over the past several years, significant policy shifts and
the adoption of evidence-based programming in schools have created a unique and unprecedented
opportunity to support a systemic change.  The tired arguments that schools cannot do
this are outdated.  Dozens and dozens of
school districts are at the ready but need resources to make it happen.  By assisting schools in institutionalizing
comprehensive programs aimed at helping improve adolescent sexual behaviors, we
can provide the needed educational information to the widest range of teens. The
current language excludes important public entities, such as schools, from
accessing funds. 

Third, ensure effective implementation.  According to the Administration’s current plan,
all of the funding for these efforts rests within a single agency within the
Department of Health and Human Services, one which currently oversees
abstinence-only-until-marriage programs. While we believe this agency can and
should play an important role in supporting community and faith-based
organizations, the agency does not have the necessary experience or
infrastructure to improve school-based programming.  Investments must be made through agencies
that have a public health framework, existing structures and relationships with
schools, and a proven record of the necessary support services to help ensure
success.  For example, allocating some
funding under the new initiative to the Centers for Disease Control and
Prevention (CDC), which already has established working structures with our
nation’s state and local educational entities, will save the government from "recreating
the wheel" – a process that all too often plagues good intentions.

This is not about semantics. 
We need to create a bold new investment that can be sustained beyond
electoral cycles, Administrations, and the occupant of the White House at any
given time.  We need a lasting commitment
with lasting effects. As currently written, the new teen pregnancy initiative
does not represent that bold, new investment. 

But it can.

Congress and the White House must listen to the chorus of
consensus within the majority of the advocacy community and support the changes requested by the broad
community of advocates and experts engaged in this issue.  Given that the White House rejected the initial
requests to specifically support sex education, these few modifications seem
hardly too much to ask.

Without these changes, the much-sought after end
of abstinence-only-until-marriage programs will not result in the ushering in of the
first ever federal program supporting comprehensive sex education about which President Obama spoke so eloquently during his campaign.  Instead, it will be the same emphasis on teen
pregnancy prevention, launched a dozen years ago by the Clinton Administration,
which was easily highjacked by social conservatives after the mid-term
election.  The result: more disjointed
patchwork prevention programming that fails our youth and blows with the
political winds. 

We have a chance to do something fundamentally different
this time around but the first step is a critically important one and has to be
placed on terra firma.  The job of advocacy groups is to push for a
firm foundation that will withstand changing political winds and to
differentiate that foundation from the thin layer of top soil that can easily
be washed away.

The President’s budget launched us in a new and important
direction. Now we just need to make sure that we arrive at the right
destination.

Commentary Politics

Democrats’ Latest Platform Silent on Discriminatory Welfare System

Lauren Rankin

The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. But there is a critical issue—one that affects millions in the United States—that is missing entirely from the draft: fixing our broken and discriminatory welfare system.

While the Republican Party has adopted one of the most regressive, punitive, and bigoted platforms in recent memory, the Democratic Party seems to be moving decisively in the opposite direction. The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. It calls for a federal minimum wage of $15; a full repeal of the Hyde Amendment, which prohibits the use of federal Medicaid funding for abortion care; and a federal nondiscrimination policy to protect the rights of LGBTQ people.

All three of these are in direct response to the work of grassroots activists and coalitions that have been shifting the conversation and pushing the party to the left.

But there is a critical issue—one that affects millions in the United States—that is missing entirely from the party platform draft: fixing our broken and discriminatory welfare system.

It’s been 20 years since President Bill Clinton proudly declared that “we are ending welfare as we know it” when he signed into law a sweeping overhaul of the U.S. welfare system. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 implemented dramatic changes to welfare payments and eligibility, putting in place the Temporary Assistance for Needy Families (TANF) program. In the two decades since its enactment, TANF has not only proved to be blatantly discriminatory, but it has done lasting damage.

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In one fell swoop, TANF ended the federal guarantee of support to low-income single mothers that existed under the now-defunct Aid to Families with Dependent Children (AFDC) program. AFDC had become markedly unpopular and an easy target by the time President Clinton signed welfare reform legislation into law, with the racist, mythic trope of the “welfare queen” becoming pervasive in the years leading up to AFDC’s demise.

Ronald Reagan popularized this phrase while running for president in 1976 and it caught fire, churning up public resentment against AFDC and welfare recipients, particularly Black women, who were painted as lazy and mooching off the government. This trope underwrote much of conservative opposition to AFDC; among other things, House Republican’s 1994 “Contract with America,” co-authored by Newt Gingrich, demanded an end to AFDC and vilified teen mothers and low-income mothers with multiple children.

TANF radically restructured qualifications for welfare assistance, required that recipients sustain a job in order to receive benefits, and ultimately eliminated the role of the federal state in assisting poor citizens. The promise of AFDC and welfare assistance more broadly, including SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps) benefits, is that the federal government has an inherent role of caring for and providing for its most vulnerable citizens. With the implementation of TANF, that promise was deliberately broken.

At the time of its passage, Republicans and many Democrats, including President Bill Clinton, touted TANF as a means of motivating those receiving assistance to lift themselves up by their proverbial bootstraps, meaning they would now have to work while receiving benefits. But the idea that those in poverty can escape poverty simply by working harder and longer evades the fact that poverty is cyclical and systemic. Yet, that is what TANF did: It put the onus for ending poverty on the individual, rather than dealing with the structural issues that perpetuate the state of being in poverty.

TANF also eliminated any federal standard of assistance, leaving it up to individual states to determine not only the amount of financial aid that they provide, but what further restrictions state lawmakers wish to place on recipients. Not only that, but the federal TANF program instituted a strict, lifetime limit of five years for families to receive aid and a two-year consecutive limit, which only allows an individual to receive two years of consecutive aid at a time. If after five total years they still require assistance to care for their family and themself, no matter their circumstances, they are simply out of luck.

That alone is an egregious violation of our inalienable constitutional rights to life, liberty, and the pursuit of happiness. Still, TANF went a step further: It also allowed states to institute more pernicious, discriminatory policies. In order to receive public assistance benefits through TANF, low-income single mothers are subjected to intense personal scrutiny, sexual and reproductive policing, and punitive retribution that does not exist for public assistance recipients in programs like Social Security and Supplemental Security Income disability programs, programs that Democrats not only continue to support, but use as a rallying cry. And yet, few if any Democrats are crying out for a more just welfare system.

There are so many aspects of TANF that should motivate progressives, but perhaps none more than the family cap and forced paternity identification policies.

Welfare benefits through the TANF program are most usually determined by individual states based on household size, and family caps allow a state to deny welfare recipients’ additional financial assistance after the birth of another child. At least 19 states currently have family cap laws on the books, which in some cases allow the state to deny additional assistance to recipients who give birth to another child. 

Ultimately, this means that if a woman on welfare becomes pregnant, she is essentially left with deciding between terminating her pregnancy or potentially losing her welfare benefits, depending on which state she lives in. This is not a free and valid choice, but is a forced state intervention into the private reproductive practices of the women on welfare that should appall and enrage progressive Democrats.

TANF’s “paternafare,” or forced paternity identification policy, is just as egregious. Single mothers receiving TANF benefits are forced to identify the father of their children so that the state may contact and demand financial payment from them. This differs from nonwelfare child support payments, in which the father provides assistance directly to the single mother of his child; this policy forces the fathers of low-income single women on welfare to give their money directly to the state rather than the mother of their child. For instance, Indiana requires TANF recipients to cooperate with their local county prosecutor’s child support program to establish paternity. Some states, like Utah, lack an exemption for survivors of domestic violence as well as children born of rape and incest, as Anna Marie Smith notes in her seminal work Welfare Reform and Sexual Regulation. This means that survivors of domestic violence may be forced to identify and maintain a relationship with their abusers, simply because they are enrolled in TANF.

The reproductive and sexual policing of women enrolled in TANF is a deeply discriminatory and unconstitutional intrusion. And what’s also disconcerting is that the program has failed those enrolled in it.

TANF was created to keep single mothers from remaining on welfare rolls for an indeterminate amount of time, but also with the express goal of ensuring that these young women end up in the labor force. It was touted by President Bill Clinton and congressional Republicans as a realistic, work-based solution that could lift single mothers up out of poverty and provide opportunities for prosperity. In reality, it’s been a failure, with anywhere from 42 to 74 percent of those who exited the program remaining poor.

As Jordan Weissmann detailed over at Slate, while the number of women on welfare decreased significantly since 1996, TANF left in its wake a new reality: “As the rolls shrank, a new generation of so-called disconnected mothers emerged: single parents who weren’t working, in school, or receiving welfare to support themselves or their children. According to [the Urban Institute’s Pamela] Loprest, the number of these women rose from 800,000 in 1996 to 1.2 million in 2008.” Weissmann also noted that researchers have found an uptick in “deep or extreme poverty” since TANF went into effect.

Instead of a system that enables low-income single mothers a chance to escape the cycle of poverty, what we have is a racist system that denies aid to those who need it most, many of whom are people of color who have been and remain systemically impoverished.

The Democratic Party platform draft has an entire plank focused on how to “Raise Incomes and Restore Economic Security for the Middle Class,” but what about those in poverty? What about the discriminatory and broken welfare system we have in place that ensures not only that low-income single mothers feel stigmatized and demoralized, but that they lack the supportive structure to even get to the middle class at all? While the Democratic Party is developing strategies and potential policies to support the middle class, it is neglecting those who are in need the most, and who are suffering the most as a result of President Bill Clinton’s signature legislation.

While the national party has not budged on welfare reform since President Bill Clinton signed the landmark legislation in 1996, there has been some state-based movement. Just this month, New Jersey lawmakers, led by Democrats, passed a repeal of the state’s family cap law, which was ultimately vetoed by Republican Gov. Chris Christie. California was more successful, though: The state recently repealed its Maximum Family Grant rule, which barred individuals on welfare from receiving additional aid when they had more children.

It’s time for the national Democratic Party to do the same. For starters, the 2016 platform should include a specific provision calling for an end to family cap laws and forced paternity identification. If the Democratic Party is going to be the party of reproductive freedom—demonstrated by its call to repeal both the federal Hyde and Helms amendments—that must include women who receive welfare assistance. But the Democrats should go even further: They must embrace and advance a comprehensive overhaul of our welfare system, reinstating the federal guarantee of financial support. The state-based patchwork welfare system must be replaced with a federal welfare assistance program, one that provides educational incentives as well as a base living wage.

Even President Bill Clinton and presumptive Democratic presidential nominee Hillary Clinton both acknowledge that the original welfare reform bill had serious issues. Today, this bill and its discriminatory legacy remain a progressive thorn in the side of the Democratic Party—but it doesn’t have to be. It’s time for the party to admit that welfare reform was a failure, and a discriminatory one at that. It’s time to move from punishment and stigma to support and dignity for low-income single mothers and for all people living in poverty. It’s time to end TANF.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.