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Testimony on Abstinence Education by Peter C. Van Dyck, M.D., M.P.H.
Acting Associate Administrator for Maternal and Child Health
Health Resources and Services Administration
U.S. Department of Health and Human Services

Before the House Committee on Commerce, Subcommittee on Oversight and Investigations
September 25, 1998

Mr. Chairman:

I am Dr. Peter van Dyck, Acting Associate Administrator for Maternal and Child Health (MCH) in the Health Resources and Services Administration (HRSA). I am pleased to have this opportunity to review with you the Maternal and Child Health Bureau's efforts to implement the Abstinence Education Grant Program established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193).

Title V Introduction

Before beginning my discussion of the Abstinence Education Grant Program -- authorized by Section 510 of Title V of the Social Security Act -- I would like to say a few words about Title V. Title V of the Social Security Act, the Maternal and Child Health Services Block Grant, is the only Federal legislation directed specifically toward improving the health of all mothers and children. Encompassed in Title V are a formula grant program to the States and two federal discretionary grant programs: Special Projects of Regional and National Significance (SPRANS) and Community Integrated Service Systems (CISS). Title V is administered by the Maternal and Child Health Bureau (MCHB), a component of HRSA within the Department of Health and Human Services (HHS). State maternal and child health agencies have local responsibility for Title V administration.

Importance of Abstinence Message

The teen birth rate has declined 12 percent between 1991 and 1996. According to a new study released last week by the Centers for Disease Control and Prevention, the proportion of American high school students who have had sexual intercourse has also fallen 11 percent during the 1990's. Despite these recent declines, teen pregnancy remains a significant problem in communities across the country. Most teen pregnancies are unintended. Each year, approximately one million pregnancies occur among teenagers aged 15-19. Almost 200,000 teens 17 years and younger have children. Teenage mothers are less likely to complete high school and more likely to be poor. Based on a 1996 Robin Hood Foundation report on the costs of adolescent childbearing, only about one-third of teenage mothers receive a high school diploma. According to the Annie B. Casey Foundation, about 80 percent of the children born to unmarried teenagers who dropped out of high school are poor. In contrast, just eight percent of children born to married high school graduates aged 20 or older are poor. Infants of teenage mothers are often low birth weight and die at disproportionately high rates.

HHS believes that all teens need to hear the message that abstinence is the surest way to prevent pregnancy, HIV and sexually transmitted disease. The abstinence education approach targets preventing teen pregnancy and premature sexual activity. Research tells us that reinforcing self confidence and positive values and attitudes is an important prerequisite.

We fully support the opportunity the Abstinence Education Grant Program affords us to develop better solutions to help young people postpone sexual activity, stay in school, and prepare to work. The program is a key component of our National Strategy to Prevent Teen Pregnancy announced by the Secretary in January 1997. As part of that strategy, HHS is also working to promote abstinence through existing teen pregnancy programs, through our new Girl Power campaign aimed at 9-14 year old girls, and through the national network of youth serving organizations that reach girls, boys, and their families.

Section 510 of Title V

Section 510 of the Social Security Act, created under Section 912 of the 1996 Welfare Reform law, established a new categorical program of grants to States for abstinence education. Its purpose is to enable States to support 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 most likely to bear children out-of-wedlock. The law provides for a mandatory annual appropriation of $50 million for each fiscal year (FY) 1998 through 2002. Grants are awarded to the States based on a statutory formula determined by the proportion that the number of low income children in the State bears to the total number of low income children for all States. Grant applications are accepted only from the State health agency responsible for the administration (or supervision of the administration) of the Title V Maternal and Child Health Service Block Grant, with funds dispersed at the discretion of the Governor unless otherwise established under State law or judicial precedent. There is a required match of three non-Federal dollars for every four Federal dollars awarded. If a State chooses not to apply for a grant, the State's allocation is returned to the Treasury and is not available for redistribution among the remaining States.

Abstinence Education Definition

Abstinence education is defined in the law as an educational or motivational program which:

  1. has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

  2. teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;

  3. 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;

  4. teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;

  5. teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;

  6. teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;

  7. teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and

  8. teaches the importance of attaining self-sufficiency before engaging in sexual activity.

It is recognized that many States receive relatively modest funding under the legislative formula which will result in the development of programs with significant variation. It is not necessary to place equal emphasis on each element of the definition, however, a project may not be inconsistent with any aspect of the abstinence education definition.

Program Implementation

In November 1996, MCHB convened a working group comprised of Federal, Regional, and State MCH staff, and representatives of MCH associations to develop application guidance to the States for the Abstinence Education Grant Program. The guidance was developed with extensive consultation with the House Commerce and Ways and Means Committees. It reflects Congressional desire that States should have primary responsibility for developing and implementing programs that respond to their unique priority needs.

MCHB released the draft application guidance for public comment in February 1997. Following review of more than 400 comments received from a variety of sources, two major features were added to the guidance. First was the inclusion of four National performance measures. The four measures are:

  1. Lowering the pregnancy rate for teenagers aged 15-17;

  2. Reducing the percent of adolescents 17 years and younger who have engaged in sexual intercourse;

  3. Reducing the incidence of youths aged 15-19 who have contracted one of the sexually transmitted diseases (i.e., gonorrhea, syphilis, or chlamydia); and

  4. Lowering the rate of births to female teenagers aged 15-17.

In addition to the four National performance measures, States are required to develop two State performance measures related to the priority needs identified by the State. States report on their progress toward meeting the National and State performance measures in Annual Reports they submit to MCHB.

Second was the inclusion of an "Abstinence Advisory" in the draft guidance. This advisory is a set of Questions and Answers (Q's and A's) developed by the Department to assist grantees in determining if their programs meet the Constitutional test that Federal money may not be used to promote religion. The Q's and A's were included with the final guidance to help Abstinence Education Program grantees make legally appropriate decisions concerning which activities may be funded. Many States requested such guidance in their comments to MCHB.

The final application guidance, titled The Abstinence Education Provision of the 1996 Welfare Law, P.L. 104-193, was disseminated to State agencies in June 1997. This guidance provides direction to the State maternal and child health agencies regarding how to apply for the appropriated funds under the Abstinence Education Grant Program. States are responsible for developing programs that best meet their unique priority needs. Both public and private organizations can provide services under the program. Abstinence Education Grant Program dollars can be used to create a completely new program in abstinence education or to augment any existing program as long as it does not contradict the statutory definition of abstinence education. The required non-Federal matching funds must be in accordance with the guidance and may be State dollars, local dollars, private or foundation dollars, or in-kind support.

FY 1998 Abstinence Education Grant Applications In July 1997, 54 States and Territories submitted applications for the first year of Abstinence Education funding. Applications were submitted by all 50 States, District of Columbia, Virgin Islands, Guam, and Puerto Rico. A panel of professionals from MCHB reviewed the proposals based upon the guidelines published in the application guidance. All of the applications were approved, and the States/Territories received their Notices of Grant Award in November 1997.

The Notices of Grant Awards included conditions which the States or Territories were required to meet in order to ensure that program funds are used for the statutorily-mandated purpose. All awards included a condition requiring the grantees to submit the purpose, scope and projected cost, including sources of matching dollars, for any contracts awarded. The intent of this condition was to provide MCHB with a measure of assurance that contracts awarded by the States and Territories comply with the law. In March 1998, New Hampshire withdrew its application. The remaining 53 States and Territories are in varying stages of implementing their programs.

The applications submitted by the State/Territory health departments for FY 1998 include multiple strategies to promote abstinence education, particularly among adolescents. The majority (41) of the States and Territories targeted 13-14 year olds as their first priority. Other frequently targeted age groups were 9-12 year olds (39 States/Territories) and 15-17 year olds (36 States/Territories). Many States targeted more than one age group. Development of a public media campaign was proposed in 33 States. Other programmatic themes included public education campaigns (23 States), mentoring (21 States), curriculum development (18 States), and during- and after-school classes (14 and 13 States respectively). In addition, 29 States proposed an evaluation component. Contracts were primarily awarded by States to community groups (29 States) and schools or school districts (29 States), followed closely by city or county health departments (27 States).

States and Territories were required to submit an abbreviated Annual Report for their FY 1998 Abstinence Education Grant in July 1998. This report covers only the first seven months of funding. A full Annual Report will be due on July 15, 1999. MCHB is currently in the process of reviewing the abbreviated Annual Reports and will compile a summary of State Abstinence Education Grant Program activities once the reviews have been completed.

FY 1999 Abstinence Education Grant Applications Applications for the FY 1999 Abstinence Education Grants, the second year of funding, were due on July 15, 1998. MCHB is currently in the process of reviewing the grant applications. Fifty-two applications were submitted - - from the 50 States, Puerto Rico, and the Virgin Islands. It is anticipated that the Notices of Grant Awards will be issued in October 1998. The guidance used for FY 1999 Abstinence Education Grant applications was unchanged from the previous year.

National Evaluation

A separate National evaluation of programs under Section 510 of Title V was mandated and funded by Section 5001 of the Balanced Budget Act of 1997. This three-year evaluation will be conducted under a contract awarded in August 1998, by the Office of the Assistant Secretary for Planning and Evaluation.


Reducing teen pregnancies and premature sexual activity is the responsibility of all of us. It is imperative that we work together with the States toward our common goal of reducing out-of-wedlock births. We look forward to continuing to work closely with the Committee to create an environment for our young people which allows them to successfully mature into adulthood.

Mr. Chairman, this concludes my testimony. Thank you for the opportunity to testify today.

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