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:
- has as its exclusive purpose, teaching the social,
psychological, and health gains to be realized by
abstaining from sexual activity;
- teaches abstinence from sexual activity outside
marriage as the expected standard for all school age
children;
- 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;
- teaches that a mutually faithful monogamous
relationship in context of marriage is the expected
standard of human sexual activity;
- teaches that sexual activity outside of the context of
marriage is likely to have harmful psychological and
physical effects;
- teaches that bearing children out-of-wedlock is likely to
have harmful consequences for the child, the child's
parents, and society;
- teaches young people how to reject sexual advances
and how alcohol and drug use increases vulnerability
to sexual advances; and
- 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:
- Lowering the pregnancy rate for teenagers aged 15-17;
- Reducing the percent of adolescents 17 years and
younger who have engaged in
sexual intercourse;
- Reducing the incidence of youths aged 15-19 who have
contracted one of the
sexually transmitted diseases (i.e., gonorrhea, syphilis, or
chlamydia); and
- 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.
Conclusion
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.
