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An Overview: Fiscal Year 2010 Edition

A Portrait of Sexuality Education and
Abstinence-Only-Until-Marriage Programs in the States
An Overview
Fiscal Year 2010 Edition
This eighth edition of the SIECUS State Profiles illustrates the significant progress advocates and educators have been making in sexuality education law, policy, and implementation—away from the failed experiment of abstinence-only-until-marriage programs and toward a more comprehensive, evidence-based approach. Advocates for comprehensive sexuality education are finally seeing, and beginning to build upon, the fruits of our labor. This Fiscal Year 2010 edition reflects this progress, particularly at the national level. As always, SIECUS continues our tradition of “following the money;” however, for the first time, the SIECUS State Profiles track not only federal abstinence-only-until-marriage funding but also federal funding for more comprehensive approaches to sex education, detailing new funding streams, grantees, and funded programs.
We were able to make this shift because in Fiscal Year 2010, after nearly thirty years of strong support from the federal government for abstinence-only-until-marriage programs, the Obama administration and Congress began to usher in a new era of sex education in this country, eliminating two-thirds of federal funding for ineffective abstinence-only-until-marriage programs and providing funding for initiatives that support evidence-based teen pregnancy prevention and more comprehensive approaches to sex education totaling nearly $190 million. The administration supported these efforts and further signaled the importance of sex education as a means to achieve sexual health by including key recommendations for sexuality education for adolescents in the National HIV/AIDS Strategy[1]and the National Prevention Strategy.[2]
We also continue to see significant leadership on sexuality education policy and implementation at the state and local levels. States and cities around the country are continuing the trend of jettisoning the failed policy of abstinence-only-until-marriage in favor of more comprehensive approaches while others continue to push the boundaries of implementing policies supportive of more comprehensive approaches to sex education in the effort to reach all young people with comprehensive sexuality education.
After over 45 years advocating for the rights of all people to accurate information about sexuality and sexual health, with a focus on comprehensive education about sexuality and sexual health services, SIECUS delivers this 2011 edition of our State Profiles with a renewed mission focused on the nexus of policy and implementation. This edition of the SIECUS State Profiles is designed to help advocates and educators across the country build on our successes and institutionalize the investment and policies that are being implemented to support comprehensive sexuality education, and to continue the trend of eliminating all federal and state policies and funding for failed abstinence-only-until-marriage programs.
This edition of SIECUS State Profiles continues to include the most up-to-date information on more comprehensive approaches to sex education and abstinence-only-until-marriage programs in the states, including state laws and policies and recent legislation. As mentioned, we also continue our tradition of “following the money” by documenting all federal funding related to sex education. For the first time, our tracking of the federal funding includes the two new funding streams—the Teen Pregnancy Prevention Initiative (TPPI) and the Personal Responsibility Education Program (PREP). We also continue to track funding allocated through the Title V abstinence-only state-grant program. We have released this edition later in the year than usual in order to include as much information as possible about the new federal grantees. The information about the state-grant programs and any relevant sub-grantees reflects research completed by August 1, 2011. As state plans progress and sub-grantees are awarded funds, we will continue our work to provide state partners and colleagues with the most relevant and current information available. Our in-depth research allows us to provide not just detailed information on each state but thoughtful analysis on some of the overall trends we are seeing at both the federal and state levels. 
  • Organizations or state entities in 33 states and the District of Columbia received federal funding in Fiscal Year (FY) 2010 for more comprehensive approaches to sex education and teen pregnancy prevention efforts.
  • The five states receiving the highest amounts of federal funding for more comprehensive sex education and teen pregnancy prevention programs in FY 2010 include: California ($14,183,520); New York ($11,832,504); Florida ($8,331,674); Georgia ($7,990,636);and Texas ($7,640,542).
  • 43 states, the District of Columbia, the Federated States of Micronesia, and Puerto Rico applied for the Personal Responsibility Education Program (PREP).
  • 30 states and Puerto Rico applied for the Title V abstinence-only program, despite more flexible guidance.
  • Three states chose not to apply for either the PREP or Title V program—Hawaii, Indiana, and Nevada—however, both Hawaii and Nevada applied for FY 2011 PREP funds and received FY 2010 funds retroactively.
  • Public and private entities in 36 states and the District of Columbia received federal funding through the Teen Pregnancy Prevention Initiative in FY 2010, reaching well over 800,000 young people through funded programs.
  • 20 states and the District of Columbia did not receive any federal abstinence-only-until-marriage funding in FY 2010, the largest number since the creation of the Title V abstinence-only program in 1996.
Federal Funding Streams
The federal government finally began to heed the evidence and urgings of the nation’s leading medical and public health organizations and created two federal funding streams—the Teen Pregnancy Prevention Initiative and the Personal Responsibility Education Program—that support programs that can be comprehensive in scope, have demonstrated their effectiveness, and are age-appropriate and medically accurate. While not a silver bullet, these federal funding streams are proving instrumental in providing youth with much needed programming. The Title V abstinence-only program remains the last vestige of dedicated funding to support abstinence-only-until-marriage programming. However, the broader guidance issued under the Obama administration means that even this program no longer has to follow the strict dogma it once did.  
Teen Pregnancy Prevention Initiative
Created in Fiscal Year 2010, the Teen Pregnancy Prevention Initiative (TPPI) funds medically accurate and age-appropriate programs to reduce teen pregnancy. The grant program, which totaled $110 million in discretionary funding for Fiscal Year 2010, consists of two funding tiers that provide grants to local public and private entities for evidence-based and innovative programs. Tier 1 totals $75 million and provides funding for the replication of evidence-based programs proven to prevent unintended teen pregnancy and address underlying behavioral risk factors. Tier 2 totals $25 million and provides funding to develop and test additional models and innovative strategies. A portion of the Tier 2 funds, $15.2 million, was allocated for research and demonstration grants to test innovative approaches, while the remaining funding, $9.8 million, was allocated for grants to support communitywide initiatives. TPPI also dedicates $4.5 million in funding to conduct evaluations of individual programs. The funding stream is under the jurisdiction of the newly established Office of Adolescent Health (OAH) within the Office of the Secretary of Health and Human Services (HHS), which works in cooperation with the Administration for Children and Families (ACF) and the Centers for Disease Control and Prevention (CDC) to implement the initiative.
OAH received over 1,000 applications for TPPI funding; however, they were able to fund only just over 100 grantees with available resources. For Fiscal Year 2010, a total of $75 million in grant awards was distributed to 75 grantees in 32 States and Washington, D.C. under Tier 1; and 19 grants were made in 14 states under Tier 2, totaling $15.2 million. The remaining $9.8 million from Tier 2 funding supports cooperative agreements awarded by the CDC in partnership with OAH for community-wide teenage pregnancy prevention programs. Eight state and local organizations are funded to demonstrate the effectiveness of innovative, multi-component, community-wide initiatives in reducing rates of teen pregnancy and births in communities with the highest rates, with a focus on African American and Latino/Hispanic youth aged 15–19. Five national organizations are funded to provide assistance and support to the community grantees. Finally, $10 million was authorized for research, evaluation, and technical assistance.
TPPI grantees are implementing a variety of programs including some designed to prevent teen pregnancy and sexually transmitted diseases (STDs), including HIV, that include information on abstinence and contraception in addition to other topics; positive youth development programs, some of which include a sex education component; and some abstinence-until-ready and abstinence-only-until-marriage programs.
State-Grants: Personal Responsibility Education Program and Title V Abstinence-Only Program
Fiscal Year 2010 also marked the first year for which federal funds were available to states to support evidence-based and innovative programs that teach about the importance of delaying sexual initiation as well as the effectiveness of contraceptive use among other topics.The Personal Responsibility Education Program (PREP), which provides young people with medically accurate and age-appropriate sex education in order to help them reduce their risk of unintended pregnancy, HIV/AIDS, and other STDs, was created as part of the Patient Protection and Affordable Care Act (P.L. 111-148), better known as health care reform. Programs funded by PREP would also foster development of life skills so that young people can make responsible decisions and lead safe and healthy lives.PREP includes a $55 million state-grant program, $10 million to fund local entities through the Personal Responsibility Education Innovative Strategies (PREIS) Program, $3.5 million for Indian tribes and tribal organizations, and $6.5 million for evaluation, training, and technical assistance.
The response to PREP was overwhelmingly positive. The vast majority of states applied for the PREP funds, including states that have staunchly supported an abstinence-only-until-marriage approach in the past. For Fiscal Year 2010 43 states and the District of Columbia, the Federated States of Micronesia, and Puerto Rico applied for PREP’s state-grant funding. Two additional states, Nevada and Hawaii, which applied for PREP funding for the first time in Fiscal Year 2011 were retroactively provided with Fiscal Year 2010 funding.  After initially applying for PREP funds, Florida’s state legislature decided to reject all funding from the Affordable Care Act and the state returned the funds. (However, of note, Florida did accept Fiscal Years 2010 and 2011 funding under the Title V abstinence-only program despite the fact the program is also funded through the Affordable Care Act).
Fiscal Year 2010 also marked the return of some dedicated funding for abstinence-only-until-marriage programming. While the Title V abstinence-only-until-marriage program was allowed to expire in June 2009, there were several attempts by conservative lawmakers to continue the funding in the year that followed and they were ultimately successful in resurrecting the program. As in previous years, the Title V abstinence-only-until-marriage program totals $50 million dollars a year and states that choose to accept the money must match three state raised-dollars for every four federal and then provide programs to youth or distribute the funds to community entities that will do so.
The new Title V abstinence-only guidance issued in the Funding Opportunity Announcement (FOA) is more flexible than it has been in previous years and states are now able to support mentoring, counseling, or adult supervision with the funding. Programs funded with Title V abstinence-only money, however, still must teach abstinence to the exclusion of other topics and must ensure that abstinence from sexual activity is an expected outcome. No funds can be used in ways that contradict the A–H federal abstinence-only-until-marriage definition. These restrictions mean that states still cannot use Title V abstinence-only funds to provide information about contraception as a means to prevent unintended pregnancy and STDs, including HIV, or provide young people with all of the information they might need to make informed and healthy decisions about their sexual behavior. Despite this flexibility, only 30 states and Puerto Rico applied for the Title V abstinence-only funding in Fiscal Year 2010. 
Overall, half the states applied for both PREP and Title V abstinence-only funds while one in four states applied solely for PREP funds and less than 15% of states applied only for the Title V abstinence-only program.[3]
Programs Selected for Replication across the Country
In order to identify effective evidence-based programs that could be implemented under Tier 1 of TPPI, OAH contracted with Mathematica Policy Research, Inc. to conduct an independent, systematic review of research around teen pregnancy prevention and risk reduction programs, and ultimately compile a list of “evidenced-based” programs. To qualify as an evidence-based program in this review, a program had to “be supported by at least one high- or moderate-rated impact study showing a positive, statistically significant impact on at least one priority outcome (sexual activity, contraceptive use, STIs, or pregnancy or births), for either the full study sample or key subgroup (defined by gender or baseline sexual experience).”[4]
While nearly 1,000 potentially eligible programs were identified, only 28 met the strict scientific criteria, “reflecting a range of program models and target populations.”[5] Of the 28 programs included on the list, 20 showed evidence of impacts on sexual activity (for example, sexual initiation, number of partners, or frequency of sexual activity), nine on contraceptive use, four on STDs, and five on pregnancy or births.[6] Of the 28, five are positive youth development programs while the other 23 focus on reducing unintended pregnancy or the underlying behavioral risk factors that may lead to unintended pregnancy, HIV, and other STDs. Eligible programs include those designed for implementation in a variety of settings including school, community-based, and clinical settings; some designed for population-specific audiences such as those in the juvenile justice or foster care systems; and programs specifically designed for, or proven effective with, youth of color. Notably, while included in the review, none of the programs which met Mathematica’s strict criteria for inclusion were abstinence-only-until-marriage programs, even though these programs are still in popular use across the country.
State Trends
As states and grantees begin to implement programs funded through the Teen Pregnancy Prevention Initiative, the Personal Responsibility Education Program, and the re-established Title V abstinence-only program, advocates and communities across the country are finally starting to see the impact this federal funding will have on-the-ground.
Addressing Health Disparities and Highest Risk Youth
The majority of federally funded PREP and TPPI programs are choosing to address the sexual health and prevention education needs of high-risk, high-need, and high-priority youth populations and communities. Grantees are choosing to address youth populations that have the highest health disparities that have resulted from social, environmental, and socioeconomic inequities such as inadequate access to health care, education, and poverty. Grantees have primarily chosen to address these health disparities by focusing programming on youth who are at highest risk of unintended pregnancy, HIV, and other STDs, including youth of color, youth in state custody, such as those in the foster care or juvenile justice systems, and those living in residential and transitional living facilities.
In some cases, such as in PREP, this focus on addressing health disparities and high-risk population is a direct result of legislative language. The innovative strategies portion of PREP details that grants must be utilized to implement innovative youth pregnancy prevention strategies and target services to high-risk, vulnerable, and culturally under-represented youth populations, including youth in foster care, homeless youth, youth with HIV/AIDS, pregnant women who are under 21 years of age and their partners, mothers who are under 21 years of age and their partners, and youth residing in areas with high birth rates for young parents.[7] The FOA for the PREP state-grant program also requires applicants to detail how they will address the above populations. And the Title V abstinence-only FOA encourages grantees to address youth who are in or aging out of foster care and youth who are in the care of the child welfare system due to their high rates of unintended pregnancy. But in most cases, as communities become strapped for cash and states increasingly fall victim to budget crises, communities are seeking as much new funding as is possible to meet the needs of those most vulnerable populations that are becoming even further disenfranchised as a result of significant cuts to social services.
Tier 1 and Tier 2 TPPI grantees in Alaska, Kentucky, Maryland, Missouri, Nevada and Vermont have designed teen pregnancy prevention models that specifically serve foster-care youth among the at-risk youth populations they are targeting, while grantees in Alaska, California, Maryland, Michigan, Nevada, and Oklahoma are all targeting youth who are in or engaged with the juvenile justice system. Both populations of young people have higher rates of unintended pregnancy, STDs, and exposure to physical and sexual violence. TPPI grantees in at least 16 states and the District of Columbia—ranging from Alabama and Georgia to Washington and Wisconsin—are focused on African-American youth and grantees in at least 10 states and the District of Columbia—ranging from Arizona and California to Massachusetts and New Jersey—are focused on addressing the prevention needs of Latino youth. In Hawaii, Louisiana, and Pennsylvania, sub-grantees of PREP state-grant programs are focusing on young men who have sex with men. A range of TPPI and PREP grantees are focused on prioritizing programming and funding for counties and communities that have the highest teen birth rates, such as in Kentucky, Mississippi, New York, and Nevada.
Unfortunately, the need for federal funding to address health disparities becomes clearer every day. CDC recently released new HIV incidence data that showed that while the annual number of new HIV infections in the United States was relatively stable at approximately 50,000 new infections each year, between 2006 and 2009, HIV infections among young men who have sex with men (MSM) increased during the same time period. The majority of this increase was due to alarming rates of infection among young, black MSM­—the only subpopulation to experience a sustained increase during the time period.[8] Sadly, this is just one example of the health disparities that many communities face and advocates, educators, and health care professionals need to continue to push for funding and programing that can address the specific needs of these subpopulations.
Availability of TPPI and PREP Expands Positive Programming
In many states and communities, TPPI and PREP are allowing implementation of more comprehensive approaches to sex education for the first time, while in others, states and local entities are using the funds to expand their already successful programming—reaching even more young people with the information and education they need. In New York, the PREP state-grant program will operate in conjunction with the state’s Comprehensive Adolescent Pregnancy Prevention (CAPP) program, a $17 million grant program supported by state and federal funds to promote adolescent sexual health that provides grants to community-based organizations to implement comprehensive sexuality education programs that “ensure access to comprehensive reproductive healthcare and family planning services for teens to prevent pregnancies, STDs, and HIV/AIDS” and address at least three adulthood preparation topics.[9] Because the goals and requirements of PREP are so similar to those of the CAPP program, rather than create a new Request for Applications (RFA), the department of health chose to sub-grant the PREP funds to 8 organizations that had submitted CAPP proposals that were “approved but not funded” due to a lack of available funds.[10] Grantees are required to implement one or more of the programs on the list of 28 evidence-based programs released by OAH.
With its TPPI funds, the Hennepin County Research, Planning, and Development Department (RPD) in Minnesota was able to expand upon its teen pregnancy prevention initiative, “Better Together Hennepin: Healthy Communities, Healthy Youth,” and can now operates the “It’s Your Future” program in all eight cities in Hennepin County with teen birth rates above the Minnesota state rate.[11] Through the expanded “It’s Your Future” teen pregnancy prevention program, Hennepin County plans to administer Teen Outreach Program (TOP) to approximately 13,000 middle and high school students and to administer Safer Sex to approximately 14,000 adolescents. Also expanding the education public school students will receive, the South Carolina Campaign to Prevent Teen Pregnancy (SC Campaign) is using its TPPI Tier 1 funding to implement the “Keep it Real, South Carolina” teen pregnancy prevention program. The program aims to decrease the number of adolescent girls in South Carolina who become pregnant before graduating from high school and increase the number of middle schools in the state that institutionalize the provision of an evidence-based teen pregnancy prevention program. The SC Campaign partners with 24 middle schools across the state to administer the program, which uses the curriculum, It’s Your Game: Keep It Real. To implement programming, the SC Campaign provides training and intensive technical assistance to education administrators and teachers in each of the 11 participating school districts. Each individual district will make its own decisions regarding local implementation and all must participate in a rigorous evaluation of the program. All program delivery complies with South Carolina state law.[12] The organization plans to reach 2,400 youth annually.[13]
And in Washington State, whose legislature in 2007 passed the Healthy Youth Act, which requires school districts that choose to teach sexuality education to provide medically and scientifically accurate information that teaches about both abstinence and contraception as well as a variety of other topics, TPPI funds are allowing for a significant expansion of schools’ ability to comply with this state law. At last count, approximately half of the state’s 304 school districts were providing sexuality education in compliance with state law[14] with many struggling to do so because of a lack of adequate resources. However, a $4 million Tier 1 TPPI grant is allowing for a dramatic increase in the number of schools who are able to fulfill the state’s law. Planned Parenthood of the Great Northwest, based in Washington State, is the lead agency implementing the TPPI funded program on behalf of the Northwest Coalition for Adolescent Health. The coalition is implementing the TOP at 73 schools and community agencies in 27 counties across five states—Alaska, Idaho, Montana, Oregon, and Washington and will reach approximately 2,000 youth annually through the program.
Southern States Turn the Tide on Abstinence-Only Programming
The South has long been plagued with high disparities in adolescent sexual health outcomes, including in the areas of teen pregnancy, HIV, and other STDs. Similarly, compared to their counterparts in the rest of the country, a larger percentage of youth surveyed in the South engage in riskier sexual health behaviors. For example, in 2009, all Southern states for which data are available report having a higher percentage of students who have had sexual intercourse prior to age 13; with Mississippi’s rate being the highest at 13.4%, over double the national average of 5.9%.[15] Mississippi also reports the highest percentage of high school students who have had intercourse with four or more partners, 23.7%, and percentages in this category for all Southern states save one, Kentucky, are above the national average of 13.8%.[16] Unfortunately, southern states have also consistently seen the highest concentration of abstinence-only-until-marriage funding over the last several years, and while there continues to be a concentration of Title V abstinence-only funding in southern states (14 of the 16 southern states and of the 30 that applied in Fiscal Year 2010), we have seen of them begin to turn the tide on abstinence-only-until-marriage programs in favor of more comprehensive and evidence-based approaches that reflect community norms and mores. Often times this has the result of coordinated efforts between state agencies and community partners.
For example, the Mississippi PREP state-grant program will provide funding to school districts that have adopted an “abstinence-plus” education policy—now allowed as one option under the new state sex education law–to provide evidence-based sex education to students that addresses both abstinence and contraception. To administer the PREP grant, the department of health partners with Mississippi First, which recently developed the Creating Healthy and Responsible Teens (C.H.A.R.T.) Initiative. Under this initiative, Mississippi First works directly with school districts to assist them in adopting an “abstinence-plus” policy.[17] School districts will then be required to choose from a list of more comprehensive, evidence-based interventions for implementation, which pulls from the list of 28 evidence-based programs used by OAH, as noted above.
Another example of coordinated state and community efforts in favor of more comprehensive, evidence-based approaches can be seen in Louisiana where the Louisiana Department of Health and Hospitals, Office of Public Health, HIV/AIDS Program (HAP) will be using its PREP state-grant to provide funding to local community-based organizations to administer HIV/AIDS prevention programming in targeted high-risk communities.   
While Texas continues to strongly support an abstinence-only-until-marriage approach, some districts are opting to implement “abstinence-plus” programs, which focus on abstinence but include some information on contraception. Schools districts in Austin, Corpus Christi, Harris, Midland, San Antonio and Plano have adopted or are in the process of adopting abstinence-plus curricula with many noting that they are “flipping” to reflect the needs of their students.[18] In addition, in their administration of the state’s Title V abstinence-only grant, the Texas Department of State Health Services is recommending that sub-grantees utilize evidence-based programs.[19] The state developed a list of evidence-based programs for use with the grant funds. Most of the programs on the Texas-approved list are on the list of 28 evidence-based programs approved for use with TPPI Tier 1 funding. Sub-grantees may also choose to implement programs that are not included on the state’s list of approved programs as long as the programs have “demonstrated impacts on sexual activity (including delaying the initiation of sexual activity), contraception use, STDs, and pregnancy and births.”[20]
The availability of new funding is giving states and communities who have historically relied on an abstinence-only-until-marriage approach the needed opportunity to invest in programs that work and to provide instruction to support the health and education needs of all young people.
Much of the Same Old for Title V Abstinence-Only State Grantees
Unfortunately, despite the more flexible guidance, most states that accepted Title V abstinence-only funding are still supporting the same tired, fear- and shame-based, and ineffective abstinence-only-until-marriage programs that they have used for years. South Carolina is still funding Heritage Community Services and Colorado is still funding the Center for Relationship Education, formerly WAIT Training, two of the most prominent abstinence-only-until-marriage industry leaders in the country. In addition, several states are using their Title V abstinence-only funds to administer the popular Choosing the Best curricula, one of the more blatantly fear- and shame-based abstinence-only-until-marriage programs available. The series continues to promote heterosexual marriage, rely on messages of fear and shame, and include biases about gender, sexual orientation, and pregnancy options. This means that, supported by federal funding, students are still being taught that the consequences of pre-marital sex include “guilt, disappointment, worry, depression, sadness, loneliness, and loss of self-esteem”[21] and that they should compare a person who has had pre-marital sex to pre-chewed gum that “isn’t as appealing as when it is unwrapped and new.”[22]
A handful of states, however, are taking advantage of the more flexible guidance and administering less harmful programs with their Title V abstinence-only funds, such as New York’s decision to focus on providing mentoring programs, adult supervision activities, and parent/care giver education to youth ages nine through 12 and their parents/care givers, including youth in foster care and in communities with high need (defined as counties with the highest number of birth to young women under the age of 20). And despite its rejection of PREP funding and its strong abstinence-only-until-marriage law, Florida is taking a page from many PREP state plans around the country and requiring Title V abstinence-only sub-grantees to implement evidence-based programs.  
Former Abstinence-Only-Until-Marriage Grantees Attempt to Remain Relevant
The abstinence-only-until-marriage industry took a significant blow when two-thirds of the federal funding for abstinence-only-until-marriage programs was eliminated in Fiscal Year 2010. Supported by legislators’ affirmation that “programs funded under [TPPI] will stress the value of abstinence and provide age-appropriate information to youth that is scientifically and medically accurate,”[23] advocates worked to ensure that the TPPI funding did not go to the same purveyors of fear- and shame-based misinformation donning their best sheep’s clothing. Unfortunately, despite best efforts, a number of organizations receiving TPPI funding previously received federal abstinence-only-until-marriage grants through the now-defunct Community-Based Abstinence Education (CBAE) and Adolescent Family Life Act (AFLA) funding streams.
Former CBAE-grantees in Florida include Trinity Church, which received $1.7 million in CBAE funds between Fiscal Years 2007 and 2009 and Live the Life Ministries, which between Fiscal Years 2008 and 2009 received nearly $1.2 million in CBAE funds. The latter received a TPPI Tier 2 grant to implement “The WAIT Project,” which trains 80 teachers to use WAIT (Why Am I Tempted?) Training in schools. WAIT Training is an abstinence-only-until-marriage curriculum that uses fear- and shame-based tactics to promote abstinence as the only appropriate behavior outside of marriage and explains to participants, for example, “When it comes to sex, men are like microwaves and women are like crockpots…. [M]en respond sexually by what they see and women respond sexually by what they hear and how they feel about it.”[24]
In Colorado, FRIENDS FIRST received a Tier 1 TPPI grant to administer Project AIM (Adult Identity Mentoring). FRIENDS FIRST also currently receives a Title V abstinence-only sub-grant, which totals $244,400 in funding for Fiscal Year 2010. The organization is both a former CBAE and AFLA grantee. Over the years, it received more than $3 million in CBAE funding and over $1.3 million in AFLA funding. Missouri TPPI-grantee, The Women’s Clinic of Kansas City (TWC), a crisis pregnancy center, received $2.2 million in CBAE funding for Fiscal Years 2005–2007. In Fiscal Year 2008, TWC was awarded an additional five-year CBAE grant and received $1 million in funding before the grant program was eliminated in 2010.TWC used its CBAE funds to support its “LifeGuard Youth Development” program, which aims to educate youth on the “risks and consequences involved in premarital sex” and “the importance of avoiding risky behaviors such as drugs, alcohol, and sex before marriage.”[25] The program administered Choosing the Best curricula in local schools. With its TPPI Tier 1funding, TWC has revamped its “LifeGuard Youth Development” program to administer TOP to students in grades seven through 10. And Father Flanagan’s Boys’ Home, in Nebraska, received a PREIS grant to implement “Your Health, Your Body, Your Responsibility: Promoting Health Behaviors among Teens in Foster Care,” which is an adaptation of the It’s Your Game: Keep it Real curriculum.Father Flanagan’s Boys’ Home is a prominent abstinence-only-until-marriage organization that has received millions of dollars in CBAE and AFLA funding. 
Sex Education under Attack
Whether it is to expand on existing programs or create programs from scratch, communities, educators and advocates have long called on the federal government to provide funding for more comprehensive approaches to sex education, indicating their understanding of the serious need to do better by their young people. The number of applications for TPPI and PREP indicate the clarion call from states and communities that they are in desperate need of federal funding if they are going to provide young people in their communities with the sexual health information and skills building they need. Despite this, conservative policy makers have seen it fit to attack the sexual and reproductive health and rights, including sex education, of Americans at every turn. 
Since the commencement of the 112th Congress, the new Republican majority in the House has acted quickly to drastically reduce the funding of several offices and programs that are dedicated to protecting and improving the health of Americans and has been working to roll back the progress that TPPI and PREP represent—starting with their first major spending proposal, the Consolidated Appropriations Act of 2011. Along with 70 other cuts that would have severely impacted health care access and prevention education, particularly that which benefits women, children, and families, the continuing resolution completely eliminated funding for TPPI. While trying to pass off the elimination under the guise of deficit reduction, the House Republicans targeted programs that many ultra-conservative members of Congress have opposed since their creation or have been trying to eliminate for years. While local communities were eager for funding they could use to serve those residents most in need, conservatives attempted to balance the federal budget on the backs of those who are most vulnerable and in need of health and education services.
After a long, protracted battle and an impending shutdown of the federal government, congressional leaders and White House officials brokered a deal to end the months-long standoff over the federal budget for Fiscal Year 2011 on April 8, 2011, seven months after the beginning of the fiscal year. Thanks to critical advocacy efforts from supporters, TPPI escaped elimination and only received a $5 million cut in its funding level for Fiscal Year 2011. 
But conservative policymakers are still not listening. On September 29, 2011, just weeks prior to the publication of this edition of the SIECUS State Profiles, the Republican majority in the House released their Fiscal Year 2012 Labor, Health and Human Services, and Education (Labor-HHS-Education) spending bill. Continuing their trend of slashing vital health and education programs, the bill decimates funding for TPPI, cutting the funding by $85 million to a total of only $20 million. And in a clear show of their deficit reduction hypocrisy, they included dedicated discretionary funding for ineffective abstinence-only-until-marriage programs, the now-defunct CBAE grant program, at a level of $20 million. The legislation also removes the language requiring TPPI-funded programs be supported by rigorous research or promising models, completely eliminating one of the central tenants of the program—that it be evidence-based and works to build the body of evidence. Because so many abstinence-only-until-marriage programs do not meet this standard, the elimination of this requirement further shows the true intent of conservative lawmakers—to appease the abstinence-only-until-marriage industry while sacrificing the best interests of our nation’s young people. The Senate Appropriations Committee on the other hand, passed their version of the Labor-HHS-Education bill with a clear show of support for sexual and reproductive health in these tight fiscal times. The Senate funding bill provided level funding for TPPI and no dedicated discretionary funding for abstinence-only-until-marriage programs. As the Fiscal Year 2012 appropriations process continues, advocates will continue to work with supportive House Members, the Senate, and the administration to protect funding for TPPI and ensure that no dedicated discretionary abstinence-only-until-marriage funding is included in the final legislation.
Also on the Republican agenda has been an effort to repealhealth care reform, the Patient Protection and Affordable Care Act (P.L. 111–148). Following their unsuccessful attempt to enact a full repeal of the legislation, House Republicans instead set out to dismantle it piece-by-piece. Their attempts have included the introduction of H.R. 1215 which would convert the $75 million in mandatory funding allocated annually for PREP to discretionary funding. If successful, their efforts would subject PREP to the politically charged annual appropriations process, during which conservatives would have the opportunity to continue to attack, and even eliminate, the funding stream.
Despite their purported desire to cut unnecessary government spending and their clear intent to eliminate any program associated with health care reform, House Republicans did not also attempt to shift the Title V abstinence-only program from mandatory to discretionary spending, despite the fact that the program was resurrected through health care reform and the federal government’s own study showed the ideologically driven programs have “no beneficial impact on young people’s sexual behavior.”[26] During consideration of the bill, Democrats on the House Energy and Commerce Committee noted the “misguided, deeply divisive, and unabashedly hypocritical” nature of H.R. 1215.[27] As they noted in their Dissenting Views: “Republicans had no answer when asked how they could justify these positions given their staunch objection to mandatory funding as a matter of principal [sic]—opposing mandatory spending not necessarily because of the substance of a program, but because of the stated belief that mandatory spending usurps Congress’s prerogative to fund or not to fund health programs.”[28] H.R. 1215 passed out of the full House Energy and Commerce Committee; however, it has yet to come to a vote on the House floor.
These attacks on TPPI and PREP clearly indicate that conservatives in the House and Senate have sexuality education in their crosshairs. And, as always, advocates and Members of Congress supportive of comprehensive sexuality education are not hesitating to fight back. Recognizing the substantial body of research proving abstinence-only-until-marriage programs ineffective and the fact that such programs require a censorship of medical information, Senator Frank Lautenberg (D-NJ) and Congresswoman Barbara Lee (D-CA) introduced the Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011 (S. 578 and H.R. 1085) in March 2011. Introduced for the first time in 2010, the bill would strike Title V, Section 510 of the Social Security Act (42 U.S.C. 710) from statute and transfer the funding allocated for the Title V abstinence-only program to PREP in order to provide even more young people with access to medically accurate, age-appropriate comprehensive sexuality education, free from stigma and prejudice.[29]
Advocates for comprehensive sexuality education have seen a dramatic shift in how federal, state, and local governments approach sex education. We have fortunately reached a time when the positive examples of policies and programs across the country are too numerous to mention in this brief overview. But we cannot rest on our laurels. It is up to comprehensive sexuality education advocates to ensure that federal, state, and local policies, initiatives, and funding streams are protected and built upon moving forward. Because every day it becomes clearer that conservative policy makers and the abstinence-only-until-marriage industry have not heard that clarion call from advocates, educators, parents and youth that they want more comprehensive approaches to sex education in their schools and communities
In the short term, we need to continue to work with supportive local, state, and federal policymakers to protect funding and policies for more comprehensive approaches to sex education. We must also work to quash the attacks on sexual and reproductive health, including sex education, to ensure that the prevention and education needs of young people are not thrown under the bus. But, for the long haul, we must remain ever vigilant in our efforts to provide young people with the information they need to make responsible and informed decision about their sexual health and the tools and skills so they can empower themselves to success. We must continue our efforts until we see the day when abstinence-only-until-marriage programs are truly eliminated and comprehensive approaches to sex education allowed to flourish.

[1]“National HIV/AIDS Strategy for the United States,” White Office of National AIDS Policy, July 2010, accessed 28 September 2011, <>.
[2]“National Prevention Strategy: America’s Plan for Better Health and Wellness,” National Prevention Council, June 2011, accessed 28 September 2011, <>.
[3]For more information, including a chart detailing the funding stream(s) for which each state applied, please see State by State Decisions: The Personal Responsibility Education Program and Title V Abstinence-Only Program.
[4]“Overview of the Teen Pregnancy Prevention Research Evidence Review,” Office of Adolescent Health, accessed 28 September 2011, <>.
[7]  Sec. 2953 – Personal Responsibility Education, Patient Protection and Affordable Care Act, Public Law No: 111-148.
[8]  “Estimated HIV Incidence in the United States, 2006–2009,” 3 August 2011, accessed 28 September 2011, <>.
[9]Personal Responsibility Education Program State Plan, New York State Department of Health, accessed 16 September 2011, <>, 32.
[10]Ibid., 33–34, 49.
[12]“CEO Announces Significant Grants to Intensity its Efforts,” South Carolina Campaign to Prevent Teen Pregnancy, 30 September 2010, accessed 15 May 2011, <>.
[13]“Teenage Pregnancy Prevention: Summary of Funded Evidence-Based Programs for 2010,” U.S. Department of Health & Human Services, accessed 14 April 2011, <>.
[14]Information provided by Caitlin Safford, program organizer for NARAL Pro-Choice Foundation of Washington, 3 June 2010.
[15]Danice K. Eaton, et. al., “Youth Risk Behavior Surveillance—United States, 2009,” Surveillance Summaries, Morbidity and Mortality Weekly Report 59.SS-5 (4 June 2010), accessed 14 June 2010, <>, Table 62.
[16]Ibid., Table 64. 
[17]“Creating Healthy and Responsible Teens (C.H.A.R.T.) Initiative, <>.
[18]Morgan Smith, “More Schools Choose to Teach Abstinence-Plus,” Texas Tribune, 15 September 2011, accessed 26 September 2011, <>.
[19]Information provided by Melanie Jamison, program coordinator for Abstinence-Centered Teen Pregnancy Prevention within the Texas Department of State Health Services, 2 March 2011.
[21]Bruce Cook, Choosing the Best JOURNEY, (Marietta, GA: Choosing the Best, Inc., 2006).
[22]Bruce Cook, Choosing the Best WAY, (Marietta, GA: Choosing the Best, Inc., 2006).
[23]Consolidated Appropriations Act, 2010, Pub. L. No. 111–117, 123 Stat. 3253, accessed 8 June 2010, <>. 
[24]Joneen Krauth-Mackenzie, WAIT (Why Am I Tempted) Training, Second Edition (Greenwood Village, CO: WAIT Training, undated).  For more information, see SIECUS’ review of WAIT Training at <>.
[26]U.S. House of Representatives, “A Report on H.R. 1215, a Bill to Amend Title V of the Social Security Act to Convert Funding for Personal Responsibility Education Programs from Direct Appropriations to an Authorization of Appropriations, with Dissenting Views,” H. Rpt. 112–63, 27 April 2011,  accessed 14 June 2011, <>.
[29]Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2010, S. 3878, 111th Congress, § 2.3 (2010), accessed 15 October 2010, <>.
National Coalition to Support Sexuality Education National Coalition to Support Sexuality Education