Maree Hampton’s sons get sexual health education at school, but she’s also told her older son, who’s 17 and in a relationship, where to find the Annex Teen Clinic in Robbinsdale.
She doesn’t know if he’s been there, but “it just gives me a calm sort of feeling to know that there is a resource where they won’t be judged,” said Hampton, who serves on the clinic’s board.
Founded 46 years ago by faith leaders, Annex Teen Clinic provided sexual health services to 1,782 youth in 2016. It takes its message to public schools, contributing to a dramatic drop in Hennepin County’s teen birthrate. Annex installs health mentors in some schools to work one-on-one with students and provides training for teachers and parents, in addition to its clinical services.
Now some of the clinic’s programs and jobs, and other Hennepin County efforts to prevent teen pregnancy, are at risk. President Donald Trump’s administration in July announced an abrupt end — two years early — to what were supposed to be five-year grants specifically aimed at preventing teen pregnancy.
In all, the U.S. Health and Human Services Department notified 81 programs in 31 states and the District of Columbia that $214 million in funding will end June 30, 2018, instead of in 2020.
Officials here and across the country are fighting to save the grants, but worry that the Republican-controlled Congress will not restore funding. Hennepin County Commissioner Mike Opat said he’ll urge the county to fill the gap if its appeal fails.
“We’ve had so much momentum, and it just makes you want to cry to think that we have to hit the brakes” on teen pregnancy prevention efforts, Opat said.
The county has been getting $1.5 million a year, and about $435,000 of that has gone to the Annex Teen Clinic — about a fifth of its total budget, Executive Director Brian Russ said. The grant’s loss could mean eliminating six Annex positions, said Ellen Saliares, its sexuality education director.
Less money also jeopardizes other county efforts to define, implement and assess teen pregnancy prevention programs with partners that include the Minneapolis Health Department, Planned Parenthood, NorthPoint Health and Wellness, and public schools. The work focuses on areas with the highest teen birthrates: central and north Minneapolis, Brooklyn Center, Richfield and Robbinsdale.
There were 419 births to teens in Hennepin County in 2016, down from 2006, when there were 1,139. “It’s a pretty significant success story in public policy,” Russ said.
Although he was blindsided by the decision to end the grants, Russ recalled watching the November election results and thinking, “This isn’t good.”
The letter notifying the county of an early end to the grants was “a complete shock,” said Kathy Wick, who manages the Better Together Hennepin project for the county’s Human Services and Public Health Department.
About 65 percent of its funding is from the federal grant. It pays for 28 health educators in six community-based organizations — including Annex — and almost three-fourths of operating costs and salaries at Better Together Hennepin.
“This is really throwing science under the bus,” Wick said. “We know this works.”
Mark Vafiades, an HHS spokesman, said that’s not at all clear. “The very weak evidence of positive impact of these programs stands in stark contrast to the promised results,” he said in a statement, and that’s why the administration “hit the pause button.”
The Obama administration commissioned an independent evaluation of some programs that received the first round of five-year grants in 2010. Most were found to be no more effective than school or community sex education programs already in place.
Brian Goesling, a senior researcher at the independent, nonpartisan Mathematica Policy Research in New Jersey, led a review of pregnancy prevention programs before that first batch of grants and later helped assess some of the results.
He said that the challenges identified then continue now: “identifying programs that have some potential for success … and trying to figure out how we can transport them to other places.”
Goesling also said that he has seen no research establishing a link between the pregnancy prevention programs and “broader trends in teen birthrates.”
Jill Farris, director of sexual health training and education at the University of Minnesota’s Healthy Youth Development/Prevention Research Center, said there is evidence that the programs work, and “to see them on the chopping block is pretty disheartening.”
Hennepin County’s efforts are valuable “because they are in lots of different places with lots of different young people,” Farris said, and the drop in teen birthrates proves there’s a positive return on the investment from the federal grant money.
Opponents of the decision pointed out that Valerie Huber, the former leader of Ascend, an abstinence advocacy group, was recently named chief of staff to the HHS assistant secretary who oversees adolescent health. “We must normalize sexual delay more than we normalize teen sex, even with contraception,” Huber said in a 2016 PBS interview.
Three abstinence programs also will lose their grants.
Farris called abstinence until marriage “a worthy goal” but added, “At some point, everyone needs to know about birth control methods.”
Efforts to reverse the grants’ demise have spread across the country. Health officials from 20 U.S. cities have written to HHS Secretary Tom Price to denounce the grants’ elimination. Minnesota Reps. Keith Ellison, Betty McCollum and Tim Walz are among 148 House Democrats who sent a July 25 letter to Price demanding an explanation within 45 days for the decision, which came just three months after Congress voted to provide full funding for the latest grants.
“At a time when young people are most in need of information and education to protect their sexual and reproductive health, this administration is denying evidence and science,” the legislators wrote.
Genevieve Martinez-Garcia, project director for a Baltimore project that’s losing its $723,000 annual federal grant, shares that view. “I am dismayed that the administration is putting personal values in place of science and evidence,” she said.
Baltimore’s Healthy Teen Network is conducting a clinical trial to evaluate a mobile app called Pulse that gives teens information about healthy sexual relationships and focuses on helping them decide to delay having sex.
Although the project is hunting for funding from other sources, the loss of federal funds means a Spanish-language version of the app probably won’t be developed and a planned long-term follow-up period will be shortened, Martinez-Garcia said.
But the work will continue. “Funds or no funds, we’re not going away,” she said.
Programs across the U.S. are scrambling:
• A Chicago Department of Public Health project that’s testing a school-based education and sexually transmitted infection screening program will lose $1 million a year.
Even if funding is found elsewhere, principal investigator Dr. Lisa Masinter said adjustments will have to be made in “how many students we assess and how long we follow them.”
• The South Carolina Campaign to Prevent Teen Pregnancy faces the loss of at least 60 percent of its funding after the elimination of two federal grants totaling $2.2 million for projects it credits with helping to reduce the state’s teen pregnancy rate by 44 percent over six years.
CEO Beth De Santis said the organization appealed to its congressional delegation to fight for a restoration of funding but added, “I’m not getting the feeling that it is top of the list for them to fight for.”
• The Johns Hopkins Center for American Indian Health will forfeit $880,000 a year for a program called Respecting the Circle of Life, a comprehensive project meant to lead to healthy choices that’s being tested by an Arizona tribe.
“We’re having to stop this evaluation midstream,” said the center’s associate director, Lauren Tingey. If money can’t be found elsewhere to continue it, she said, “taxpayer money spent in the first three years will be in vain.”
Wick hasn’t given up hope for the Hennepin County grant, calling the decision to pull the plug on it “unfounded given our great performance.” For the Trump administration “to criticize a program for working to nail down the most effective programs for specific populations is unfair and disingenuous.”
Hampton is just as blunt. “It’s just crazy,” she said, “not to be doing this work when we know it works.”