Teen pregnancy prevention programs

There is some evidence that pregnancy prevention programs reduce sexual activity, reduce sexually transmitted infections (STIs), increase use of contraceptives (Goesling 2014) including condom use (Bordogna 2023, Cochrane-Lopez 2016a), and reduce teenage pregnancy (Bordogna 2023, Goesling 2014, Harden 2009, Cochrane-Oringanje 2016). However, effects vary by program and community context (Farb 2016); additional evidence is needed to confirm effects (Cochrane-Lopez 2016a, Juras 2019, Cochrane-Oringanje 2016).

Programs that focus on specific skills and take place over longer periods of time may be more effective than shorter or more general programs (Robin 2004), and individualized programs may work better than group programs (Juras 2019). To be effective, messaging should be consistent, tailored to the audience, and comprehensive; social and cultural factors should be considered when tailoring messaging (Knopp 2021). Evidence about the effects of teen pregnancy prevention programs is strongest for Black youth; more studies are needed to confirm effects for other groups, particularly Latinos and populations at high risk of teenage pregnancy such as youth in foster care and American Indian and Alaska Natives (Goesling 2014). There are a wide range of teen pregnancy prevention programs. Program effects and effectiveness can vary based upon population and setting, and local community needs are crucial in determining which program is most appropriate (Goesling 2014).

Service learning programs decrease pregnancy rates among adolescents (CG-HIV/AIDS and pregnancy, Kirby 2007) and may also delay the initiation of sexual intercourse, reduce frequency of sex, and increase the use of condoms and other contraceptives (Alford 2012, Kirby 2007, CG-HIV/AIDS and pregnancy, Urban-Eisen 2000). Youth development (Harden 2009) and multi-component programs appear to lower the rate of unintended pregnancy among adolescents (Cochrane-Oringanje 2016, Kirby 2007, Campbell-Scher 2006). Some programs for pregnant and parenting teens can decrease rapid repeat pregnancy (Corcoran 2007, Akinbami 2001). Comprehensive risk reduction programs reduce behaviors such as engagement in sexual activity, frequency of sexual activity, number of partners, and frequency of unprotected sexual activity (Underhill 2007, Cochrane-Underhill 2008, CG-HIV/AIDS and pregnancy, Chin 2012, Mathematica-Knab 2019). Comprehensive risk reduction programs also increase use of contraception (Bordogna 2023, Chin 2012, CG-HIV/AIDS and pregnancy, Campbell-Scher 2006, Bennett 2005) and may also reduce pregnancy (Chin 2012, Cochrane-Underhill 2008, Underhill 2007) and STIs among adolescents (CG-HIV/AIDS and pregnancy, Chin 2012).

To continue reducing teen pregnancy, experts suggest increasing teens’ knowledge about contraceptives, improving accessibility of contraceptive services for teens, strengthening social norms around the significance of pregnancy and postponing pregnancy after adolescence, and engaging in high-quality research to inform program efforts (Brown 2020).

Teen pregnancy prevention programs have the potential to decrease disparities in teen pregnancy between adolescents of color and those who are white when programs are tailored and/or provided in locations and communities experiencing higher teen birth rates and administered to populations most in need (Maness 2013). However, effects vary by program, context, and population. Many evaluations of teen pregnancy prevention programs measure outcomes related to intention to engage in sexual activity rather than teen pregnancy or birth outcomes (Goesling 2014), making it difficult to understand how effective programs are at reducing pregnancy among adolescents of color (Maness 2013).

Teen pregnancy prevention programs can be tailored to meet community needs (Goesling 2014). Some programs to reduce rapid repeat pregnancy among Black adolescent mothers have been effective at reducing pregnancy in participants (Lewin 2019, Maness 2013). Curriculum adapted by Native communities to incorporate culturally appropriate language and learning appears to increase self-efficacy (Tingey 2022, Kenyon 2019) and parent and child communication on sexual health topics (Chambers 2022). Implementation of programs in predominantly Latinx schools may improve knowledge and self-efficacy (Manlove 2021) and may increase contraceptive use in the short-term (Mathematica-Covington 2017).

Evidence for other high risk groups vary. Programs serving youth in foster care and involved in the juvenile justice system suggest comprehensive sexual education programs may increase use of contraception by adolescent males 17 years old and older who live in group homes, but not among younger participants (Mathematica-Covington 2016). Another program increased knowledge around sexual activity and improved youth attitudes toward birth control for juvenile justice participants (Combs 2019). A program for homeless teenage girls linked them to sexual health care and increased birth control use (Begun 2019). A Kentucky-based study suggests teen pregnancy prevention programs in rural communities may increase the use of contraception among teens that were already sexually active (Mathematica-Goesling 2018).

To eliminate racial disparities in teen birth rates, public health officials should address social determinants of health (SDOH) specific to a community and effectively engage partners in order to have a broad impact in their community (Fuller 2018).

Before the 1960s, social norms largely prevented teaching sex education and sexual health outside the home (Elia 2009). Sex education in schools began receiving widespread support in the 1960s but it was met with resistance from more socially conservative groups. By the 1980s a majority of people supported incorporating sex education into public school curriculums, though persistent disagreements around the use of comprehensive sex education approaches or abstinence only programs became prominent and have persisted in to present day politics (Kantor 2008).

Teen pregnancy rates have been declining since 1991 (CDC-Teen pregnancy), which may be due to teens delaying or not engaging in sexual activity (Brindis 2020, Brookings-Sawhill 2019a), decreasing overall numbers of sexual partners, more consistent use of contraception (Brindis 2020), and increased use of long acting reversible contraceptives (Brookings-Sawhill 2019a). During this time period, many communities implemented evidence-based programs designed to prevent teen pregnancies, which had a positive impact on youth behavior (Salas-Wright 2019). However, teen pregnancy rates in the U.S. are still higher than in the industrialized world and racial and geographic disparities exist within the country (CDC-About teen pregnancy).

While birth rates have decreased over the years, they remain high for young women of color (Fuller 2018, CDC-About teen pregnancy), and those for American Indian and Alaska Natives, Asians, Native Hawaiians, and other Pacific Islander adolescents have seen little to no change recently (CDC-About teen pregnancy). American Indian and Alaska Native teens have the highest birth rates, and Hispanic and Black teens’ birth rates are two times higher than that of non-Hispanic White teens (CDC-About teen pregnancy).

• Do adolescents in your community have access to the necessary knowledge and resources to prevent teen pregnancy?
• Where can a teen pregnancy prevention program be implemented in your community (i.e., school, in conjunction with extracurricular programs, religious communities)?
• How can you adapt a teen pregnancy prevention program to meet your community's needs?
• Is your teen pregnancy prevention program linguistically and culturally appropriate for your community? Are there any barriers to accessibility?

As of 2023, the U.S. Department of Health and Human Service’s Office of Adolescent Health funds 79 grants to communities, through the Teen Pregnancy Prevention (TPP) Program. The TPP program is housed in the Office of Population Affairs (OPA) and is an evidence-based program that funds diverse organizations that are working towards preventing teen pregnancy (US DHHS-TPP).

There are many examples of teen pregnancy prevention programs. Reducing the Risk is an evidence-based sexual health curriculum designed to help prevent pregnancy and STIs. States that have implemented this program include Missouri, Texas, and California (Kelsey 2016), and it has been implemented in rural Kentucky through a federal grant funded by the Personal Responsibility Education Program (PREP) (Mathematica-Goesling 2018). PREP awards grants for programs educating teens on both abstinence and contraception to prevent pregnancies and STIs. PREP focuses on providing education to youth ages 10-19 who are homeless, in foster care, live in rural areas, live in areas with high teen birth rates, or from racial or ethnic minority groups (ACF-FYSB PREP Fact sheet).

To expand accessibility to knowledge around sexual health public health officials, with the help of web developers, have created an evidence informed software application that can be used on smartphones. The interactive app is designed to provide adolescent girls patient-centered contraceptive information in both English and Spanish (Tebb 2019). In response to the COVID-19 pandemic, some in-person teen pregnancy prevention programs, like Respecting the Circle of Life, moved to a virtual platform, which was found to be a feasible and acceptable format (Patel 2022).

‡ Resources with a focus on equity.

Brookings-Sawhill 2019a^‡ - Sawhill IV, Guyot K. Preventing unplanned pregnancy: Lessons from the states. Washington, D.C.: Brookings Institution; 2019.

CEBC - California Evidence-Based Clearinghouse for Child Welfare (CEBC). Information and resources for child welfare professionals: List of programs.

Connaughton-Espino 2021 - Connaughton-Espino T, Reese BM. North Carolina Youth Connected: Lessons learned in engaging community leaders in preventing teen pregnancy. Progress in Community Health Partnerships: Research, Education, and Action. 2021;15(4):517-524.

SPTW - Social Programs That Work (SPTW). Full list of programs.

US DHHS-OPA-NTPPM Toolkit - U.S. Department of Health and Human Services (U.S. DHHS), Office of Population Affairs (OPA). National Teen Pregnancy Prevention Month (NTPPM) toolkit. 2021.

US DHHS-TPP Programs - U.S. Department of Health and Human Services (U.S. DHHS), Office of Adolescent Health (OAH). Teen pregnancy prevention resource center (TPP): Evidence-based programs (31 programs).

YG-Teen pregnancy prevention - Youth.gov (YG). Welcome to the teen pregnancy prevention evidence review.

* Journal subscription may be required for access.

ACF-FYSB PREP Fact sheet - State Personal Responsibility Education Program (PREP) fact sheet. Family and Youth Services Bureau (FYSB), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (U.S. DHHS); 2020.

Akinbami 2001 - Akinbami LJ, Cheng TL, Kornfeld D. A review of teen-tot programs: Comprehensive clinical care for young parents and their children. Adolescence. 2001;36(142):381-393.

Alford 2012 - Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. Washington, D.C.: Advocates for Youth; 2012.

Begun 2019* - Begun S, Combs KM, Torrie M, et al. “It seems kinda like a different language to us:” Homeless youths’ attitudes and experiences pertaining to condoms and contraceptives. Social Work in Health Care. 2019;58(3):237-257.

Bennett 2005* - Bennett SE, Assefi NP. School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials. Journal of Adolescent Health. 2005;36(1):72-81.

Bordogna 2023* - Bordogna AL, Coyle AC, Nallamothu R, Manko AL, Yen RW. Comprehensive sexuality education to reduce pregnancy and STIs in adolescents in the United States: A systematic review and meta-analysis. American Journal of Sexuality Education. 2023;18(1):39-83.

Brindis 2020 - Brindis CD, Decker MJ, Gutmann-Gonzalez A, Berglas NF. Perspectives on adolescent pregnancy prevention strategies in the United States: Looking back, looking forward. Adolescent Health, Medicine and Therapeutics. 2020;11:135-145.

Brookings-Sawhill 2019a - Sawhill IV, Guyot K. Preventing unplanned pregnancy: Lessons from the states. Washington, D.C.: Brookings Institution; 2019.

Brown 2020 - Brown SS. What will it take to further reduce teen pregnancy in the U.S.? Journal of Adolescent Health. 2020;66(5):522-523.

Campbell-Scher 2006* - Scher L, Maynard RA, Stagner M. Interventions intended to reduce pregnancy-related outcomes among adolescents. Campbell Systematic Reviews. 2006:12.

CDC-About teen pregnancy - Centers for Disease Control and Prevention (CDC). About teen pregnancy.

CG-HIV/AIDS and pregnancy - The Guide to Community Preventive Services (The Community Guide). HIV/AIDS, STIs, and pregnancy.

Chambers 2022* - Chambers R, Rosenstock S, Patel H, et al. Improving communication between American Indian youth and caregivers to prevent teenage pregnancy. Health Education Research. 2022;37(1):23-35.

Chin 2012* - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-294.

Cochrane-Lopez 2016a* - Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database of Systematic Reviews. 2016;(6):CD012249.

Cochrane-Oringanje 2016* - Oringanje C, Meremikwu MM, Eko H, et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database of Systematic Reviews. 2016;(2):CD005215.

Cochrane-Underhill 2008* - Underhill K, Montgomery P, Operario D. Abstinence-plus programs for HIV infection prevention in high-income countries. Cochrane Database of Systematic Reviews. 2008;(1):CD007006.

Combs 2019* - Combs KM, Aparicio EM, Prince DM, et al. Evidence-based sexual health programs for youth involved with juvenile justice and child welfare systems: Outcomes across settings. Children and Youth Services Review. 2019;100:64-69.

Corcoran 2007* - Corcoran J, Pillai VK. Effectiveness of secondary pregnancy prevention programs: A meta-analysis. Research on Social Work Practice. 2007;17(1):5-18.

Elia 2009* - Elia J. Chapter 3: School-based sexuality education: A century of sexual and social control. In: Schroeder E, Kuriansky J, eds. Sexuality education: Past, present, and future, Vol 4: Emerging techniques and technologies. Westport: Praeger; 2009:33-57.

Farb 2016 - Farb AF, Margolis AL. The Teen Pregnancy Prevention Program (2010-2015): Synthesis of impact findings. American Journal of Public Health. 2016;106(S1):S9-S15.

Fuller 2018* - Fuller TR, White CP, Chu J, et al. Social determinants and teen pregnancy prevention: Exploring the role of nontraditional partnerships. Health Promotion Practice. 2018;19(1):23-30.

Goesling 2014* - Goesling B, Colman S, Trenholm C, Terzian M, Moore K. Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: A systematic review. Journal of Adolescent Health. 2014;54(5):499-507.

Harden 2009* - Harden A, Brunton G, Fletcher A, Oakley A. Teen pregnancy and social disadvantage: Systematic review integrating controlled trials and qualitative studies. BMJ. 2009;339:b4254.

Juras 2019* - Juras R, Tanner-Smith E, Kelsey M, Lipsey M, Layzer J. Adolescent pregnancy prevention: Meta-analysis of federally funded program evaluations. American Journal of Public Health. 2019;104(4):e1-8.

Kantor 2008 - Kantor LM, Santelli JS, Teitler J, Balmer R. Abstinence-only policies and programs: An overview. Sexuality Research & Social Policy. 2008;5(3):6-17.

Kelsey 2016 - Kelsey M, Blocklin M, Layzer J, et al. Replicating Reducing the Risk: 12-month impacts of a cluster randomized controlled trial. American Journal of Public Health. 2016;106(S1):S45-S52.

Kenyon 2019 - Kenyon DB, McMahon TR, Simonson A, et al. My Journey: Development and practice-based evidence of a culturally attuned teen pregnancy prevention program for Native youth. International Journal of Environmental Research and Public Health. 2019;16(3):470.

Kirby 2007 - Kirby D. Emerging answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, D.C.: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007.

Knopp 2021 - Knopp K, Rhoades G, Rue L, Floren M, Floren K. Messaging considerations in teen pregnancy and sexually transmitted infection prevention. Health Behavior and Policy Review. 2021;8(6):596-608.

Lewin 2019* - Lewin A, Mitchell SJ, Quinn DA, et al. A primary care intervention to prevent repeat pregnancy among teen mothers. American Journal of Preventive Medicine. 2019;56(3):404-410.

Maness 2013 - Maness SB, Buhi ER. A systematic review of pregnancy prevention programs for minority youth in the U.S.: A critical analysis and recommendations for improvement. Journal of Health Disparities Research and Practice. 2013;6(2):91-106.

Manlove 2021* - Manlove J, Welti K, Whitfield B, et al. Impacts of Re:MIX—A school-based teen pregnancy prevention program incorporating young parent coeducators. Journal of School Health. 2021;91(11):915-927.

Mathematica-Covington 2016 - Covington RD, Goesling B, Tuttle C, et al. Final impacts of the POWER Through Choices Program: Impact report from the evaluation of adolescent pregnancy prevention approaches. Washington, D.C.: Mathematica Policy Research (MPR); 2016.

Mathematica-Covington 2017 - Covington RD, Luca DL, Manlove J, et al. Final impacts of AIM 4 Teen Moms. Princeton: Mathematica Policy Research (MPR); 2017.

Mathematica-Goesling 2018 - Goesling B, Lee J, Wood RG, et al. Evaluating a teen pregnancy prevention program in rural Kentucky. Washington, D.C.: Mathematica Policy Research (MPR); 2018.

Mathematica-Knab 2019 - Knab J, Wood RG, Lee J, et al. Delivering adolescent pregnancy prevention to high-risk youth: The impacts of Teen Choice in New York. Princeton: Mathematica Policy Research (MPR); 2019.

Patel 2022 - Patel H, Masten K, Chambers R, et al. Feasibility and acceptability of virtual implementation of a sexual reproductive health teen pregnancy prevention program for Native youth. American Indian and Alaska Native Mental Health Research. 2022;29(2):63-84.

Robin 2004* - Robin L, Dittus P, Whitaker D, et al. Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: A decade in review. Journal of Adolescent Health. 2004;34(1):3-26.

Salas-Wright 2019* - Salas-Wright CP, AbiNader MA, Vaughn MG, Sanchez M, De La Rosa M. Trends in participation in teen pregnancy and STI prevention programming, 2002–2016. Preventive Medicine. 2019;126:105753.

Tebb 2019 - Tebb KP, Leng Trieu S, Rico R, et al. A mobile health contraception decision support intervention for Latina adolescents: Implementation evaluation for use in school-based health centers. JMIR Mhealth Uhealth. 2019;7(3):e11163.

Tingey 2022* - Tingey L, Chambers R, Littlepage S, et al. The Respecting the Circle of Life teen pregnancy prevention intervention: Its impact among different subgroups of Native American youth. Children and Youth Services Review. 2022;138:106533.

Underhill 2007 - Underhill K, Operario D, Montgomery P. Systematic review of abstinence-plus HIV prevention programs in high-income countries. PLoS Medicine. 2007;4(9):e275.

Urban-Eisen 2000 - Eisen M, Pallito C, Brader C, Bolshun N. Teen risk-taking: Promising prevention programs and approaches. Washington, D.C.: Urban Institute; 2000.

US DHHS-TPP - U.S. Department of Health and Human Services (U.S. DHHS): Office of Adolescent Health (OAH). Teen pregnancy prevention resource center (TPP).