Funding for Abstinence-Only Education and Adolescent Pregnancy Prevention: Does State Ideology Affect Outcomes?

Am J Public Health. 2019 Mar;109(3):497-504. doi: 10.2105/AJPH.2018.304896. Epub 2019 Jan 24.


Objectives: To examine the relationship between adolescent pregnancy-prevention and sexuality and abstinence-only education funding and adolescent birthrates over time. Also, to determine whether state ideology plays a moderating role on adolescent reproductive health, that is, whether the funding has its intended effect at reducing the number of adolescent births in conservative but not in liberal states.

Methods: We modeled time-series data on federal abstinence-only and adolescent pregnancy-prevention and sexuality education block grants to US states and rates of adolescent births (1998-2016) and adjusted for state-level confounders using 2-way fixed-effects models.

Results: Federal abstinence-only funding had no effect on adolescent birthrates overall but displayed a perverse effect, increasing adolescent birthrates in conservative states. Adolescent pregnancy-prevention and sexuality education funding eclipsed this effect, reducing adolescent birthrates in those states.

Conclusions: The millions of dollars spent on abstinence-only education has had no effect on adolescent birthrates, although conservative states, which experience the greatest burden of adolescent births, are the most responsive to changes in sexuality education-funding streams.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Family Planning Services / economics*
  • Family Planning Services / statistics & numerical data
  • Family Planning Services / trends*
  • Female
  • Forecasting
  • Humans
  • Pregnancy
  • Pregnancy in Adolescence / prevention & control*
  • Sex Education / economics*
  • Sex Education / statistics & numerical data
  • Sex Education / trends*
  • Sexual Abstinence*
  • United States