General Articles

Overwhelming Majority of States Choose PREP over Title V Abstinence-Only Funds

States submitted their initial grant application materials to the U.S. Department of Health and Human Services on August 30, 2010 for the Personal Responsibility Education Program (PREP) and Title V abstinence-only state-grant program for Fiscal Year (FY) 2010 funds. This marks the first year for which federal funds are available to support comprehensive sex education programs that teach about the importance of delaying sexual initiation as well as the effectiveness of contraceptive use among other topics discussed.
The PREP state grant, passed into law through health care reform, the Patient Protection and Affordable Care Act (P.L. 111-148) of 2010, totals $75 million per year in mandatory funding for a period of five years, 2010–2014, with just over $55 million dedicated to state grants. The grant program awards a minimum of $250,000 per year to each state that applies for the funds. Programs supported by PREP are required to provide information on both abstinence and contraception for the prevention of unintended pregnancy and sexually transmitted diseases, including HIV/AIDS, with a substantial emphasis on both abstinence and contraceptive use. Programs must also address three of the following adulthood preparation topics: healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills. The grant requires no matching funds from states.
The Patient Protection and Affordable Care Act also reauthorized the failed Title V abstinence-only-until-marriage program for five additional years, also 2010–2014. While the abstinence-only grant program originally expired on June 30, 2009, it was resurrected by conservative lawmakers during consideration of the health care reform bill and kept in the final legislation signed by the president in a last-minute bargaining move. The Title V abstinence-only state-grant program totals $250 million over the next five years and requires states to contribute 75% of the grant in matching funds.
The guidelines issued for the FY 2010 Title V abstinence-only grant offer more flexibility than in previous years on how the funds can be used; however, programs supported by the grant must still teach abstinence to the exclusion of other sexual health and prevention methods and may in no way contradict the A–H definition for “abstinence education” that is included in federal statute. The definition specifies, in part, that “a mutually faithful monogamous relationship in the context of marriage is the expected standard of all human sexual activity” and that “sexual activity outside the context of marriage is likely to have harmful psychological and physical effects.”[1]
Despite the grant’s revised guidelines, only a small number of additional states opted back into the Title V abstinence-only program for FY 2010 as compared to FY 2009. In total, 30 states and Puerto Rico submitted initial application materials for the grant this year, compared to 26 states and Puerto Rico that applied for the funds in FY 2009. In contrast, 43 states, the District of Columbia, the Federated States of Micronesia, and Puerto Rico applied for the PREP funds. 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. Finally, only three states did not apply for either program—Hawaii, Indiana, and Nevada; however, both Hawaii and Nevada plan to apply for FY 2011 PREP funds.
Given that the overwhelming majority of states applied for funding that supports comprehensive sex education, it is clear that states recognize the need to teach young people age-appropriate and medically accurate information that is complete and that gives them the tools and skills necessary to make informed decisions and develop healthy relationships. Even among the seven states that chose to reapply for Title V abstinence-only funds in FY 2010 after having rejected the funds in previous years, five of these states also applied for PREP funds. Only Minnesota and Virginia chose to apply for Title V abstinence-only funding and not to apply for PREP funds.
Sexual and reproductive health advocates in both Minnesota and Virginia have criticized their governors’ decisions to reject funding for comprehensive sex education as political maneuvers aimed to appeal to conservative voters and leverage the decisions for personal political gain. “We are outraged Governor Tim Pawlenty is willing to continue to play games with the lives of Minnesota youth,” Linnea House, executive director of NARAL Pro-Choice Minnesota, was quoted as saying in the Minnesota Independent. “During a time of tremendous budgetary challenges for our state, the governor has once again shown that he will put his political games ahead of sound policy recommendations.”[2]
It has been reported that Pawlenty is a Republican presidential hopeful for the 2012 election; and he has taken a strong stance publicly against health care reform—what he refers to as “Obamacare”—and instructed state agencies to reject any funding associated with health care reform. Pawlenty stated in a news release that “Obamacare is an intrusion by the federal government into personal health care matters and it’s an explosion of federal spending. . . . To the fullest extent possible, we need to keep Obamacare out of Minnesota.”[3]
Governor Bob McDonnell of Virginia has also opposed the new health care reform law. After the Patient Protection and Affordable Care Act was enacted in March of this year, Virginia filed a lawsuit opposing the constitutionality of the new law along with 20 other states. A spokesperson for McDonnell, Stacey Johnson, stated that his decision to forego PREP funds is consistent with his long-term support of abstinence-only-until-marriage programs.[4] Planned Parenthood Advocates of Virginia strongly opposed the governor’s decision and have criticized McDonnell for applying for funds that support ineffective programs. The group voiced its disdain in an action alert it issued after hearing of McDonnell’s decision: “Today we learned that Governor McDonnell will ONLY apply for Title V [abstinence-only] funding, a program that fails to teach teens how to prevent unintended pregnancy or sexually transmitted infections (STIs), including HIV/AIDS. . . . The simple fact is that young people deserve honest information, not political ideology in their health classrooms.”[5]
It seems clear that the decision to reject PREP funds was made by Governors Pawlenty and McDonnell on political and ideological grounds and without true regard for young people’s health. Indeed, states that have historically supported an abstinence-only-until-marriage approach as the only option for young people chose to apply for PREP funds, acknowledging the need to invest in comprehensive sex education programs in order to effectively reduce poor sexual health outcomes among teens. Among states that have long invested in an abstinence-only approach, Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, and South Carolina all submitted initial application materials for the PREP grant. Officials in the Arkansas Department of Health in particular expressed their support for PREP funds and instituting comprehensive sex education programming for young people in the state. Arkansas is eligible for an estimated $485,372 in annual PREP funds. “Will we let this opportunity pass us by? I don’t think so,” said a spokesperson for the state health department, Ed Barham, in an interview with the Arkansas Democrat Gazette. “We have a big problem here and we know that. We very much welcome the help this represents.”[6]
Illinois and Oklahoma, two states that have traditionally supported an abstinence-only-until-marriage approach, chose not to apply for Title V abstinence-only funds for the first time and only applied for PREP funds. In addition, Indiana, which has consistently received Title V abstinence-only funding in the past, made the decision not to submit a preliminary application for the FY10 funds. Youth in both Illinois and Oklahoma have been severely impacted by poor sexual and reproductive health outcomes. Illinois ranks seventh in the number of reported AIDS cases in the United States among young people ages 13–19.[7] A statement released by the Illinois Caucus for Adolescent Health commends Governor Pat Quinn’s rejection of Title V abstinence-only funds and application for PREP funds for moving the state “one giant step closer to ensuring that all youth receive sexual health education that is accurate, effective, and free from bias and political ideology.” [8] “Governor Quinn has taken an important first step to reducing unplanned pregnancies and sexually transmitted infections in our state,” the statement reads. “Our hope is that he will keep us moving in the right direction . . .”
Concerning Oklahoma, the state’s teen birth rate ranked eighth in the United States in 2005, with a rate of 54.2 births per 1,000 young women ages 15–19; and the state’s teen birth rate increased 10% between 2005 and 2006.[9] According to an article published by the Yahoo news source The Upshot, a spokesperson for the Oklahoma State Department of Health said that the state chose not to apply for the Title V abstinence-only funds based on a growing body of evidence showing these programs to be ineffective.[10]
For more information, including a chart detailing the funding stream(s) for which each state applied, see SIECUS’ new factsheet, State by State Decisions: The Personal Responsibility Education Program and Title V Abstinence-Only Program.

[1] Section 510(b) of Title V of the Social Security Act, P.L. 104–193

[2] Andy Birkey, “Pawlenty Forgoes $850,000 in Federal Sex Ed Funds for Strings-attached Abstinence Dollars,” Minnesota Independent, 31 August 2010, accessed 19 September 2010, <>.

[3] John Croman, “Pawlenty Turns Down $868,000 Sex Education Grant.” KARE 11, accessed 19 September 2010, <>.

[4] Julian Walker, “McDonnell Seeks Abstinence-Only Education Funds,” Hampton Roads, 1 September 2010, accessed 19 September 2010, <>.

[5] Planned Parenthood Advocates of Virginia, “Tell Governor McDonnell You’re Disappointed,” action alert, 31 August 2010, accessed 19 September 2010, <>.

[6] Sarah Wire, “Change in Air for State’s Sex-Education Classes,” Arkansas Democrat Gazette, 15 August 2010, accessed 19 September 2010, <>.

[7] Centers for Disease Control and Prevention, “Slide 15: “Reported AIDS Cases among Adolescents 13 to 19 Years of Age, 2007—United States and Dependent Areas,” HIV/AIDS Surveillance in Adolescents and Young Adults (through 2007), (Atlanta, GA: Centers for Disease Control and Prevention, May 2009), accessed 25 March 2010, <>.

[8] Illinois Caucus for Adolescent Health, “Thank Gov. Quinn for Supporting Comprehensive Sexuality Education!” action alert, 2 September 2010, accessed 19 September 2010, <>.

[9] Guttmacher Institute, U.S. Teenage Pregnancies, Births, and Abortions: National and State Trends and Trends by Race and Ethnicity (Washington, DC: Guttmacher Institute, January 2010), accessed 5 March 2010, <>, table 3.2.

[10] Liz Goodwin, Longshot: Lured by New Grant, Some States Reject Abstinence-only Funding, Yahoo News, 23 August 2010, accessed 19 September 2010, <>.