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After winning much-needed teen-pregnancy assistance grant, Tennessee might have to give money back

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MahurinEcon_Thumb1_1191.jpg

Successful statewide efforts to restrict teen access to abortion coupled with unsuccessful efforts to enhance sex education in public schools (most receiving attention only teach abstinence) have set many states up for potential rises in teen pregnancy rates. Only time will tell if a rise will materialize.

In the meantime, the Obama administration has set out to deal with the nation’s teen birth rate, which, according to the Centers for Disease Control and Prevention, remains higher than in other developed countries. The CDC reports that in 2009, the live birth rate for 15- to 19-year-olds was 39.1 per 1,000 women (approximately 410,000 teens); the U.S. teen birth rate fell by more than one-third from 1991 to 2005, then increased by 5 percent over two consecutive years.

The Pregnancy Assistance Fund (PAF) –- one answer to the pregnant 16-year-old’s “Now what?” -– is a new federal grant program established as a rider in the Patient Protection and Affordable Care Act passed in 2010 and was created to assist pregnant and parenting teens, particularly those with little resources and support. It is not a pregnancy-prevention program, but a pregnancy-assistance program.

The initiative, sponsored by Sen. Bob Casey (D-Penn.), was packaged as somewhat of a compromise between both sides of the abortion debate particularly after Obama’s health care bill was, at the last minute, infused with legislation that would limit insurance coverage of abortion. (Neither side seemed to be particularly appeased at the time: As documented by a Guttmacher Institute analysis, the anti-abortion rights side wanted the PAF money to be designated to crisis pregnancy centers, specifically to advocate against abortion, while some on the abortion-rights side posited the bill as an encouragement of teen pregnancy.)

After a competitive application process, in September 2010, the U.S. Department of Health and Human Services awarded $27 million annually through 2019 to 17 states and 13 tribal organizations to develop and implement programs that help pregnant and parenting teens with services and assistance.

Many states have not even started putting the money to use, and HHS spokesperson Tara J. Broido told The American Independent that not enough time has elapsed for the government to analyze the federal program as a whole, though an eventual audit is imminent. States such as California and Minnesota -– both awarded $2 million annually –- have made little headway, barely sketching the infrastructure of their plans.

However, one state not only has a detailed plan, specific goals and partnering institutions on board, but also a plan that could overturn its crippling teen-pregnancy and infant-mortality rates while simultaneously influencing state programs with its ingenuity. But this state -– Tennessee -– might have to return the $1.4 million awarded by HHS, thanks to state and local efforts to eliminate two offices that manage women and infant health issues.

Much-needed program in peril

It began with the order of new Gov. Bill Haslam, who assumed office in January, to shut down the Governor’s Office of Children’s Care Coordination (GOCCC), which was charged with managing and overseeing the grant program. The closure of this office, which state Republicans threatened to close last year, was announced in March and will go into effect June 30.

Already, the initial implementation of the Pregnancy Assistance Grant in Tennessee was delayed, according to Susan Miller, women’s health director of the GOCCC. Miller told The American Independent that the initial delay resulted partly from the turnover of executive leadership and waiting for the state to expand the budget to include the federal money. Miller said it was a challenge drafting the application in the summer, as she needed to get input from teachers and school officials as how to best implement the program. The application was submitted in August 2010 and approved in September. The office was ready to go in October. But the go-ahead from the state only came this past April.

For Miller, the state’s high infant-mortality rate (ranked sixth in the nation — including the District of Columbia — by the Henry J. Kaiser Family Foundation based on data collected between 2004 and 2006) was a major impetus for applying for the PAF, as many of premature births result from pregnancies by young women. The program is being implemented and administered exclusively in Shelby County, located in Memphis, which has the state’s highest teen-pregnancy and infant-morality numbers.

The bulk of the state’s strategy is to coordinate and assess which existing teen-pregnancy and prenatal programs are working and how to best fit them to individual girls, said Julie Coffey, the office administrator of the Shelby County Office of Early Childhood and Youth (OECY), the entity that develops and coordinates programs for children and families. Administering the Pregnancy Assistance Fund is now in OECY’s hands, following the elimination of the state child-care coordination office. State-level management has been moved to the Tennessee Department of Health, Maternal and Child Health Division, a transition that will officially occur June 30, Miller told TAI.

Among the services outlined in the state’s PAF design include providing teens vouchers for things like breast pumps and diapers, sending teens to service centers and organizations appropriate to their needs, arranging peer home visits and assigning social workers to Memphis schools to collect comprehensive data on all of its pregnant and parenting teens and — notably – the fathers of their children. Like all of the other state plans, Tennessee’s does not include any focus on contraception or pregnancy prevention.

“I poured my heart and soul [into applying for the grant],” Miller said last month, but she assured TAI that the program would continue. “The point of service to teens on the ground remains unchanged.”

Gutting programs for children and families in the state’s neediest county

Fast-forward to this week, when during a board of commissioners meeting, the Shelby County Commission voted to defund the OECY, cutting $450,000 out of the county’s fiscal year 2012 budget. The budget amendment was proposed by Commissioner Wyatt Bunker, who according to Memphis newspaper The Commercial Appeal, is well-known for speaking out against social programs, advocating the position that churches and civic organizations should care for the poor and vulnerable.

Coffey told TAI she believes the move to defund the office was “politically motivated,” and noted that the Commission voted against a measure to defund its own catering and travel budgets, $25,000 and $12,500 respectively.

“This is a symbol of what is happening nationwide -– cutting children’s programs,” Coffey said. “[Political leaders] don’t understand that children’s programs are directly linked to improving our economy.”

She said the notion that the OECY is unnecessary and inefficient is false, pointing out that since the office opened in fiscal year 2009, its budget has shrunk while it has been able to leverage millions of dollars in federal grants. One example, of course, is the PAF grant, which Coffey said would likely be further delayed due to this new defunding development and potentially be returned to HHS. Another example is a $2 million grant the Department of Justice recently awarded the county (one of only three in the nation that received the award) to develop a program to address children exposed to violence.

Also left hanging is the county’s one-year-old initiative, the SHELBY Child Impact Assessment, which creates child impact statements, documents that assess how various policies would affect children. The one-of-a-kind program has already garnered praise and was due to be implemented in the citywide, Coffey said.

But Bunker, she said, “believes governments have no place in the lives of children.”

Bunker did not return TAI’s requests for comment.

Concerned by the city’s high teen-birth rate, Memphis Mayor AC Wharton, Jr. — formerly the mayor of Shelby County and founder of the OECY — said he hopes the money to keep the office alive is reinstated.

“We are all certainly guilty of not putting enough effort on sex education,” Wharton said. “If we do a better job in that arena, the question to abort or not abort will be less and less and less.”

Though the measure was approved 8 to 3, Shelby County Mayor Mark H. Luttrell, Jr., told TAI that he “absolutely [did] not” support the commission’s amendment and would persuade the board to fund the office or, failing that, will explore other possibilities to leverage funds to maintain the OECY’s programs before the county’s budget is finalized in the next two weeks. The measure can come up for another vote at the next board meeting if one of the three dissenting commissioners – Walter Bailey, Melvin Burgess and Mike Carpenter — calls for it.

“Our community has one of the more acute issues related to infant mortality,” Luttrell said. “It is not a time to be defunding programs. We’re going to find a way to sustain that office. It’s too important.”

This week Luttrell sent a message to Coffey, which she revealed to TAI in an email, saying the mayor will pledge his commitment to funding the office no matter how the county commission votes.

And while the state of Tennessee continues to delay a paid-for program to provide resources for pregnant teens, proposed legislation restricting abortion abounds, including the recent signing of Senate Joint Resolution 127, a proposed constitutional amendment, to be put on the ballot in the 2011 general election, which declares that “nothing in Constitution of Tennessee secures or protects rights to abortion or requires the funding of an abortion.” If passed, state lawmakers would have total authority to enact, amend and repeal statutes regarding abortion in all cases.

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