The Pregnancy Assistance Fund (PAF) seeks to improve the educational, health, and social outcomes for vulnerable individuals who are expectant or new parents and their children. PAF is administered by the Office of Adolescent Health (OAH) in the Department of Health and Human Services' (HHS') Office of the Assistant Secretary for Health (OASH). The Patient Protection and Affordable Care Act (ACA; P.L. 111-148 , as amended) established the program and provided $25 million in annual mandatory funding for a 10-year period from FY2010 through FY2019. PAF funding is awarded competitively to the 50 states, District of Columbia (DC), U.S. territories, and tribal entities that apply successfully. The grantees may use the funds for any of the following purposes: providing subgrants to institutions of higher education (IHEs), high schools, or community service providers to enable these subgrantees to establish, operate, or maintain pregnancy or parenting services for the expectant and parenting population; providing, in partnership with the state attorney general's office, certain legal support, hotline, and other supportive services for women who experience domestic violence, sexual assault, or stalking while they are pregnant or parenting an infant; and supporting, either directly or through a subgrantee, public awareness about PAF services for the expectant and parenting population, including individuals who are victims of domestic violence and sexual violence. Through FY2018, HHS has awarded PAF funding to 30 states, DC, and 5 tribal entities. Generally, these grantees have provided PAF subgrants to high schools, community service organizations, and IHEs. Subgrantees reported most frequently using the funds to support case management, referrals to other supports, group workshops on specific topics (e.g., pregnancy prevention), and home visiting services. Congress may consider extending program funding beyond FY2019, when mandatory spending authority lapses. This report provides background to Congress about the program's implementation. It first discusses the history of PAF's enactment, the challenges facing vulnerable expectant and new parents who are eligible for PAF, and an overview of how program funding is distributed to meet those challenges consistent with the authorizing statute. Next, the report discusses selected program requirements. Data on participants and services provided in FY2016 are also presented, along with findings from an early evaluation showing the services to be effective in at least a limited context. The report then discusses the role of PAF in the context of other federal programs with certain overlapping or related goals, and it concludes with a brief discussion of considerations for Congress if it chooses to extend the program. Section 10212 of the ACA established PAF "to assist pregnant and parenting teens and women." The legislative language for the PAF program originated in an amendment by Senator Bob Casey that was printed in the Congressional Record on December 9, 2009, during Senate consideration of the Patient Protection and Affordable Care Act ( H.R. 3590 ). This amendment was not subsequently offered on the floor. Instead, the PAF legislative language was included as an amendment to H.R. 3590 that was agreed to by the Senate on December 22, 2009. The Senate passed H.R. 3590 , as amended, on December 24, 2009, with the PAF language at Section 10212. The House agreed to the Senate amendment to the bill on March 21, 2010. The PAF provision appears to have been added as a way to bolster supports for pregnant youth and women who might otherwise consider abortion. A press release from Senator Casey about PAF and selected other programs in the context of health care reform stated: "it was critically important to me to include positive support for vulnerable pregnant women, which the research clearly shows as the most effective way to reduce the number of abortions." The PAF program focuses on meeting the educational, social service, and health needs of vulnerable expectant and parenting individuals and their children during pregnancy and the postnatal period. The authorizing statute identifies these populations as expectant and parenting teens, college students, young adults, or women of any age who experience domestic violence, sexual violence, sexual assault, and stalking. About 194,400 births in the United States in 2017 (5.0%) were to teenagers aged 15 to 19. The research literature indicates that teen pregnancy has high costs for the families of teen parents and society more generally. Teenage mothers and fathers tend to have less education and are more likely to live in poverty than their peers who are not parents. Nearly one-third of teen girls who have dropped out of high school cite pregnancy or parenthood as a reason. Children of teenage mothers are more likely to have poorer education, health, and social outcomes than children of mothers who delay childbearing. In addition, teen births lead to larger societal impacts, such as costs related to public sector health care and lost tax revenue. Parenthood can also influence whether students pursue postsecondary education. For example, one analysis found that single young women who had children after enrolling in community college were 65% more likely to drop out than their same-age peers who did not have children after enrolling. PAF also provides supports for teens and women who are victims of domestic violence or sexual violence while they are pregnant or parenting an infant. The research literature indicates that approximately 3% to 9% of women experience domestic violence during pregnancy. Some studies indicate that this risk is greater among low-income women. Domestic violence is associated with heightened sexual risk-taking by the woman or her partner, such as inconsistent condom use and greater risk of having an unplanned pregnancy or induced abortion. Women victimized during pregnancy have poorer maternal health outcomes than women who are not abused, and their babies face health challenges. These women are 2 1/2 times more likely to report depressive symptoms than pregnant women who are not abused. Research on neonatal outcomes indicates that babies born to victimized women tend to have low birth weight and increased risk of pre-term birth, both of which are leading causes of neonatal morbidity and mortality. As part of a process study about the PAF program, HHS has found that state and tribal grantees used their own needs assessments or needs assessments from other programs to determine that few supports have been available in communities to meet the needs of the pregnant and parenting population that is eligible for PAF, such as teens and other young parents. These other needs assessments were drawn from programs serving similar populations or seeking similar participant outcomes, such as the federal Personal Responsibility Education program (PREP) to prevent teen pregnancy and the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Grantees reported that in response to these assessments, they have focused on avoiding redundancy in services and building connections across agencies and providers. Specifically, the grantees reported that PAF funds are intended to fill gaps in services available to vulnerable expectant and parenting individuals, particularly supports for father engagement, mental health, transportation, and child care; enhance an existing service by adding or refining components and making services available to more vulnerable expectant and parenting individuals, such as by expanding the number of sites at which individuals are served; and/or improve coordination across state or tribal agencies to avoid duplication of program services and make services more readily accessible, such as through formal and informal partnerships, joint trainings, and sharing resources. HHS distributes PAF funding on a competitive basis to address the vulnerabilities of the expectant and parenting populations and their children . The 50 s tates, DC, territories, and tribal entities may apply for PAF funding ( hereinafter, "state grantees" ) . State grantees must specify how they intend to use the funds and identify the lead agency to administer such funds. In the most recent cohort of grantees, the state public health department was the most frequently designated lead agency. State departments of education or human services and other entities also served as lead agencies. State grantees determine how to use their PAF funding to serve the expectant and parenting population and their children within four purpose areas: providing subgrants to high schools and community service centers, providing subgrants to institutions of higher education (IHEs), partnering with offices of state attorneys general, and supporting public awareness activities, as provided either by state grantees directly or by their subgrantees and partners. Figure 1 shows how PAF funding flows from the federal government to state grantees, and then on to subgrantees that directly support participants. It also includes examples of the types of supports that have been provided with PAF funding. In general, these supports can be grouped as education, social services, health, or public awareness activities. Each purpose area specifies certain activities. The activities are generally the same for the high schools/community service centers and IHEs, and therefore are grouped together in the subsequent discussion. ( Figure A-1 summarizes the four purpose areas, the populations they target, and the activities supported in each of the categories.) State grantees provide subgrants to high schools, community service centers, and IHEs for these institutions to establish, maintain, or operate services for pregnant and parenting teens/students and their children. The law defines (1) "high school" as public and private schools that operate grades 7 through 12, 9 through 12, or 10 through 12; (2) "community service centers" as nonprofit organizations that provide social services to residents of a specific geographic area via direct service or by a contract with a local governmental agency; and (3) an "eligible institution of higher education" as a vocational school or public or nonprofit private college or university. Such institution of higher education must establish and operate, or agree to establish and operate (if it receives PAF funding), an office for pregnant and parenting students. The law specifies that subgrantees can carry out selected activities on campus and in the local community.