Since 1991, U.S. teen pregnancy, abortion, and birth rates have fallen considerably. However, after 14 years of decline, the teen birth rate increased from 40.5 per 1,000 females ages 15 to 19 in 2005 to 41.9 in 2006 and 42.5 in 2007. However, in 2008, the teen birth rate reversed the two-year increase trend and dropped to 41.5 births per 1,000 females ages 15 to 19. The teen pregnancy rate increased from 69.5 per 1,000 females ages 15 to 19 in 2005 to 71.5 in 2006. The 2005 teen pregnancy rate was the lowest recorded teen pregnancy rate since 1972, when this series was initiated. Although the pregnancy rate for teenagers increased in 2006 (latest available data), it is still down 38% from the 1991 level of 115.3. Even so, it still is higher than the teen pregnancy rates of most industrialized nations. According to a recent report on children and youth, in 2009, 32% of 9 th graders reported having experienced sexual intercourse. The corresponding statistics for older teens were 41% for 10 th graders, 53% for 11 th graders, and 62% for 12 th graders. About 20% of female teens who have had sexual intercourse become pregnant each year. For many years, there have been divergent views with regard to sex and young people. Many argue that sexual activity in and of itself is wrong if the persons are not married. Others agree that it is better for teenagers to abstain from sex but are primarily concerned about the negative consequences of sexual activity, namely unintended pregnancy and sexually transmitted diseases (STDs). These two viewpoints are reflected in two pregnancy prevention approaches. The Adolescent Family Life (AFL) program encompasses both views and provides funding for both prevention programs and programs that provide medical and social services to pregnant or parenting teens. The Abstinence Education program centers on the abstinence-only message and only funds programs that adhere solely to bolstering that message. (For information on Title X, which serves a much broader clientele than teens and pre-teens, see CRS Report RL33644, Title X (Public Health Service Act) Family Planning Program , by [author name scrubbed].) The AFL demonstration program was enacted in 1981 as Title XX of the Public Health Service Act ( P.L. 97-35 ). It is administered by the Office of Adolescent Pregnancy Programs, Department of Health and Human Services (HHS). From 1981 until 1996, the AFL program was the only federal program that focused directly on the issues of adolescent sexuality, pregnancy, and parenting. The AFL program was designed to promote—family involvement in the delivery of services, adolescent premarital sexual abstinence, adoption as an alternative to early parenting, parenting and child development education, and comprehensive health, education, and social services geared to help the mother have a healthy baby and improve subsequent life prospects for both mother and child. The AFL program authorizes grants for three types of demonstrations: (1) projects provide "care" services only (i.e., health, education, and social services to pregnant adolescents, adolescent parents, their infant, families, and male partners); (2) projects which provide "prevention" services only (i.e., services to promote abstinence from premarital sexual relations for pre-teens, teens, and their families); and (3) projects which provide a combination of care and prevention services. Any public or private nonprofit organization or agency is eligible to apply for a demonstration grant. AFL projects can be funded for up to five years. Currently (2009-2010), the AFL program is supporting 52 demonstration projects across the country. (See http://www.hhs.gov/ opa/ familylife/ grantees/ grantees.html .) AFL care demonstration projects are required to provide comprehensive health, education, and social services (including life and career planning, job training, safe housing, decision-making and social skills), either directly or through partnerships with other community agencies, and to evaluate new approaches for implementing these services. AFL care projects are based within a variety of settings such as universities, hospitals, schools, public health departments, or community agencies. Many provide home visiting services and all have partnerships with diverse community agencies. Currently, 31 care projects are being funded. AFL prevention demonstration projects are required to develop, test, and use curricula that provide education and activities designed to encourage adolescents to postpone sexual activity until marriage. Since 1997, all AFL prevention projects that have been funded have been abstinence-only projects that were required to conform to the definition of abstinence education as defined in P.L. 104-193 . Most of these projects try to reach students between the ages of 9 to 14 in public schools, community settings or family households; all involve significant interaction with parents to strengthen the abstinence message. Currently, 21 abstinence-only projects are being funded. Each demonstration project is required to include an internal evaluation component designed to test hypotheses specific to that project's service delivery model. The grantee contracts with an independent evaluator, usually one affiliated with a college or university in the grantee's state. The AFL program also authorizes funding of research grants dealing with various aspects of adolescent sexuality, pregnancy, and parenting. Research projects have examined factors that influence teenage sexual, contraceptive and fertility behaviors, the nature and effectiveness of care services for pregnant and parenting teens and why adoption is a little-used alternative among pregnant teenagers. Since 1982, the AFL program has funded about 70 research projects. P.L. 104-193 , the 1996 welfare reform law, provided $250 million in federal funds specifically for the abstinence education program ($50 million per year for five years, FY1998-FY2002). Funds must be requested by states when they solicit Title V Maternal and Child Health (MCH) block grant funds and must be used exclusively for teaching abstinence. To receive federal funds, a state must match every $4 in federal funds with $3 in state funds. This means that full funding for abstinence education would total at least $87.5 million annually. Although the Title V abstinence-only education block grant has not yet been reauthorized, the latest extension, contained in P.L. 110-275 ( H.R. 6331 ), continued funding for the abstinence-only block grant through June 30, 2009. P.L. 105-33 , enacted in 1997, included funding for a scientific evaluation of abstinence education programs; Mathematica Policy Research won the contract. (See Impacts of Four Title V, Section 510 Abstinence Education Programs, April 2007, at http://www.mathematica.org/ publications/ PDFs/ impactabstinence.pdf .) To ensure that the abstinence-only message is not diluted, the law ( P.L. 104-193 , Section 510 of the Social Security Act) stipulated that the term "abstinence education" means an educational or motivational program that (1) has as its exclusive purpose, teaching the social, psychological, and health gains of abstaining from sexual activity; (2) teaches abstinence from sexual activity outside of marriage as the expected standard for all school-age children; (3) teaches that abstinence is the only certain way to avoid out-of-wedlock pregnancy, STDs, and associated health problems; (4) teaches that a mutually faithful monogamous relationship within marriage is the expected standard of human sexual activity; (5) teaches that sexual activity outside of marriage is likely to have harmful psychological and physical effects; (6) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society; (7) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and (8) teaches the importance of attaining self-sufficiency before engaging in sex. In FY2008, only 28 states and 2 territories sponsored an abstinence education program. As a result, in FY2008, only $28 million of the possible $50 million in Title V Abstinence Education block grant funds was expended. Abstinence education programs launch media campaigns to influence attitudes and behavior, develop abstinence education curricula, revamp sexual education classes, and implement other activities focused on abstinence education. State funding is based on the proportion of low-income children in the state as compared to the national total. In FY2008, federal mandatory abstinence education funding (among the states) ranged from $88,991 in North Dakota to $4,777,916 in Texas. In FY2009, $23 million (of $37.5 million) was expended on the Title V Abstinence Education block grant program. P.L. 111-148 (the Patient Protection and Affordable Care Act (PPACA); enacted March 23, 2010) restored funding to the Title V Abstinence Education block grant to states at the previous annual level of $50 million for each of FY2010-FY2014 ($250 million over five years). (For information on the Obama Administration's and Congress' new approach to teen pregnancy prevention, see CRS Report R40618, Teen Pregnancy Prevention: Background and Proposals in the 111 th Congress .) P.L. 106-246 appropriated $20 million for FY2001 to HHS under the Special Projects of Regional and National Significance (SPRANS) program for abstinence-only education for adolescents aged 12 through 18. P.L. 106-554 provided $30 million for FY2002 for the SPRANS abstinence education program; P.L. 107-116 increased SPRANS program funding from $30 million to $40 million for FY2002. The SPRANS program funding was increased by P.L. 108-7 to $55 million for FY2003, and by P.L.