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Last July, the Trump administration issued a notice to the dozens of organizations receiving Teen Pregnancy Prevention Program grants.

“Program materials are expected [to] reflect the immutable biological reality of sex, not radical gender ideology, and may not promote anti-American ideologies such as discriminatory equity ideology,” the document reads, listing five executive orders organizations needed to comply with to keep their grants. “Programs with such unauthorized content are not eligible for federal funding.”

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Grantees scrambled to adapt to the new requirements. One of them, Healthy Futures of Texas, provides sexual health education in community centers, school districts, and juvenile justice and faith communities in San Antonio, Dallas, and the Rio Grande Valley in Texas.

“We had to essentially adapt and revise all of the already approved curricula to be in alignment with the executive orders — so that for us was 11 different programs that we adapted,” explains Ginger Mullaney, the organization’s president and CEO.

The process took months. “After all of that work, we were re-awarded and all of our programs have been deemed in compliance,” she says. “We have submitted progress reports thus far and our programs were still in alignment even up until recently — in November, we submitted another adaptation for a program and were approved.”

So two weeks ago, when the organization’s $2 million annual grant was canceled, effective immediately, Mullaney was stunned.

In fact, in late June, the federal Department of Health and Human Services canceled all but a dozen Teen Pregnancy Prevention Program grants, totaling $66 million for grantees across the country. Grantees included a wide range of organizations from public health departments and universities, to Planned Parenthood and Bethany Christian Services affiliates. The five-year grants had two years left to go.

According to a list of terminations obtained by NPR, the given reason was: “Misalignment with agency priority, specifically normalizing sexual activity for minors.”

For Mullaney, the sudden funding cut means 13 employees are losing their jobs, and they may have to reduce their services.

“I’m frustrated that these are lives that were being changed — there’s generational impact and social and economic mobility for our communities using programs that are proven and demonstrated to be effective,” she says.

A history of ‘rigorous’ evaluation

The teen pregnancy rate has declined dramatically in the U.S. since the 1990s, but rates are still higher than they are in peer countries. The cost to young parents is high — they are less likely to earn a high school diploma and more likely to have lower lifetime earnings. The costs to taxpayers were estimated in one study to be $9 billion per year.

Before the Teen Pregnancy Prevention funding stream was established in 2010, a series of programs were “evaluated using randomized controlled trials, which are really the gold standard for understanding the effectiveness of public policy,” explains Nicholas Mark, a sociologist at the University of Wisconsin Madison.

Congress then established the funding stream “to put in place the programs that had been shown to be effective in reducing teen pregnancy, increasing healthy behaviors, decreasing unhealthy sexual behaviors among teens,” he says. “So the whole basis of the program was in effective, rigorously evaluated programs.”

But the grants have long been a target of the Trump administration and some conservative groups like the Heritage Foundation. All of the grants were canceled by the Trump administration during the president’s first term, although the funding was restored after grantees sued.

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Even before the administration canceled the grants, President Trump’s recent budget request called for eliminating the Teen Pregnancy Prevention program. “There is no evidence that these specific programs have contributed to this historic decline in teen pregnancy, which is now at an all-time low. Moreover, TPP issues grants to problematic organizations like abortion clinics that waste American taxpayer dollars on abortion services and promote radical leftist ideology,” the document reads.

However, Trump also signed $101 million in funding for the program into law earlier this year, a point raised by Senate and House Democrats in a pair of letters sent to Health Secretary Robert F. Kennedy Jr. last week, demanding that the funding be reinstated.

The Department of Health and Human Services did not respond to multiple requests for comment from NPR about why the grants were canceled.

‘Normalizing sexual activity for minors’

Paige Preston just turned 18. She lives in Tuba City, Arizona, part of the Navajo Nation. Earlier this year, she attended a LiFT workshop — one of the evidence-based programs that the federal grants support — put on by Hózhǫ́ Horizons from the Johns Hopkins Center for Indigenous Health.

“It connects you with your trusted adult, so for me, I went with my sister and she is the person that I kind of go to for everything,” Preston says. “She was learning how to create a safe space for me and to make me feel heard. And then what I learned was how I show my affection for other people and how to be safe if we ever do come to that conclusion that there’s some activity that we want to participate in.” She says she also learned about birth control options beyond condoms, such as the pill and IUDs.

Preston says she knows this information is important — several of her peers got pregnant in high school. Nationally, American Indian and Alaska Natives have the highest teen pregnancy rate among racial and ethnic groups.”I know in my community it is a big problem,” she says.

Preston is now the chair of the Hózhǫ́ Horizons Youth Council, and was ready to help with another LiFT workshop later this summer. It was canceled when the funding was cut.

“In all honesty, I’m very sad and disappointed,” she says. She thinks the workshop brings information to young people that they might not learn at home or at school. “When you participate and you learn from people like you — like in Indigenous communities — that means a lot more because it’s showing you that someone like you is so knowledgeable about a subject, and they’re really passionate about that and it kind of makes you want to listen more.”

Nicholas Mark from the University of Wisconsin argues that the reason that agency gave for canceling these grants — “normalizing sexual activity for minors” — is a “bizarre” framework.

“In a world where teens have smartphones, teens are surrounded by sex and such easy access to sex and sexual imagery, sexual iconography,” he says. “It seems silly to think that having a source of verifiable, trusted information on safe sex would be worse than the information environment that people are already steeped in.”