Ahead of the 4th of July weekend, the Trump administration issued a sweeping rewrite of a successful program aimed at reducing teen pregnancy rates. The changes have ignited fierce concern among public health experts, sexual health educators, and LGBTQ+ advocates who warn it could undo decades of progress, erase essential health information, stifle research, and leave vulnerable youth at risk.On July 1, the Department of Health and Human Services issued new guidance for the $100 million Teen Pregnancy Prevention Program. The policy to stop the radical indoctrination of children and ensure parental oversight explicitly bars federal funds from supporting materials deemed to promote radical ideology, including references to gender identity and LGBTQ+ themes. It also prohibits instruction on non-penetrative sexual activities like masturbation and discussions of sexual pleasure, practices many experts say are crucial tools for reducing unintended pregnancies and sexually transmitted infections.Related: Project 2025 vowed to roll back LGBTQ+ rights. Here's everything Trump has done so farThe department said the policy safeguards the rights of parents to protect their children from content that undermines their religious beliefs and declared that program materials are expected to reflect a binary understanding of sex and not gender identity, and may not promote anti-American ideologies such as diversity, equity and inclusion measures which the Trump administration calls discriminatory. In an announcement of the policy change on July 2, Acting Assistant Secretary for Health Dorothy Fink said that prioritizing parental involvement in the education of children on sensitive topics promotes a healthy environment for children to engage with the administrations medically accurate and age-appropriate materials.HHS is committed to ensuring a flourishing and healthy American youth, including through reducing teen pregnancy, Fink said.A deepening ideological shiftThe new policy instructs grantees to align their programs with multiple Trump executive orders, including Executive Order 14190, Ending Radical Indoctrination in K-12 Schooling, and Executive Order 14187, Protecting Children From Chemical and Surgical Mutilation. The guidance insists that federal funding cannot support teaching minors about ideological content, and singles out discussions about gender identity as radical.Related: Teaching Kids About LGBTQ People Is Not Sex Education, It's EqualityThe official policy document states that TPP-funded programs cannot be funded if they include materials or activities that are inconsistent with, or beyond the scope of, the statutory requirements for TPP programs. Specifically prohibited is content encouraging, normalizing, or promoting sexual activity for minors, including anal and oral sex, or masturbation, as well as the eroticization of birth control methods, creating more pleasurable sexual experiences, or foreplay techniques.Dr. Cynthia Graham, senior scientist at The Kinsey Institute at Indiana University, says such prohibitions are flatly at odds with best practices in public health. Currently, the evidence we have is that covering these things in a comprehensive way is effective and lowers the likelihood of teen pregnancy, Graham told our sister brand, The Advocate. Including things like pleasure in programs enhances interventions. We know that as well.Rolling back decades of progressPublic health leaders warn that the new policy echoes the abstinence-only education models of the past, which were widely discredited for failing to reduce teen pregnancy rates.Dr. Rachel Levine, former Assistant Secretary for Health and the first out transgender official confirmed by the U.S. Senate, emphasized how such programs have historically driven progress in lowering teen pregnancies. Levine said, One of the victories of public health in the last 40 years has been the consistent decline in the adolescent pregnancy rate. That is because of programs like Title X and TPP, and dedicated work to prevent unintended pregnancies in general and to prevent pregnancies in adolescence.Related: This New Bill Hopes to Require LGBTQ+ Inclusive Sex Ed NationwideTitle X, established in 1970, is the federal program dedicated to providing confidential family planning and reproductive health services, particularly for low-income and uninsured individuals, including contraception, preventive care, and sexual health education.Levine, who spent decades working in adolescent medicine, noted that her career began in a Title X clinic during her fellowship in the late 1980s. She later launched and directed a Title X program at Penn State Hershey Childrens Hospital.The evidence base is more than strong and robust about how comprehensive education in schools and programs like Title X and availability of family planning clinics and confidential family planning reduce adolescent pregnancy, the trained pediatrician told The Advocate in an interview.Reflecting on her time overseeing the Office of Population Affairs at HHS, Levine expressed deep concern about reversing those gains. As these programs are changed by the Trump administration, we have great worry for those changes to turn around, she said. We were concerned that that was going to happen in the first Trump administration. We turned it back around during the Biden administration, and now Im sure well see some challenges both to TPP as well as Title X.Recent government reports indicate that the U.S. teen birth rate decreased to 13.1 births per 1,000 teens aged 15 to 19 in 2023, representing a 4 percent drop from 2022 and a 79 percent decline since its peak in 1991, according to the March National Vital Statistics Report. Nevertheless, even as fewer high school students are having sex, dropping from 47 percent in 2013 to 32 percent in 2023, condom use has also fallen, from 59 percent to 52 percent, data from the CDCs Youth Risk Behavior Survey Data Summary & Trends Report 20132023 show.Former Deputy Assistant Secretary for Population Affairs during the Biden-Harris administration and one of HHSs out LGBTQ+ appointees, Lynn Rosenthal, told The Advocate that the policy shift undermines more than a decades worth of work developing effective interventions for teen pregnancy prevention. When you restrict what can and cant be said, what communities can and cant address, it undermines this really important comprehensive work thats been underway.Adrian Shanker, an LGBTQ+ health advocate who worked at HHS in the last administration, added, Before the Teen Pregnancy Prevention program, the George W. Bush administration threw enormous sums of money at abstinence-only education models, all of which failed to reduce teen pregnancy rates in our country. Tinkering with an evidence-based program to meet political goals will not reduce our teen pregnancy rates. It could have the opposite effect.Graham, who has worked on sexual health programs in the U.S. and the U.K., noted that discussions of sexual pleasure, non-penetrative sex, and contraception techniques, including demonstrations like the classic condom-on-a-banana, are not about encouraging sexual activity but equipping young people with practical skills.Theres no evidence that teaching about things like sexual role play, masturbation, or techniques to make sex more pleasurable leads to riskier sexual behavior, she said. The evidence shows the opposite.Rosenthal echoed that view from her own experience as a health educator. People need practical information. Its not about eroticizing contraception. Its providing information for people who are sexually active about how they can avoid risky sexual behavior, she said.Science under siegeResearchers say the new HHS policy is not occurring in a vacuum but is part of a broader political effort to restrict research and public discourse on sexuality, gender identity, and LGBTQ+ health.In March, Graham and dozens of other leading editors and scientists signed a forceful editorial in The Journal of Sex Research, warning that U.S. government directives to remove terms like gender, transgender, LGBT, and nonbinary from research publications represent clear examples of censorship of science and thus a political attempt to obstruct the discovery of knowledge.Related: Biden administration creates $700k grant to create inclusive sex ed for trans male teensResearch into sexuality and gender is vital for identifying social, cultural, and medical needs of populations, and addressing inequalities, the statement read. Removing certain terms from academic papers and limiting research into specific topics represents an attempt to ignore or erase these populations, and it may have disastrous consequences for health and wellbeing.The editorial cautioned that such censorship could undermine key public health goals, including efforts to fight HIV, and harm minoritized communities already facing significant health disparities.Rosenthal called the administrations actions very damaging. She warned that anti-DEI and anti-trans efforts undermine the core principles of public health, which is you look at each population and each community and have the community define for themselves what their risk factors are, what interventions would be effective.Graham, too, highlighted the broader public health consequences. Its going to reduce the likelihood that studies on things like improving condom use through pleasure-based interventions are going to be funded, she said. Its going to reduce information given to youth about sexuality broadly, even more than it already is.The cost of shameAt the heart of the administrations new policy, experts warn, is shame, and the consequences can be devastating. When you tell youth that you cant talk about certain things with them, then it makes them feel like they are bad or wrong, Rosenthal said. Information is not what creates problems. Shame is what creates problems.Shanker added, Sexual health is an LGBTQ issue, period. For LGBTQI+ adolescents who are often in the process of fully discovering who they are, they deserve the same sexual health information as all other people their age. Yet under the new policy, even medically accurate discussions about LGBTQ+ topics could be forbidden if viewed as contradicting the administrations interpretation of biological reality.Related: Queer Sex-Ed Gets a Needed Makeover in A Sexplanation DocRosenthal cautioned that withholding information drives young people toward less reliable sources. What young people want is to talk about decision-making and relationships. They want to know how to take care of themselves, she said. We can trust young people with information. But only if we treat them with respect.The Advocate contacted HHS for comment but did not receive a response.A future in limboThe new guidance stipulates that grantees must resubmit all previously approved educational materials by October 1 to remain eligible for funding. Rosenthal predicted a rocky road.Some providers will choose not to receive these funds under these conditions, she said. Other providers will look and see if they can still do their important work in the community. Thats a situation that each organization has to decide for itself.Graham worries that the United States, already among the countries with the most restrictive sex education policies, is poised to slip even further behind. Its only going to increase that isolation and lack of information and the likelihood, if you dont have information, of engaging in risky sex, she said. - YouTube youtu.be Graham to resources like the institutes free Crash Course sex education series narrated by sexologist Shan Boodram, which covers topics including gender and sexual orientation. She said these kinds of accurate, accessible materials are vital in a climate where young people risk being left without reliable information.For Rosenthal, the bottom line is simple. Anything that promotes shame, anything that says you cant talk about certain things because theyre bad topicsthats egregious.