Tag Archives: Family Planning

Maybe reading is harder than I thought: On “The Comprehensive Family Planning and Reproductive Health Program”

We very occasionally pay attention to bidders conferences; usually, however, we usually avoid them for the reasons last discussed in “My first bidders conference, or, how I learned what I already knew.” Despite knowing that bidders conferences are mostly a waste of time, we’re sufficiently masochistic careful enough that we’ll occasionally look into one anyway.

New York State’s “Comprehensive Family Planning and Reproductive Health Program” bidders conference was a special example of silly because it literally consisted of the presenter reading from slides that regurgitated the RFP. As the “conference” went on, it became steadily more apparent that the conference would literally only consist of . . . repeating what’s in the RFP. This is as informative as it sounds.

After 20 minutes of listening to the presenter read, I gave up. I can read it myself. Still, as I shook my head at the seemingly pointless waste of time, my mind drifted back to some of my experiences teaching college students, and I have to wonder if the presenter read the RFP as a defensive strategy against inane questions that could easily be answered by the RFP. Something similar happens to me in class at times.

One recent example comes to mind. I had a student who seemed not to like to read much (note: this is a problem in English classes), and one day I handed out an essay assignment sheet with specific instructions on it. I told students to read it and let me know if they had questions. This student raised her hand and I had a conversation that went like this:

Student: “Can you just go over it in general?”
Me: “What’s confusing?”
Student: “I mean, can you just say in general what the assignment is about?”
Me: “That’s what the assignment sheet is for.”
Student: “I don’t understand. Can you go over it?”
Me: “What part confuses you?”
Student: “The entire thing.”
Me: “Which sentence is confusing to you?”
Student: “Can you just go over it in general?”

This was not a surrealist play and by the end of the exchange—I did not reproduce the whole exchange—I was somewhat confused, so I began reading each individual sentence and then checking in with the student. This was somewhat embarrassing for everyone in the class but I didn’t really know what else to do.

When I got to the end of the assignment sheet, the student agreed that it was in fact clear. I know enough about teaching not to ask the obvious question—”What was all this about?”—and yet I’ve had enough of those experiences to identify, just a little, with the people running the world’s boringest* bidders conferences.


* Not an actual word, but I think it fits here.

Teenage Pregnancy Prevention and the Replication of Evidence-based Programs: the Research and Demonstration Programs and Personal Responsibility Education Program are Two RFPs that Provide a “Madeleine Moment” for a Grizzled Grant Writer

Everyone has a Madeleine Moment from time to time, when a breakfast pastry or, for an old grant writer, an RFP, sends one into a reverie. I experienced a Madeleine Moment recently when the Office of Adolescent Health (OAH) issued two RFPs, one for Teenage Pregnancy Prevention: Replication of Evidence-based Programs and one for Replication of Evidence-based Programs and Teenage Pregnancy Prevention: Research and Demonstration Programs and Personal Responsibility Education Program.

There’s nothing like $100 million for the same old teen pregnancy prevention ideas that I used to write proposals about during the latter days of the Nixon administration to get the juices flowing. When we started Seliger + Associates 17 years ago, there was still lots of money for teen pregnancy prevention programs that provided “medically accurate” information, like the requirements of the two new RFPs. “Medically accurate” is a euphemism for teaching about family planning, which is also a euphemism for teaching about contraception, condoms, and birth control pills. In the old days, referral for what was termed “clinical services” (e.g., family planning services, which meant birth control pills) was typically mandatory.

About ten years ago, the pendulum shifted and suddenly there was no more money for the medically accurate/clinical referral approach to teen pregnancy prevention project concepts. We started writing endless “abstinence” education proposals instead, in which birth control could never be mentioned and clinical referrals could never be made.

The new RFPs, compared to old version of medically accurate RFPs, do not want information on clinical referrals for the teens. So the proposal can discuss how the young folk will be told about birth control and family planning but not actually mention how they might actually receive birth control services. To be charitable to the GS 11s who wrote these RFPs, both include the following coded statement:

As appropriate and allowable under Federal law, applicants may provide teenage pregnancy prevention related health care services and/or make use of referral arrangements with other providers of health care services(e.g., substance abuse, alcohol abuse, tobacco cessation, family planning, mental health issues, intimate partner violence), local public health and social service agencies, hospitals, voluntary agencies, and health or social services supported by other federal programs (e.g., Medicaid, SCHIP, TANF) or state/local programs.

Note that “family planning” is stuck randomly between “tobacco cessation” and “mental health issues”. Reminds me of the scene in American Graffiti in which Toad is trying to buy booze for the blond bombshell he just met and says to the suspicious store clerk, “Let me have a Three Musketeers, and a ball point pen, and one of those combs there, a pint of Old Harper, a couple of flash light batteries and some beef jerky.” Why is referral for family planning, arguably the most important aspect of teen pregnancy prevention, not required and only mentioned once in a laundry list of referral services in the RFPs? Because the unstated but obvious implication is that family planning (clinical) referrals mean not only birth control pills for the young ladies, but possibly referrals for “you know what” if the birth control fails.

Writing one of these proposals is a bit of a Kabuki exercise. For staff who actually run supportive services programs for teens, this obfuscation about family planning and Title X is nonsense, since they know the feds actually spend about $300 million dollars annually funding “family planning” services under Title X of the Public Health Service Act. And they have since 1980. Over 4,500 family planning clinics, many run by Planned Parenthood, receive federal funding for birth control and related services, but you’d never know it from these two new OAH RFPs, which pretend Title X doesn’t exist.

We’re writing a few of these new-fangled (or new-old-fangled) teen pregnancy prevention proposals, which for us just means taking a short stroll down memory lane to The Thrilling Days of Yesteryear!.* I don’t have a dog in the “medically accurate” versus “abstinence” versus “clinical referral” fight and don’t wish to raise the ire of advocates with this post. I’m just a grizzled grant writer who wants to help you young whippersnappers out there understand that grant writing moves in waves, as Jake describes at the link. What was old is new again and whatever you’re writing today, you’ll write again someday, when the pendulum inevitably swings back.


*As far as I am concerned, Clayton Moore will always be the one and true Lone Ranger. Hi Yo Silver, Away!

What to do When Research Indicates Your Approach is Unlikely to Succeed: Part I of a Case Study on the Community-Based Abstinence Education Program RFP

The Community Based Abstinence Education Program (CBAE) from the Administration on Children, Youth and Families is a complicated, confusing, and poorly designed RFP based on suspect premises. That makes it an excellent case study in how to deal with a variety of grant writing problems that relate to research, RFP construction, and your responses.

CBAE is simple: you’re supposed to provide abstinence and only abstinence education to teenagers. That means no talk about condoms and birth control being options. In some ways, CBAE is a counterpoint to the Title X Family Planning funding, which chiefly goes to safe-sex education and materials rather than abstinence education. Its premise is equally simple: if you’re going to have sex, use condoms and birth control. Congress chooses to fund both.

Were I more audacious regarding CBAE proposals, I’d have used George Orwell’s 1984 as a template for the programs, since almost everyone in the novel conforms to the numbing will of an all-powerful state and many belong to the “Junior Anti-Sex League,” complete with scarlet sashes. I hope someone turned in a CBAE application proposing scarlet sashes for all participants.

More on point, however, page two of the RFP says:

Pursuant to Section 510(b)(2) of Title V of the Social Security Act, the term “abstinence education,” for purposes of this program means an educational or motivational program that: […]

(B) Teaches abstinence from sexual activity outside marriage as the expected standard for all school age children

Who is enforcing this “expected standard?” Society in general? A particular person in society? But it gets better:

(D) Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity;

This requirement ignores decades of anthropological research into indigenous societies as well as plenty of research into our own society, which Mary Roach described in Bonk, Alfred Kinsey described using imperfect methods in his famous but flawed research in the 50’s, and that Foucault described in his History of Sexuality. It also ignores the sexuality of other cultures and even our own, as discussed in books like Conceiving Sexuality: Approaches to Sex Research in a Postmodern World, or, better yet, Culture, Society and Sexuality: A Reader, which describes the way societies and others build a social model of sex. Through the CBAE program, Congress is building one such model by asserting it is true and using “expected standard” language, without saying who is the “expecting” person or what is the “expecting” body. It’s an example of what Roger Shuy calls in Bureaucratic Language in Government and Business a term that “seems to be evasive,” as when insiders “use language to camouflage their message deliberately, particularly when trying to avoid saying something unpleasant or uncomfortable.” In this case, the evasion is the person upholding the supposed standard.

Furthermore, the abstinence conclusion isn’t well supported by the research that does exist, including research from previous years of the program, which is at best inconclusive. A Government Accountability Office report (warning: .pdf file) says things like, “While the extent to which federally funded abstinence-until-marriage education materials are inaccurate is not known, in the course of their reviews OPA [Office of Population Affairs] and some states reported that they have found inaccuracies in abstinence-until-marriage education materials. For example, one state official described an instance in which abstinence-until-marriage materials incorrectly suggested that HIV can pass through condoms because the latex used in condoms is porous.”

The one comprehensive study that has been conducted by a nonpartisan firm is called “Impacts of Four Title V, Section 510 Abstinence Education Programs” by Mathematica Public Research, which was spun off from the guys who brought us the Mathematica software. The study was prepared for DHHS itself, and it says such encouraging things as, “Findings indicate that youth in the program group were no more likely than control group youth to have abstained from sex and, among those who reported having had sex, they had similar numbers of sexual partners and had initiated sex at the same mean age.” The programs it studied are based around the same methods that the CBAE demands organizations use, all of which boil down to inculcating a culture of fear of sex outside of marriage. The social stigma the program recommends is based around STDs and whether you’ll get into college (although an editorial in the L.A. Times argues otherwise), and, to a lesser extent, altering peer norms. Still, even in Puritan times this was not entirely effective, as Bundling by Henry Stiles explains. The practice meant sleeping in the same bed with one’s clothes on, as a solution to the problems of inadequate heat and space. But, as Jacques Barzun says in From Dawn To Decadence: 500 Years of Western Cultural Life, “Experience showed the difficulty of restraint and […] the rule was made absolute that pregnancy after bundling imposed marriage […] So frequent was this occurrence that the church records repeatedly show the abbreviation FBM—fornication before marriage.”

There are counter-studies that purport to show abstinence education as effective, like this one from a crew that, not surprisingly, is selling abstinence education materials. But it, like most others, has little bon mots amid its intimidating numbers and verbose language like, “In addition, the high attrition rate limits our ability to generalize the findings to a higher-risk population” (strangely enough, the .pdf file is set to disallow copying and pasting, perhaps to discourage irate bloggers like myself). But the study doesn’t list the attrition rate, making it impossible to tell how severe the problem is. In addition, even if it did, the population selected might also suffer from cherry picking problems of various kinds: that is to say, organizations are more likely to serve the participants who are most likely to be receptive to services and, concomitantly, less likely to do things like have early sex. This is an easy and tempting way to make a program look good: only let the kids in who are likely to benefit. And it’s a hard problem to tease out in studies.

So be wary of dueling studies: if you don’t read these carefully, it’s easy to accept their validity, and even if you do read them carefully, it’s easy to nitpick. This is why peer review is so helpful in science and also part of the reason evaluations are so difficult. Furthermore, many of the studies, including Heritage’s, come from biased sources, a problem Megan McArdle writes about extensively in a non-abstinence-related context. (See her follow-up here). Most of you justifiably haven’t followed the blizzard of links I put up earlier or read the books I cited for good reason: who has the time to sift through all this stuff? No one, and even pseudoscience combined with anecdote like this article in New York Magazine has an opinion (hint: be wary of anyone whose title has the word “evolutionary” in it).

Given this research, which is hard to miss once you begin searching for information about the efficacy of abstinence instruction, how is a grant writer to create a logic model that, as page 44 says, should list “[a]ssumptions (e.g., beliefs about how the program will work and is supporting resources. Assumptions should be based on research, best practices, and experience)”? (emphasis added).

Two words: ignore research. And by “ignore research,” I mean any research that doesn’t support the assumptions underlying the RFP. If you want to be funded, you simply have to pretend “Impacts of Four Title V, Section 510 Abstinence Education Programs” or the GAO study don’t exist, and your proposal should be consistent with what the RFP claims, even if it’s wrong. This is, I suspect, one of the hardest things for novice grant writers to accept, which is that you’re not trying to be right in the sense of the scientific method of discerning the natural world through experimentation. You’re trying to be right in the Willie Stark sense of playing the game for the money. No matter how tempting it is to cite accurate research that contradicts the program, don’t, unless it’s to knock the research.

Remember too that the grant writer is to some extent also a mythmaker, which is a subject Isaac will address more fully in a future post. The vital thing to consider is that the mythology you need to create isn’t always the same as the reality on the ground. As in politics, the way events are portrayed are often different than how they actually are. David Broder wrote an article on the subject of inventing political narratives, which occasionally match reality; your job as a grant writer is inventing grant narratives. We hope these match reality more often than not. Sometimes the myth doesn’t, as in this application, and when that happens, you’re obligated to conform to the RFP’s mythology, even if it isn’t your own.

The second part of this post continues here.