Narrative: e.

Minnesota’s female population ages 15 to 44 in 2016 was estimated at 1,054,708. Of the total resident births (69,746), 47,245 were to married women, 22,472 were to women who were not married and 29 were unknown. Thus, the out-of-wedlock birth rate in Minnesota for 2016 was 21.3/1000 for women ages 15 to 44. The out-of-wedlock birth rate in Minnesota for 2015 was 21.3/1000, for 2014 was 21.4/1000, for 2013 was 21.7/1000, and for 2012 it was 21.6/1000. The out-of-wedlock birth rate for Minnesota has remained relatively stable over the last several years. Minnesota still continues to face significant challenges in trying to lower its out-of-wedlock birth rate.

Minnesota has focused significant attention on reducing unintended pregnancies, particularly those occurring to teens and young adults who are less likely to be married or prepared to care for a child. While Minnesota’s teen pregnancy rate compares well to national rates, it masks significant and persistent racial and ethnic disparities. African American and American Indian youth are three to four times more likely to have a child when they are a teen than is a white youth. In an effort to address these disparities, the Minnesota legislature provided the Minnesota Department of Health with $2 million annually in TANF funds that support non-profit and government agencies in reducing the disparities in teen pregnancy rates in Minnesota.

The Minnesota Department of Health receives up to $796,021 annually in federal abstinence funds to support evidenced-based efforts to delay sexual activity in youth. Minnesota’s program is a coordinated countywide approach in St. Paul-Ramsey County and Hennepin County focusing on adolescents 14 and under, reaching them before they start engaging in sexual activity. St. Paul-Ramsey County’s Healthy Teen Initiative has three components: direct service to youth in schools and community settings through Teen Outreach Program Clubs; reaching out to parents in the community through It’s That Easy: A Guide to Raising Sexually Healthy Children Parent Education Training; and the Making Authentic Connections Program, which trains parents and others in making authentic connections in relationships with youth. Hennepin County’s Better Together Hennepin Initiative has two components: direct service to youth in schools through Project Aim programming; and reaching out to parents in the community through It’s That Easy: A Guide to Raising Sexually Healthy Children Parent Education Training.

The Minnesota Department of Health was also re-awarded a federal Personal Responsibility Education Program (PREP) grant ($884,189 annually). The MN PREP sub-awardees serve male and female youth in the following target populations: the juvenile justice system; attending area learning centers (ALC); in or aging out of foster care; runaway and homeless; with HIV/AIDS; pregnant, mothers’ and fathers’ who are under 21 years of age; lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ); American Indians; culturally underrepresented; out of school; at risk of being trafficked for commercial sexual exploitation; and residing in areas of high teen birth rates. The overarching goals of this program are to decrease teen pregnancies and STI rates among participating teens, focusing on ages 15-19, and to increase healthy youth behaviors and life-skills in teens 10-19 years of age. This is accomplished through the implementation of high quality, medically-accurate and evidence-based programs. It also assists high- risk adolescents to successfully transition from youth to adulthood.

Efforts are also directed at increasing access to family planning services for individuals who are low- income and at high risk for unintended pregnancies. Minnesota’s Family Planning Special Projects (FPSP) grant program is administered by the Minnesota Department of Health. Funded through the state Legislature, the current two-year grant cycle made available $12,706,000 (including $2,312,000 in TANF funding) to 27 community family planning clinics across the state. Grantees include one county-operated clinic and one university-operated clinic, 10 local public health agencies, and 15 non-profit organizations. In State Fiscal Year 2016, FPSP provided family planning counseling services to 34,307 women and 5,435 men who were low-income and at risk for unintended pregnancy. FPSP grantees provided 30,477 men and women with a contraceptive method — 26 percent of whom were age 19 or younger. To assist individuals in accessing subsidized family planning services, the Minnesota Department of Health also funds a 1-800 family planning hotline. In State Fiscal Year 2016, the hotline responded to 3,375 inquiries including 1,439 web chats and 742 text messages.

Federal Title X funds totaling $3.1 come to Minnesota through direct grants to Planned Parenthood of Minnesota, North Dakota and South Dakota and Ramsey Public Health. Access to subsidized family planning services has also been increased through the Minnesota Family Planning Program. The Minnesota Family Planning Program (MFPP) increases access to family planning services for low- income Minnesotans and helps reduce the number of unintended pregnancies. The program is available to people who are not enrolled in Medical Assistance. In 2016, the program served more than 21,000 people, with a monthly average enrollment of about 12,000. Total spending for the program was just over $9 million. Federal Medicaid funding for most services is at a 90-percent matching rate. The MFPP was implemented beginning July 1, 2006, as a federal waiver demonstration project approved by the Centers for Medicare & Medicaid Services. The Affordable Care Act established a new Medicaid eligibility group and the option for states to provide family planning services under the Medicaid State Plan. The 2014 Minnesota Legislature directed the Minnesota Department of Human Services to seek federal authority to operate the MFPP under the Minnesota Medicaid State Plan. Effective Jan. 1, 2017, the MFPP became a Medicaid State Plan program.

Other state efforts supporting reducing unintended pregnancies include The Family Home Visiting Program administered by the Minnesota Department of Health. Approximately $8 million in federal TANF funds are directed to the Family Home Visiting Program. The Family Home Visiting program administered by the Minnesota Department of Health provides funding to all of Minnesota’s local public health agencies and to nine of the 11 tribal governments to support home visiting services to families at or below 200 percent of poverty. The goal of the program is to prevent child abuse and neglect, reduce juvenile delinquency, promote positive parenting and resiliency in children and promote family health and economic self-sufficiency. The program has a strong focus on providing family supports that reduce the risk of teen pregnancies and working with pregnant or parenting teens to delay subsequent pregnancies.

These family home visiting efforts are augmented by receipt of approximately $8.5 million annually for 2016 and 2017 in federal Maternal, Infant, and Early Childhood Home Visiting Program funds. Beginning in 2017, a total of $8 million in Minnesota state funding supports implementation of the evidence based home visiting models such as Nurse Family Partnership, Healthy Families America and Family Spirit.