Among the programs shut down by federal grant terminations this summer were sexual health curricula written specifically for young people in foster care, a population that published research identifies as facing barriers their peers do not.
Children's Aid, a New York City organization that has worked in under-resourced communities for more than 170 years, delivered programming in foster care settings alongside schools and community sites before losing a $936,700 annual grant with two years remaining. It had received federal teen pregnancy prevention funding since 2015, and the award was eligible for renewal through 2028.
"It was an overnight shutdown with no transition period for staff or for young people who were relying on these resources," said Rhonda Braxton, vice president of health and wellness at the organization. Pascale Saintonge Austin, its director of family planning and pregnancy prevention programs, said foster youth face distinct challenges that generic health information cannot address. "We won't be able to provide such a specific curriculum to them anymore that was tailored and made for them," she told The 19th.
The terminations were nationwide, affecting programs in group homes, juvenile justice facilities and homeless shelters. What makes the foster youth piece distinct is what the research says about their baseline.
The Access Gaps Documented Before Any Program Closed
Research on this population has consistently found worse sexual health outcomes and more obstacles to care than among adolescents generally.
Foster care is associated with younger age at first intercourse, more sexual partners, and lower contraceptive use, according to research summarized in the child welfare literature. Teenagers make up roughly a quarter of the nearly 400,000 children and youth in the foster care system, including more than 12,000 who remain in care past age 18.
The barriers are structural rather than attitudinal. A qualitative study of adolescents and young adults formerly in foster care in North Texas identified multifactorial obstacles to healthcare access that consequently affected sexual and reproductive health, spanning material and psychological dimensions.
An investigative review of policy documents across all 50 states, published by The Imprint, found that most states provide little or no guidance for caregivers or caseworkers on sexual and reproductive health. In dozens of states, there is little or no mention of healthy relationships education, sexually transmitted infection prevention, or foster youths' rights to access contraception. Some state policies had not been updated in decades.
The Question of Who Decides
The obstacle most specific to this population concerns decision-making authority, and it has no equivalent for other adolescents.
When biological parents lose custody but retain some legal rights, it is frequently unclear who may consent to a young person's healthcare. Caseworkers, foster parents, agencies and courts may each hold partial authority, and the boundaries vary by state and by case.
Some state policies impose restrictions on foster youth that conflict with minors' rights generally, including requirements that a foster youth obtain judicial approval to access birth control, a step no other minor in that state must take.
"These findings highlight all the barriers young people in care face to accessing reproductive health care that their peers don't," said Amy Dworsky, a senior research fellow at Chapin Hall at the University of Chicago and a nationally recognized expert on pregnant and parenting youth in foster care, quoted in the Seattle Times. She added that the situation looks ripe for a lawsuit, since in some states young people in foster care appear not to have the same rights to reproductive healthcare as peers outside the system.
The absence of clear guidance also transfers discretion to individual adults. Where policy is silent, caregivers and caseworkers decide how and whether a young person receives sexual health education, which introduces variation based on personal and religious views rather than on the young person's needs.
The Fallbacks That Are Not Available
Adolescents who lose a school-based program can often find information elsewhere. Several of those routes are narrower for foster youth.
Placement changes interrupt continuity. A young person who moves between homes may change schools, clinics, and caseworkers, and a curriculum delivered over weeks is not completed by someone who leaves midway. Medical records follow imperfectly.
Transportation depends on an adult willing to provide it. A teenager living with a parent can often reach a clinic; a teenager whose foster placement is 30 miles from the nearest provider depends on someone else's schedule and willingness.
Confidentiality is harder to secure. Asking a foster parent for a ride to a reproductive health appointment forfeits privacy in a way that discourages seeking care at all.
Programs designed for this population addressed those conditions directly. Curricula developed for foster youth typically build in trauma-informed approaches, acknowledge placement instability, and cover advocacy skills for navigating adult gatekeepers. Children's Aid also provided programming at the city Administration for Children's Services Children's Center, where children may stay while awaiting placement, and reached more than 1,200 young people annually across neighborhoods including Harlem and the South Bronx. Nine staff members were affected. HHS did not respond to The 19th's initial request for comment.
The pattern extended beyond New York. Healthy Futures of Texas said its nearly $2 million grant had funded 11 programs serving populations including youth in foster care and runaway and unhoused young people.
The Services That Have Not Changed
Nothing in the grant terminations changes what clinicians may provide or what rights young people hold under state law.
Most states allow minors to consent to sexually transmitted infection testing and treatment without parental involvement, and many allow minors to consent to contraceptive services. Those rules apply to foster youth as they do to others, notwithstanding conflicting child welfare policy in some states.
Title X clinics, federally qualified health centers and school-based health centers provide confidential adolescent reproductive health services on a sliding fee scale regardless of insurance. Young people in foster care are generally eligible for Medicaid, and former foster youth remain eligible up to age 26 in every state.
Caseworkers and foster parents can ask a state child welfare agency directly what its policy provides, and court-appointed advocates can raise health access at review hearings. MedicalDaily has reported on screening services that remain available through those routes.
Foster youth who are unsure of their own rights can contact a state or local legal services organization for children in care, which can clarify what consent authority applies in their state. MedicalDaily has covered access barriers affecting other underserved populations where public programs are the primary route to care.
Key Questions Answered
What programs were lost? Sexual health and youth development curricula delivered in foster care settings, group homes, juvenile justice facilities, and homeless shelters, funded through federal Teen Pregnancy Prevention Program grants, were terminated in late June.
How large was the New York example? Children's Aid lost a $936,700 annual grant with two years remaining, affecting nine staff and services reaching more than 1,200 young people a year.
What does research show about foster youth health access? Foster care is associated with younger age at first intercourse, more sexual partners, and lower contraceptive use. Research identifies multifactorial barriers to healthcare access that consequently affect sexual and reproductive health.
Why is consent a particular obstacle? When biological parents lose custody but retain some legal rights, authority over healthcare decisions is often unclear across caseworkers, foster parents, agencies and courts. Some states require judicial approval for foster youth to access birth control, a step other minors do not face.
What do state policies say? An investigative review of all 50 states found most provide little or no guidance to caregivers and caseworkers on sexual and reproductive health, with dozens omitting mention of relationship education, STI prevention, or contraception rights.
Why are fallback options narrower for this group? Placement changes interrupt program completion and medical records, transportation depends on an adult's willingness, and asking a foster parent for a ride to a reproductive health appointment forfeits confidentiality.
What services remain available? Most states allow minors to consent to STI testing and treatment, and many allow consent to contraceptive services. Title X clinics, community health centers, and school-based health centers provide confidential care on a sliding scale. Foster youth are generally Medicaid eligible, and former foster youth remain eligible to age 26.
