Teen pregnancy and birth rates in the United States have declined significantly since 1990, but teen parenting is still a national problem with far-reaching repercussions. One in six adolescent females currently gives birth before age 20, and about one in four adolescent mothers has a second birth during her teenage years. Teen mothers face a host of adverse circumstances—compared to older mothers, they are more likely to have obstetric and neonatal difficulties, receive welfare, and have children with developmental and behavioral issues. Furthermore, those who are pregnant again within 18 months are at even higher risk of having a still- or preterm birth; they are also less likely to stay in or complete high school, work, or maintain economic self-sufficiency.

Policy responses have included interventions delivered in health clinics, community-based settings, and the homes of individual program participants to delay repeat teen pregnancies and increase the use of effective methods of birth control. The T.O.P.P. program employs a unique approach using care coordination, motivational interviewing, and logistical support to address barriers to contraceptive use and consistency, and focuses on long-acting reversible contraceptive (LARC) methods such as intrauterine devices (IUDs) and contraceptive implants.