In 1998, when Dr. Hatim Omar came to the Kentucky Children’s Hospital at the University of Kentucky, the state had one of the highest teen pregnancy rates in America. According to Omar, repeat births for teen moms overall were high at that time, but Kentucky’s rates had climbed higher than the national average—which, in turn, could have an effect on the teens’ ability to access education.

“Lots of girls were having babies, and a lot of these girls were not finishing school,” said Omar.

One of only 600 adolescent medicine doctors in the world, a subspecialty obtained after three years of fellowship training on top of a pediatric, family medicine, or internal medicine residency, Omar said: “What I wanted to do was provide comprehensive care to teens. Not one thing at a time. A one-stop shop where everything is done.”

With that in mind, Omar helped to begin a division of the adolescent medicine program at the Kentucky Children’s Hospital. The Young Parents Program specifically serves moms 18 years old and younger, though both parents are encouraged to come, with siblings and extended family members invited as well.

Chasidy DeCoteau, a mom of three, started coming to the Youth Parents Program when she was 15 years old and pregnant with her first child. While in the program, DeCoteau received medical care for both herself and her children, as well as counseling. “I was really nervous about being pregnant with a child, but, you know, they made me feel like it was OK and they actually made me feel as if, you know, I was a person with a face,” DeCoteau said.

With more than 30 staff members, including medical providers, mental health counselors, psychologists, licensed clinical social workers, nutritionists, and a nursing clinical staff, the adolescent medical center doesn’t just cater to obstetrical and gynecological needs. “The main point is, we are working on all aspects of life, not just pregnancy,” said Omar. “If you’re a 15-year-old with a baby and you … don’t have support, then you’re more likely to be depressed .… We want to prevent suicide.”

“We have so many programs targeting one thing at a time,” Omar said, speaking about the medical community as a whole. He used the example of isolated programs to treat underage alcohol use: “A 16-year-old girl who is drinking is more likely to have sex, more likely to commit suicide, more likely to have a car accident. So all those things are connected.”

The “one-stop shop” aspect has tangible benefits: Teenagers do not have to travel to more than one health-care provider, which saves them time and cuts down on transportation costs. And because they can take their children along with them for all appointments, they don’t have to pay for child care.

The national statistics on repeat pregnancies for teen moms are grim. The CDC estimates that nearly one in five pregnancies for girls between ages 15 and 19 are repeat births. In 2015, the repeat birth rate for women under 20 years old in Kentucky was 16 percent (compared to 17 percent in the United States overall). But a study that specifically followed participants in the Young Parents Program between 1999 and 2003 found the repeat pregnancy rate for program participants dropped to less than 1 percent. Overall, according to the National Campaign to Prevent Teen and Unplanned Pregnancy, the teen birth rate in Kentucky declined 53 percent between 1991 and 2015, which is consistent with a pattern seen throughout the country during that time.

As Omar explained, this drop in repeat pregnancies largely had to do with programs that don’t just address pregnancies when they happen, but take a preventive approach. Prevention is key to the Young Parents Program. In addition to birth control counseling services, the center regularly distributes condoms and educational pamphlets about sex and pregnancy prevention. Kentucky is one of only 11 states where abstinence education is required to be covered when sex education is taught—and contraceptive education in the state is not. But Omar was clear, as is the research in this area: Abstinence-only programs do not work when it comes to preventing teen pregnancy.

What works best, according to Omar, is nurturing all aspects of a teenager’s life, including the psycho-emotional ones. In addition to providing counseling services and a supportive community, the Young Parents Program helps teenagers with the basics like food and clothing, raising money through clothing drives.

“One of the major issues in Appalachia is … lack of economic growth or lack of things to do,” explained Omar, “Essentially, what do [teens] do when school is done?” In a place like eastern Kentucky, adolescents don’t have many teen-friendly, safe places to spend their free time.

In the program, DeCoteau made friends that she still keeps today. She eventually got her GED, attended some college, and works at a job that supports her children.

DeCoteau has technically aged out of the program, but she and her children still receive medical care from some of the doctors there; the Young Parents Program continues to be a safe haven for her. “Anything I needed, they provided me with, and they still do … they’re always there to help me no matter what the situation,” said DeCoteau.

More than 20,000 teenagers visit the center per year, which provides medical and mental health services to patients whether they have health insurance or not. “We do not turn anyone away,” said Omar.

“15-year-old moms who are now finishing medical school, a couple of them finishing law school, some [who] are teachers or nurses,” said Omar, “that’s for me the success. It’s not just that they didn’t have another baby.”

But Omar expressed concern about federal cuts that the Trump administration has proposed—budget cuts that pointedly target initiatives like the Young Parents Program, as well as other youth programs around the country that provide resources, education, and enriching activities for low-income teenagers.

The Young Parents Program has already taken some hits from the state of Kentucky. “On the state level, a lot of things are happening that people are not aware of,” said Omar. “There were a lot of changes done that are restricting access to care … [a] decrease in funding across the board for reproductive health issues” except for funding toward abstinence education in Kentucky schools, “cuts in total funding to health departments at the state and national level, as well as cuts to schools.”

Even so, Omar feels confident that the Young Parents Program will survive, if only from sheer force of will. “I’ve told the university many times, I will continue to do what I do and if we lose more, we lose more. Either I’ll get fired, or the university will absorb the cost,” he said.

“Basically,” he said, “I am not going to change.”