When I started my sexuality-education career in the late 1990s, the pendulum was swinging away from the comprehensive programs that had been instituted in response to the rising HIV epidemic. Congress had just allocated a big chunk of money to teach young people that sex outside of marriage would have inevitable harmful effects. Though abstinence-only-until-marriage programs were not new, what had once been the province of religious institutions earned the federal stamp of approval, and states were funding programs that compared having sex outside of marriage to starting a fire in the middle of your living room instead of your fireplace.

And all of this was happening under the Democratic administration of President Bill Clinton.

Since then, I’ve watched changes with every administration. When George W. Bush took office a few years later, the push for these moralistic programs masquerading as teen pregnancy prevention grew stronger. By the end of his administration, abstinence-only-until-marriage programs were receiving $176 million per year. Then came the Obama administration, and the pendulum swung back a little bit. Some funding for abstinence-only-until-marriage was cut (though Congress made sure these programs didn’t disappear), new guidance toned down the abstinence rhetoric, and funding was finally made available for evidence-based teen pregnancy prevention programs.

Now it’s time for a new administration to take over. Since neither President-elect Donald Trump nor his advisors have shared any thoughts about sexuality education, advocates don’t know what to expect yet. But many are not optimistic.

Local Control, But Federal Purse Strings

The bright spot in the future of sex education is that as influential as federal policy can be, the final word on what gets taught is decided much closer to home. Debra Hauser, president of Advocates for Youth, told Rewire that local control will be key to sustaining the progress that has been made in instituting high-quality sexuality education in communities across the country.

Her organization was instrumental in the 2011 creation of the National Sexuality Education Standards, which were developed to address the inconsistent implementation of sexuality education nationwide. The standards outline the minimum essential content that should be included in sex education and the skills young people should acquire by certain grade levels. Advocates for Youth also authored a curriculum that provides teachers of all grade levels with lesson plans that address the topics covered in the standards.

Hauser said that this curriculum has gone out to more than 4,000 teachers, and that five of the ten largest school districts in the country are using it to fill gaps in their existing programs.

Hauser points to successes in improving sexuality education in large school districts like Clark County, Nevada, and Broward County, Florida. Clark County, which includes Las Vegas, is the fifth-largest school district in the country. This summer, its school board voted to expand sexuality education to include more information about important topics such as contraception (including where students could access birth control) and sexually transmitted infections (STIs). Broward County made a similar decision two years ago when it voted to overhaul sex education. Students from kindergarten through fourth grade learn about anatomy and personal safety, while students in the fifth through 12th grades now learn about a wide range of topics including dating violence, STI prevention, sexual abuse prevention, and sexting.

But Hauser acknowledges that a change in funding on the federal level will affect local communities, especially those in conservative states. Still, she said, “it’s hard to believe that a flip of a switch would turn back this kind of progress.”

That’s partly because the federal government has little direct input into the sexuality education that is taught in most schools across the country. Rules about whether schools must address sexuality, what topics must be taught, and what cannot be said all come from the state. Specifics about textbooks and curricula are most often decided by local school boards. Some money for programs also comes from the state.

The federal government does have a say, however, on sex education both in and out of schools.

The administration, Congress, and government agencies like the Department of Health and Human Services (HHS) all play roles in creating additional funding streams, allocating money, and deciding what programs need to look like in order to qualify for that money. Some of these funds—such as the Teen Pregnancy Prevention Program (TPPP)—are administered directly by the HHS, which means the agency decides which organization gets the money and what it does with it. Others—like the Title V abstinence-only funding stream—are given to states in the form of block grants, and the state decides exactly which programs to fund.

Funding May Get Cut (Or Increased)

Under the Bush administration, when abstinence-only was king, we saw a proliferation of such programs, the growth of an entire industry to support them, and legislation that supported an abstinence-only approach. Even states that had previously had comprehensive sex education were susceptible to legislation supporting abstinence.

Though the Obama administration has supported an evidence-based approach to sexual education, Congress has continued to push funding for abstinence-only-until-marriage programs. So both types of programs currently receive federal money.

According to the Sexuality Information and Education Council of the United States (SIECUS), there were two funding streams in Fiscal Year 2016 for evidence-based programs.

The Personal Responsibility Education Program receives $75 million annually and is given out mainly as block grants to states to support “evidence-informed or innovative approaches that offer medically accurate and age-appropriate education for adolescents.” Programs can teach about abstinence and/or contraception to prevent pregnancy and STIs.

Another funding stream that supports evidence-based programs is the Teen Pregnancy Prevention Program (TPPP), which provides a little more than $100 million to public and private entities in 33 states primarily to replicate prevention programs proven effective by research. These programs must be medically accurate, age-appropriate, and based on or informed by evidence.

Although there is no evidence that abstinence-only-until-marriage programs work to prevent teen pregnancy or STIs, the federal government continues to fund these program to the tune of $85 million per year. Most of that money ($75 million) goes through the Title V abstinence-only-until-marriage funding stream, which currently funds 35 states and two territories. States that accept the money must match every four federal dollars with three state dollars or in-kind services.

The other stream of abstinence-only receives only $10 million but reflects the rebranding that the abstinence industry has attempted during the last few years. Though the programs it supports are now referred to as “sexual risk avoidance” (SRA), the definition of these emerging programs prove that nothing substantive has changed. These programs are required to include medically accurate information, but they focus on what they call “voluntary self-regulation,” meaning teaching young people to avoid nonmarital sex along with risky behaviors like sexual coercion or drug use.

With the eradication of abstinence-only programs extremely unlikely, a victory for sexuality education advocates during the Trump administration would be to keep all the funding for both the good and the bad programs at current levels. However, it is more probable than not that funding for abstinence-only programs under the SRA label will increase, and very possible that at least some of the funding for evidence-based programs will dry up.

As the agency that oversees this funding and makes sure that programs follow the federal lead, HHS has a good deal of influence over programs across the country. In some cases, the agency administers the grants itself, giving it decision-making authority over which organizations receive the money and what they do with it. Even when the funds are given to states to administer, however, the federal agency is responsible for advising how these funds should and shouldn’t be used. It can, for example, be very strict about making grantees conform to the official eight-point definition of “abstinence education” like the Bush administration did, or be somewhat looser as have subsequent administrations.

There are other ways that government agencies set the agenda around sexuality education and sexual health besides controlling the purse strings. In 2010, HHS created the Office of Adolescent Health (OAH), which took responsibility for many programs, including the TPPP, as part of its effort to support prevention and health promotion activities. OAH operates at the discretion of the Secretary of HHS and, as such, may not continue to exist in the Trump administration if a new secretary doesn’t prioritize adolescent health.

It’s a Waiting Game

Ultimately, it is hard to predict what the Trump administration will do about sexuality education and how quickly it will act. The president-elect has never addressed sexuality education directly, and his positions on tangential topics suggest that he is unpredictable at best (he thinks Roe v. Wade should be overturned but called the Supreme Court decision legalizing marriage equality “settled law”). His vice president, Mike Pence, has supported an abstinence-only-until-marriage approach. Pence is also on record calling condoms poor protection against STIs and saying that the only “safe sex” is “no sex.”

But sex education doesn’t seem to be high on anyone’s agenda. Rep. Tom Price (R-GA), Trump’s pick for the HHS job,  is focused on dismantling the Affordable Care Act. And as a donor and activist, selected Secretary of Education Betsy DeVos was devoted to promoting school voucher programs (though she is also connected to crisis pregnancy centers, which have received a lot of abstinence-only-until-marriage funding over the decades).

As Chitra Panjabi, the president and CEO of SIECUS put it, “The radio silence from the incoming administration on adolescent health is driving uncertainty, fueling fear, and challenging the field of sex ed’s ability to plan for the future—not unlike someone subject to an abstinence-only program.”