Emergency Contraception in School Based Clinics

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School Based Health Clinics (SBHC) are an important component in giving teens access to comprehensive health care.  There are 2000 school based health centers in the US according to HRSA.  These clinics provide many different services ranging from immunizations, mental health care and general primary care.  Most of the services offered by SBHCs are noncontroversial and widely accepted.   SBHCs have begun to expand their services so that they offer family planning and STD prevention.  New York City schools caused a significant controversy when they decided to offer emergency contraception in their school based clinics.  This was despite the well established safety profile of emergency contraception whose availability has been endorsed by ACOG, AAFP and the AAP.  Access to emergency contraception for teens is an important component of reproductive family planning.  The United States continues to have the highest rates of teen pregnancy in the developed world.  In Oklahoma  ranks 15th in the US in teen pregnancies in teens age 15-19.  This is not a record to be proud of.  Many in the state and local government are proponents of abstinence only education which has been proven to not work.

https://i1.wp.com/www.choiceusablog.org/wp-content/uploads/2012/09/ec.jpg

The decision made by NYC schools and many other cities is based on sound health policy.  Access to emergency contraception is an important part of providing adolescent health care.  Having emergency contraceptives available in SBHCs will help remove  barriers by providing access in the place where teen spend their days.  They may also feels more comfortable accessing care in schools than in other clinics.  This is also an opportunity for providers in these clinics to educate the teen on long term family planning options and STD prevention.  Ignoring the issue of teen reproductive health  will lead to more teen pregnancies and STDs.  By offering family planning in school based clinics, this issue can addressed in an evidenced based manner.

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5 Responses to “Emergency Contraception in School Based Clinics”

  1. My Orange Chair Says:

    I think the most important point you touched on was that this could lead to a wider use of school-based services. In a country that currently eschews comprehensive sex education, teens need to get their information and care somewhere and school-based clinics could be a good option.

    However, the likelihood of emergency contraception becoming accessible in conservative communities is unlikely. Further, students could see the school-based clinic as an unsafe place – other students could find out that they’ve been there and they might not trust the staff or nurses to keep their information confidential.

  2. sdennis76 Says:

    It is a tough fight however progress can be made especially given the science and the widespread support by pediatricians and the larger health community (who are trusted sources of health information).

    I think students are more likely to trust SBHCs when they know that they are advocating for their whole health and not afraid or forbidden to talk about certain taboo subjects. It’s important that these providers be able to talk about and address all the issues that impact teens lives.

  3. skim276 Says:

    I also agree that school-based health clinics offer a great venue through which teenagers can access family planning/reproductive health services. With the Affordable Care Act increasing funding for SBHCs, introduction of emergency contraception services as well inclusion of health education and other preventative services in these settings could improve adolescent reproductive and other health outcomes.
    The debate over policy on sex education/family planning services for teenagers has long-lasted. I believe it’s important to actively publicize data and evidence on the ineffectiveness of abstinence-only policies (For example, an article reported that increasing emphasis on abstinence education is positively correlated with
    teenage pregnancy and birth rates (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0024658) and to build evidence on other family planning/pregnancy prevention strategies/programs.

  4. lsbroadhead Says:

    The proposal is interesting, but I find myself torn on the subject. I appreciate the concept of receiving parental approval forms to ensure that parents are okay with the schools providing this service to their children. However, the data presented in the New York Times article is unclear about how many forms were returned, and whether these services could be provided if no form was returned.

    The program offers a great opportunity for health professionals to educate adolescents about safe sex practices and healthy family planning. However, I have two concerns. First, by only offering the emergency contraceptive, you are only receiving students who have already engaged in sexual acts. You are not reaching them beforehand. This is a largely missed opportunity for education. Second, by only offering the emergency contraceptive for free—and not other forms of contraceptives—the schools are eliminating the responsibility associated with having sex. If the adolescent no longer has to pay to receive this medicine, there is no incentive for the adolescent to purchase any form of protection as they now have a free method to combat unwanted pregnancy risks. For some adolescents, the fear of teenage pregnancy is more of a driving force behind their choice for abstinence and safe sex practices than is the risk of contracting an STD.

    These concerns could be alleviated however if clinics were allowed to offer ALL forms of contraceptive—condoms, birth control pills, emergency contraceptive pills, etc—for a small fee (cheaper than drug store pricing) at the schools. This would allow adolescents to come to a safe place for contraceptive advice, and still places a level of responsibility on the adolescents’ shoulders for making safe sex choices. Additionally the health practitioners could educate adolescents about the benefits of each contraceptive option and the health risks involved in sexual acts before some adolescents begin to engage in sexual activities.

  5. sdennis76 Says:

    I agree that care should be comprehensive and not just emergency contraception. I think that this would be the ideal situation. But in lieu of this being able to offer emergency contraception is a way to get a teen who is in a crisis identified by a health provider and not only intervening in that moment but then discussing long term family planning. I doubt that any clinician would feel it is the best plan for teens to take these pills without further discussion of std prevention and pregnancy prevention. These aids are not consequence free either.

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