A Question of Care: Birth Control in School

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A school board in Maine made headlines this week with a resolution allowing health centers to give birth control to students — some as young as 11. Divya Mohan, spokeswoman for the National Assembly on School-Based Health Care, goes behind the uproar to explain the role of the modern school nurse.

ALISON STEWART, host:

A school board in Portland, Maine, passed a resolution, a vote 7 to 2, to allow King Middle School to prescribe birth control to students. It means pills, patches, condoms could all be made available to students as young as 11 years old.

Now yesterday on NPR's DAY TO DAY, Portland School Committee member Lori Gramlich who voted for the measure spoke about how she made her decision.

(Soundbite of archived NPR recording)

Ms. LORI GRAMLICH (Member, Portland School Committee): I had a very long and deliberate conversation with my daughter. And so I asked her very - you know, kind of very pointedly, are there kids in middle school having sex? She said, you know, mom, there are. They're not really 11-year-olds or 6th or 7th graders. But she said, I know 8th graders who have. So it's not that I would ever do that but I know 8th graders who have. But I said, what do you think about telling their mom or dad? And she said, mom, let's be realistic. There's no way that a kid will get services if they had to tell their mom or dad.

So I mean, I guess kind of what brought me to the conclusion of voting for this was that if we can do whatever we can to prevent one teen pregnancy, then I think we've done our job.

STEWART: So all the different points of views have been talked about and debated about on TV and talk radio. But we wanted to know about these semi-independent health clinics that are on school campuses. It's part of an initiative called the school-based health centers.

Now, the public relations people for the national group presenting these centers - representing these centers were fielding calls all day to talk about the contraception case in Maine, but we found out there's much more to these health providers.

Divya Mohan is a spokeswoman for the National Assembly on School-Based Health Care.

Good morning, Divya.

Ms. DIVYA MOHAN (Spokesman, National Assembly on School-Based Health Care): Hi, Alison. How are you?

STEWART: I'm doing great. Let's be really clear about these school-based health clinics - SBHCs. What are they, and what is their primary goal?

Ms. MOHAN: School-based health centers are doctors' offices in the schools. They're funded through a variety of sources, but they're located in the school, oftentimes just housed in the school, which - but the - one of the greatest strengths of school-based health centers is that the services provided in every center is determined as such by the needs of the community.

So in Portland, the cases that they determined - the Division of Public Health in Portland determined that they wanted to provide contraception in middle schools, and they voted, and that's what they decided. And as a national organization, we support the model, which provides school-based - which provides the needs of the community services in the center.

STEWART: So how many of them are there actually in the country?

Ms. MOHAN: There are about 1,700.

STEWART: And…

Ms. MOHAN: And unfortunately, that's only about 2 percent of the schools in the country, but we target locations that are, you know, urban or rural so that we can meet students with the greatest needs and give them health access where they otherwise wouldn't have that health access. And reproductive health services are among the smallest subset of services provided in the school-based health center.

The most common primary care services provided by school-based health centers are treatment of acute illness, comprehensive health assessments, screenings, asthma treatment. For instance, if you - if a student needs to get a physical to play a sport, but doesn't have health access otherwise, he can go to the school-based health center and get a sports physical and thus be allowed to play sports at that school. I mean, these are great, great - this is a great alternative to the health care model in this country and is much needed by so many kids.

STEWART: It sounds like it's a no-brainer, but there's, obviously, got to be some groups who aren't happy about this idea. Who are your biggest obstacles?

Ms. MOHAN: I think that people have a misconception about what school-based health centers do. Nobody in the country is going to deny that we want our kids healthy and ready to learn in schools. But I think that stories like Portland kind of make people think that we are trying to provide services in the school-based health centers to kids without letting their parents know what's happening. So - and neither this misconceptions that people have about them, but…

LUKE BURBANK, host:

Well, how is it a misconception, exactly? I mean…

Ms. MOHAN: Well, you know, the majority of school-based health clinics require a - well, almost all school-based health centers require parental consent. And parents have the option of knowing every single service provided in the school-based health center. And the majority of them also parents(ph) the opportunity to restrict access to specific health services in the center.

So if a parent doesn't want their student to have access to, you know, nutrition counseling, they can - they can opt out of that particular service. So…

STEWART: So the centers are actually on the campuses, does that mean the school is picking up the bill or the state's picking up the bill?

Ms. MOHAN: Oh no.

STEWART: Who's picking up the bill?

Ms. MOHAN: There are a lot of non - funding sources, state government, private foundations, the county and the city government, and in some cases even corporations and businesses. We look for sponsors to host these centers - not host. The school hosts the centers, but we look for sponsors to fund the centers. And it's usually community and public health organizations.

STEWART: Yesterday was a big news day for you, guys. I know you were fielding calls all day about the Maine story, but you also had a provision in the SCHIP bill, the one that went down.

(Soundbite of laughter)

STEWART: What was your group fighting for?

Ms. MOHAN: We wanted school-based health centers to be a provider listed under SCHIP so that the services provided in the school-based health center would be reimbursed by SCHIP. In some cases, that is happening. A lot of the time, Medicaid is 72 percent of the third-party payers for health center visits. But having a provision in SCHIP would just have given us some legitimacy and really provide an additional funding source for so many kids that are uninsured in this country.

STEWART: Divya Mohan is a spokesman for the National Assembly on School-Based Health Care. Thanks for explaining the program to us.

Ms. MOHAN: Oh, no problem. Thanks for having me, Alison and Luke.

BURBANK: Thank you.

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