AUDIE CORNISH, HOST:
Washington, D.C., has a high teen pregnancy rate even after years of efforts and initiatives. In some parts of D.C., as many as 1 in 3 girls will become mothers as teenagers. This inspired a midwife in the area to try something unusual - work out of a high school clinic. NPR's Selena Simmons-Duffin has this profile.
SELENA SIMMONS-DUFFIN, BYLINE: Loral Patchen has a big, magnetic presence and striking silver hair.
LORAL PATCHEN: How are you, my dear?
SIMMONS-DUFFIN: Early on this Monday morning at Anacostia High School, one pregnant student wanders into the clinic.
PATCHEN: You're coming this early to see me.
UNIDENTIFIED STUDENT #1: I'm going to come to you at lunch. You know, I've got to go to class. I'm a scholar.
PATCHEN: I love it when I'm walking in or, you know, in the hall because I see people. And they come in to ask me a question, and they've got their two girlfriends with her. And we'll talk about condom use, or they'll say, I heard...
SIMMONS-DUFFIN: Almost all the students here are African-American from low-income families. The school clinic is pretty big with several exam rooms, a pediatrician, a nurse, some medical students, plus every other Monday, a social worker and Patchen, the school midwife. They work as a team as part of TAPP, the Teen Alliance for Prepared Parenting. Patchen started TAPP two decades ago at MedStar Washington Hospital Center. Then in 2015, a grant from CareFirst BlueCross BlueShield allowed them to work right in D.C. schools.
PATCHEN: Come on in.
SIMMONS-DUFFIN: Pretty soon, her patients for the day start arriving.
PATCHEN: How are you?
UNIDENTIFIED STUDENT #2: Good.
SIMMONS-DUFFIN: Back in the exam room, Patchen's energy is way quieter. She's attentive and direct. The first student comes in for a pregnancy test. It's negative, but it's the second time she's been in for a test. Patchen asks about what's going on. Her boyfriend wants kids. He won't use protection. She loves him, she says. But she doesn't want to get pregnant. They talk about different birth control options. Patchen can provide long-term options like IUDs on the spot. The student shows some interest in the IUD but in the end chooses birth control pills. Patchen gets her a pack, explains how it works.
PATCHEN: All right, I'll see you in two weeks.
SIMMONS-DUFFIN: And the student heads back to class.
PATCHEN: And that's specifically possible because of the CareFirst Grant.
SIMMONS-DUFFIN: She says having the full range of contraceptive methods available on site, same day is a big deal. Young people often don't have easy access to doctors and pharmacies. The other part of Patchen's job is prenatal care for students who do get pregnant. Last year, Kiera was one. We're only using her first name to protect students' privacy. She got pregnant at 15.
KIERA: I was scared when I first got pregnant.
SIMMONS-DUFFIN: She met with Patchen all the way through her pregnancy, one of the advantages of being right there in the school.
PATCHEN: That allowed us to not only focus on the benefits of breastfeeding and how you're going to do that in a school setting but also, so what are your conversations like right now with D'Monte?
SIMMONS-DUFFIN: Since D'Monte, the baby's father, was a student at the school too, Patchen could talk to them together about parenting. Now their baby is a toddling 1-year-old.
KIERA: Say, hi.
UNIDENTIFIED BABY: (Laughter).
D'MONTE: Look at her laugh.
PATCHEN: Oh, look at her. Oh, look at that face.
UNIDENTIFIED BABY: (Laugher).
PATCHEN: I love when they come to the office 'cause her daughter - you know, she's laughing, and she's responsive to things. And they're responsive to her. It's a beautiful thing.
SIMMONS-DUFFIN: Loral Patchen wants to be clear. She's by no means saying that teen pregnancy is a great thing. But she feels strongly that students who do get pregnant need real, steady support.
PATCHEN: They are very aware of all the judgment, the assumption they will fail. You won't be able to; now you can't. It is our mandate to make sure that they still see themselves as having a future and an opportunity. And that means not buying in to the fact that they will fail with the next, you know, 60 years of their lives.
SIMMONS-DUFFIN: She says a lot of people say what she does sounds dire, working with young people facing so many challenges. She says that's not her experience.
PATCHEN: My day at the school health center is the highlight of my week.
SIMMONS-DUFFIN: She wants more - more days in the school clinic, more schools in the program, more staff. She thinks there's real potential here to actually bring down the high rate of teen pregnancy for these young women. Selena Simmons-Duffin, NPR News, Washington.
CORNISH: This story is part of a reporting partnership with NPR and Kaiser Health News.