Students\' Access to Birth Control

Students' Access to Birth Control Services

Confidential Condom and Birth Control Pills for Middle School Students?

The argument put forward in this paper is that today's teenager, whether in senior high school or middle school, should be given access to confidential health care - e.g., condoms and prescription birth control - in order to reduce the rate of teen pregnancy, and to avoid the physical and psychological ramifications of pregnancy. Teens are sexually active at an earlier age than previously - that fact along with other pertinent data will be substantiated in this paper. It is also true that teens tend not to request contraceptive materials until after they have become sexually active, and generally speaking, the realities and complications that accompany a pregnant girl in her early teens far outweighs problems and issues associated with a school handing out condoms and providing females with appropriate birth control medications.

And indeed, there are good points-of-view on both sides of this issue. Many passionately expressed points-of-view were publicized nationally recently when the school board for King Middle School in Portland Maine authorized school officials to make condoms and contraceptives available to students (in a confidential, authorized health care setting). And while an objective review of the issues surrounding this controversy will be present, the bottom line for this paper is that the policy put forward by the well-informed, courageous people at King Middle School, is the correct policy.

A brief review of the King Middle School controversy is worthwhile at the outset of this paper. In October, 2007, by a 7-2 vote, the School Committee set in motion a policy that authorizes the health center to give a "full range of contraception" to students in grades 6 to 8 (that is 11 to 15 years of age), according to the Portland Press Herald (Nov. 26, 2007). King Middle School has been providing condoms "as part of comprehensive reproductive health care" since 2,000, but under this new policy, this school is the first in Maine to offer the full range of contraception to middle school students.

This decision by King Middle School has stirred up controversy nationwide, but as to local reaction, the Portland Press Herald reports there is a recall movement to remove three members of the School Committee - Rebecca Minnick, Robert O'Brien, and Sarah Thompson. These three were apparently among the leadership in the committed that spearheaded the move to expand the contraception program. And the newspaper also reports that indeed students require written parental permission to be treated at the King Middle School health center, Maine state law allows students "...to receive confidential care for reproductive health, mental health, and substance abuse issues," the Portland Press Herald explains.

Reader comments posted on the Portland Press Herald on December 4 reflected the emotions stirred by the controversy (http://pressherald.maintoday.com)."Schools are for education not health care. Health care is between a parent and child, not government" ("silence dogood, Augusta ME); "...This recall will cost Portland taxpayers $35-50,000. Glad Portland has the money to burn." (Oldguy, Biddeford, ME); "Access is critical in health care matters, particularly for young people...isn't it better to give them the protection they need then to risk the consequences?" (parker66, South Portland, ME).

LITERATURE REVIEW

Parents Have the Right to Know When Their Children Receive Family Planning Services at School," an essay by Tana L. Green (Opposing Viewpoints: Students' Rights 2005), points to the author's belief that parents should be informed when their children are being given birth control advice and materials. When parents are not informed of these facts, their authority as parents is undermined, Green writes, and she clearly implies that at this time students are receiving contraceptives and birth control advice without their parents' knowledge. A survey that Green uses in his essay shows that there has been a dramatic increase in school-based healthcare clinics in recent years; in 1990 there were 200 school-based clinics (SBCs); by 2005, that number had skyrocketed to 1,135, according to Green's sources. Part of that rise in numbers of clinics was due to the HIV / AIDS pandemic, she points out, but "...the truth is," Green continues, "SBCs don't protect young people from AIDS or other sexually transmitted diseases (STDs).

Green flatly states that once the SBC is in place, having been "stealthily" created, they work through PR strategies to "gain community support and a buy-in from parents" and then begin dispensing birth control information and condoms. She paints a picture of deception, and of SBCs that "chip away at parental rights." Green also suggests that SBCs are "heavily located exclusively in poor urban, black neighborhoods," which raises the issue of institutional racism and bias. Going further in her contentions about ethnic bias, Green even asserts that there is a "veiled genocidal scheme" in that birth control clinics (SBCs) established in schools that are predominately African-American are not there just to provide for the health and safety of the students. They are there to keep black people from expanding their population numbers, which she does not back up with data, notwithstanding the provocative nature of her accusation.

The suggestion here by Green is that racist policies are behind the push for more SBCs in black schools, and the main substantiating point she offers is that the Centers for Disease Control reports that abortion rates are higher in "urban areas" (translate that, the hood), and that "36% of all abortions are performed on black woman...although blacks constitute 13% of the total population" (Green 2005).

Those controversial assertions aside, Green's main point at the conclusion of the article is that "parents must therefore stay informed... [and] make their voices heard when administrators attempt to usurp their authority by making decisions for their children."

Requiring Parental consent for Contraceptive Services Puts Teens at Risk" is an essay written by Christine Watkins (National Family Planning and Reproductive Health Association, 2005), which in effect rebuts the previous essay by Green. Watkins alludes to Title X of the Public Health Services Act, which provides money for clinics to offer "a variety of contraceptives, counseling, and testing" for STDs. She claims that annually, publicly funded family planning services "help teenagers to avoid almost 400,000 unintended pregnancies." Without publicly funded family planning services, Watkins continues, teen pregnancies would have been about 20% higher over the past twenty or so years.

There are legislators who have attempted to amend Title X so that parental consent would be required in all cases of minors using birth control services, but Watkins insists that studies she is familiar with show teens either "delay or avoid" going to use those services. That delay or avoidance on the part of teams places them "at risk for unwanted, unplanned pregnancies" as well as putting them at risk to get STDs - including HIV / AIDS.

Watkins backs up her contention with data; to wit, the Journal of the American Medical Association (JAMA) published research in 2002 that found some "59% of the teens" in their survey said that "knowing their parents would be notified would prevent them from seeking family planning services." Of those, 99% said they "would still have sex" with or without birth control assistance. As additional backup for her positions, Watkins writes that in the year following the elimination of parental consent for HIV testing in Connecticut, "...the number of teens aged 13-17 obtaining HIV tests doubled."

Moreover, fifty-eight percent of high school students in three public schools in Massachusetts responded to a survey by indicating they "did not want to share with their parents" their personal health concerns. Until the Green essay, Watkins' article is heavy with data supporting her position, including a list of nationally recognized medical and healthcare organizations that "oppose mandatory parental notification" or requirements for parental consent "in order for young people to obtain family planning services." Those organizations include: American College of Obstetricians and Gynecologists; American Academy of Pediatrics; American Academy of Family Physicians; American Public Health Association; American Medical Women's Association; and the National Medical Association.

Even the American Medical Association (AMA), not known for progressive or liberal leanings, has as a policy statement opposition to "...regulations that require parental notification when prescription contraceptives are provided to minors" through programs that are federally funded. The reason for the AMA's opposition to regulations requiring parents to be notified is that those regulations "...create a breach of confidentiality in the physician-patient relationship."

It is important to note that "the vast majority of teens" that seek to be served at a Title X clinic have been sexually active; in other words, teens don't just suddenly decide they will become involved in a sexual relationship and go to a clinic for birth control assistance. In face, "on average," Watkins' article states, "teens are sexually active for 14 months prior to making a family planning visit." By requiring parental approval, Watkins goes on, states and other jurisdictions are "erecting roadblocks" to good health strategies to youth, many of whom are "attempting to behave responsibly" by attending the clinic in the first place.

In conclusion, Watkins draws an important link between teen childbearing and poverty, which takes this discussion past morals and values and moves it into socioeconomic territory. Half of all mothers currently on welfare assistance "were teenagers when they had their first child," Watkins writes. Also, a) less than a third of teen mothers "ever finish high school"; b) the children born to teenage mothers "are twice as likely to raise their children in poverty"; c) the children of teen mothers "...are more likely to do poorly in school, more likely to drop out of school, and less likely to attend college"; and d) girls whose mothers were teenagers at the time of their birth are "...22% more likely to become mothers as teens themselves," thus completing the cycle and perpetuating the problem into future generations.

An article by Jennifer a. Hurley ("Promoting the Use of Birth Control Reduces Teen Pregnancy") reports that society is making some progress in slowing down teenage pregnancy notwithstanding some wrong-headed policies by the federal government. Albeit this piece is seven years old, it does point out how wrong the federal policy was that required states to show they were teaching abstinence (and denying birth control) prior to receiving sex education funding. Hurley points to the specifics that government bureaucrats required of states under this program that had a moralistic, ideological spin.

In order to receive funds, states (under the federal guidelines in place in 2000) must have a policy through which any sex education class at the high school level would push an "abstinence-only" philosophy. The schools must teach that abstinence from having sex "is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases," and other health problems associated with sexual activity. That same sex education program must convince the federal bureaucrats who are making decisions on grant funding that it is teaching teens that a "...faithful monogamous relationship in context of marriage is the expected standard" of sexual involvement for Americans. There is more, but suffice it to say, the requirements sounded like a page out of the Conservative Christians' handbook rather than a federal list of reasonable guidelines. Hurley also points out that regulations such as the ones mentioned above fly in the face of the facts regarding most Americans' sexual activities during their lifetimes. To wit, a national scientific study of adult sexual behavior quoted by Hurley showed that "...fewer than 7% of men and 20% of women age 18 to 59 were virgins when they married."

Further, the "abstinence-only law" put forward by the executive branch of the government would decree (if it were taken seriously by fair-minded average Americans) that "...it is wrong and harmful for the 74 million Americans who are gay, single, divorced or widowed to have sex." Do abstinence-only policies work? Two surveys alluded to by Hurley suggest strongly that they do not work. For example, a 1997 study by the University of Nebraska - which carefully reviewed and analyzed "more than two dozen abstinence-only programs - found that "the majority had no effect on the timing or amount of teen sexual activity." And another study, this one conducted by Education Now, Babies Later, a program involving 187,000 teens in California, found that abstinence-only programs "had no impact on the age at which teenagers began to have sex."

For her part, Hurley suggests a better approach would be to promote "abstinence-plus," which suggests that "you give weight to abstinence," and explain to kids that by abstaining from sexual intercourse a girl can be 100% certain of not becoming pregnant. Also, you point out how horrible it is to get herpes, how serious STDs can be, but you also talk "...about condoms and contraception in a 'balanced and accurate' manner," Hurley concludes.

The subject of that federal law regarding the teaching of abstinence-only in order to qualify for money from the Department of Health and Human Services (HHS) was addressed in a research article in Education Week (Samuels, 2006) ("GAO Opinion Renews Debate on Abstinence-Only Programs"). In fact, an opinion by the Government Accountability Office (GAO), the congressional watchdog agency, spells out that by limiting grantees to those schools and states that promote abstinence-only, the Bush Administration is basically violating a federal law. That was the opinion of Gary L. Kepplinger, general counsel of the GAO; in reporting to the Congress Kepplinger stated that recipients of federal grants to promote abstinence-until-marriage sex education must by law include "medically accurate" information about condoms. If those grantees do not provide students with updated birth control and condom information, whether because of pressure from the Bush Administration or not, are in violation of federal law.

The National Abstinence leadership council - educators who support abstinence-only policies and provide curriculum in that regard - came out recently and announced that its members "were committed to medical accuracy in their programs," Samuels' article reports. The council states that its information comes from government publications and "other reputable sources." That having been said, William Smith, a vice president for public policy at the Sexuality Information and Education Council of the United States (SIECUS), claims that abstinence education programs "continue to be rife with misinformation." States that get the money from HHS and go along with the program - even if they know federal law requires them to education students about condoms and birth control - "just dismiss it," Smith accused. "They don't seem to care," he added.

As for Horn with HHS, he asserts that the GAO legal opinion "is just that, a legal opinion," that HHS is not obliged to adhere to. But Smith issued a warning: "if they do not come into compliance with federal law, they will be in court."

What happens when a state pushes abstinence but refuses to offer birth control information and services to teens? Texas is a classic example of that mentality. Indeed, Texas is a state that has always considered itself independent and very sure of itself in terms of values, morality, and social mores. it's the only state where schoolchildren repeat the pledge to both the American flag and the state flag - the long star flag of Texas. But how are Texas parents and schools handling the matter of teen pregnancy? An article (Garrett, 2007) in the Dallas Morning News indicates that things are getting out of control. Indeed, while the teen birth rate is slowing across the United States, "Texas has made far less headway," Garrett writes, and that is "alarming public health officials and child advocates.

To wit, Texas today is ranked number one in the nation when it comes to teens having babies. The nonprofit group Child Trends reports that the latest statistics available - for 2004 - show that in fact 24% of Texas' teen births were not the girl's first delivery. In Texas, school officials, community leaders, some parents and religious leaders push abstinence-only sex education programs. Some experts are now asking serious questions about that approach, pointing out that between 1991 and 2004, the teen birth rate in Texas dropped 19% while in other states the teen birth rate dropped by far larger margins.

For example, in California during the same window of time, the teen birth rate dropped by a dramatic 47%. In California, schools teach abstinence in sex education classes but also contraception is fully explained and birth control methods - condoms - have been dispensed to boys and girls at no cost, with no parental consent required, in community clinics and doctor's offices, Garrett explains in the article.

California and Texas are worlds apart not only in geography but in political and religious cultural approaches to society and values, but they share a common dynamic; both have fast-growing immigrant populations. And both immigrant populations, Garrett continues, "are especially at risk of teen childbearing." Indeed Hispanics have the highest teen birth rates "of any ethnic group." In 2004, Hispanic girls between the ages of 15 to 19 accounted for "61% of teen births" even though the percentage of Texas teens that were Latino was only 39%.

In Texas, when George W. Bush was governor, he endorsed legislation that now requires schools to teach "abstinence as the 'preferred choice' for unmarried young people." it's clear that the Bush initiative has not succeeded to the level that it was hoped for. Meantime, when comparing California and Texas, one has to understand the universe of difference in approaches to social issues and problems. For example, first look at the data between the two states; in California the teen birth rate (2004, latest statistics available) is now at 39 per 1,000 girls between ages 15-19. That is down from 74 births per 1,000 in 1991. In Texas, the 1991 mark was 78 births per 1,000 girls (ages 15-19) and in 2004 that Texas data changed only slightly, to 63 births per 1,000 teenaged girls.

Now, with that juxtaposition spelled out, enter Cathie Adams, a leader in the Texas social conservative movement called "Eagle Forum." Adams is quoted in this Dallas Morning News article as saying, "I certainly wouldn't believe anything coming out of California. I don't know where abortion comes in under their laws... [but] Most anything that plays in California is out of step with the rest of America."

So the implication is clear: the reason California teenagers are having far fewer babies than Texas teenagers is not due to progressive sex education programs and birth control services. it's because there are more abortions in California. At least from the conservative anti-California viewpoint that is true. It might also be said that anything coming out of Texas is out of step with the rest of America.