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May 22, 1989
"Minn. Clinics Work for Teens"
San Jose Mercury News
By Barbara Taylor and Timothy Taylor
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THE most topsy-turvy complaint against sex education in public schools is blaming these programs for the rise in teen- age pregnancy. The logic of the complaint resembles accusing firefighters of starting fires, just because they often show up near burning houses. It is silliness squared to believe that the few weeks of classroom sex education, all most high school students receive, leads to a million teen-age pregnancies a year.

One proven way to make sex education work is to combine it with a health clinic inside the school. The Health Start program in St. Paul, Minn., was the first to try this approach, and school-based health clinics have now been operating in St. Paul for the last 16 years.

Two-thirds of clinic activity is plain, ordinary health care, focusing on things that school nurses don't have the authority to do: physical check-ups for students on sports teams, immunizations, diagnostic tests (like throat cultures or blood tests), counseling for emotional and family problems, nutrition advice, skin care, and so on. For an alarming number of students, the clinic is their only source of non-emergency health care.

But health care for adolescents must inevitably deal with teen-age sexuality and pregnancy, which is when it becomes controversial. In St. Paul, however, the program has been operating long enough to demonstrate its effectiveness.

Since 1973, when the first clinic opened, the number of girls who deliver babies has fallen from about 8 percent a year to only 3.5 percent. That translates into more than 100 fewer mothers every year at the five St. Paul schools with clinics.

Perhaps more important, the number of repeat births has been cut to nearly zero. With day-care help from family and friends, a teen-age mother with one child has a decent shot at finishing school, getting a job, and taking control of her own life. After a second or third child, the responsibilities of child care are more likely to control her life.

Clinic opponents have two main charges: that contraception encourages teens to have sex and that clinics promote abortions. Neither assertion is supported by the evidence.

The forces that push adolescents into or away from sexual activity are more complex and powerful than a health clinic or sex ed class. By the time a student walks in, the decision about whether to have sex has been made months or years earlier.

At that stage, the clinic can teach the teen-ager about the available choices.

Choice A is "abstinence," but it's unavoidable that many students will continue making other choices. Clinics in the St. Paul schools do not dispense birth control, but after a complete physical and several counseling and teaching sessions, they do write birth control prescriptions that can be filled at nearby medical facilities.

The clinics then encourage teens to stick with their choices, whether the choice is abstinence, the pill, or another method.

The St. Paul school-based clinics have a long-standing policy that they do not provide abortion counseling or referrals, unless requested to do so by parents. If a pregnant teen-ager raises the question, she is encouraged instead to talk with her parents, school staff, and other caring adults. If the girl decides to continue her pregnancy, she can receive prenatal care and classes through the clinic. In any case, she needs to learn how to avoid facing another unwanted pregnancy.

Actually, the percentage of girls who choose abortion tends to be lower at schools with health clinics. One big reason is probably that repeat pregnancies, and thus repeat abortions, are prevented.

By providing preventive care, school-based health clinics save money for society as a whole.

For example, as a result of prenatal care and counseling, the St. Paul clinics have cut the number of babies born with unhealthy low birth weights in half. Hospital care for a low birth-weight baby can easily run $1,500 a day for several months.

At that rate, the cost saving from preventing a single premature or low birth weight baby is roughly enough to cover the cost of one clinic, like the one at St. Paul Central High School, for a year.

Over time, a health clinic based in a school can become as much a part of the school as health class or a trip to the guidance counselor. By becoming a part of everyday life for teen-agers, school-based clinics provide a unique channel for encouraging healthy lifestyles.

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