School Health Clinic Would Give Teens Contraceptives

Alarmed at the runaway rate of teen-age pregnancies and inadequate health care for some adolescents, San Diego city school officials are considering a plan to dispense contraceptives to students at a school-based health clinic.

The clinic, now being studied by the school district’s Health Services Department, would also handle the routine medical needs of adolescents, including physical examinations, immunizations, laboratory tests, counseling and perhaps dental care--all in a setting that is easily accessible to teens who otherwise might not receive those services.

But its most controversial component would be a proposal to make contraceptives, such as birth control pills, condoms and foam, available to teen-age students, said Edward S. Fletcher, director of Health Services.

“More than one-third of all teen-age girls become pregnant before they turn 20,” Fletcher said Wednesday. “I think we need to look at that and see what we can do.”

The idea of school-based medical care has flourished around the country simply because there is “a large percentage of adolescents who don’t have any source of regular medical care,” Fletcher said.

The proposal raises several political, economic and ethical questions--including location, funding, eligibility for services, parental consent requirements and cost to users--that have not yet been answered, Fletcher said.

Southeast San Diego or Linda Vista might be appropriate sites for the clinic because of the number of low-income students in those areas, Fletcher said. Ideally, the facility would be operated by an outside agency, which could avoid strict parental notice requirements placed on school officials by government regulations, he said.

Well aware that the proposal will be vehemently debated, Fletcher and physician Philip Nader plan to recommend that the idea be studied further by a community task force when they submit a report to Supt. Thomas W. Payzant in mid-January. That group, which could include parents, teachers and religious leaders, would make further recommendations before Payzant decides whether to bring the proposal to the Board of Education, Fletcher said. The strategy was mapped out in a meeting with Payzant on Monday, he said.

While Fletcher’s staff has concluded that a health clinic that dispenses contraceptives would be “beneficial,” others already are against the idea.

School board President Larry K. Lester said dispensing contraceptives “tends to legitimize students’ sexual activity, and I think the focus should be on discouraging that. I really question whether that’s the role of the school.”

The Rev. John Proctor, vice-officialis of the Catholic Diocese of San Diego, agreed.

“Obviously, the church is going to take a position that this is not in the best interests of the students or in the best interests of society,” Proctor said. “People who aren’t married shouldn’t have sexual intercourse.”

But school board Vice President Susan Davis, who said she would not make a final decision on a clinic until details are decided, generally supported the idea. “The bottom line has to be What’s going to benefit kids the most?” she said. “What’s going to prepare them for life? If we can prevent a few pregnancies, I’d like to do that.”

Planned Parenthood of San Diego and Riverside counties also will back the proposal, said Lenore Lowe, director of community affairs. “Planned Parenthood is in favor of school-based clinics because we believe that access to information and contraceptives is truly the only way we’re going to reduce the problem of teen-age pregnancy,” Lowe said.

In 1981, the latest year for which figures are available, about 1.1 million females age 15 to 19 became pregnant, according to the Alan Guttmacher Institute in New York City. The family planning organization says about 40% of all women in the United States will become pregnant before their 20th birthday.

Planned Parenthood estimates that 2,772 San Diego County girls age 17 and under became pregnant in 1984. The figure is extrapolated from the 1,109 children born to girls of the same age group last year.

City schools already hold special classes for pregnant students at Garfield and Twain independent learning centers, and allow students to bring their infants to special day care centers at Garfield and at San Diego and Abraham Lincoln high schools. Pregnant students also may continue to attend their neighborhood schools.

Across the country, 42 school-based health clinics, mainly in high schools, provide family planning services, and nine give out contraceptives, said Douglas Kirby, director of research for the Center for Population Options in Washington. Last month, the Los Angeles school board decided to establish a pilot health clinic that will offer contraceptives.

The cost of establishing such a clinic can range from $25,000 to $400,000, but generally averages $125 for each student served, Kirby said. Most do not charge students for services.

Almost all request a general parental consent form at the beginning of each school year, but do not notify parents each time a teen-ager uses a service, Kirby said. Requiring parental notice for each visit would discourage students from obtaining contraceptives at the clinic, he said. Most clinics spend about 85% of their time on services other than family planning, Kirby said.

Evidence from one clinic in St. Paul, Minn., showed that, after students had had access to contraceptives for about five years, the high school birth rate was cut in half, Kirby said.