Condoms and Contraceptives in Junior High and High School Clinics

Abstract

The experiences of visiting on site a few school-based health clinics are recounted: the Little Rock's Forest Heights Junior High School clinic and the Wellness Clinic, Arkansas; Health Start clinic services in St. Paul, Minnesota. Selected opinions are reported from journal articles and prominent public health professionals: Sandra Samuels, MD; William R. Archer, MD; Sid Crosby, MD; Joycelyn Elders, MD; and others. The overriding concern is finding an answer to the question of what should be done about adolescent pregnancy and sexually transmitted disease prevention without promoting sex behavior. Many approaches have been tried and evaluated. In Little Rock's junior high school program, health care was devoted entirely to helping girl's find the most appropriate birth control plan; referrals are made to the state-supported mall clinic near the school. In the Wellness Clinic, the literature was devoted to defining "safer sex" and promoting condom usage for control of sexually transmitted diseases. A visit to Dr. Elders as Director of the Arkansas Health Department showed her to be "warm, articulate, and dynamic" and a believer in reproductive counseling. Today, there are more than 300 schools with school-based clinics across the country. Programs vary in their mandate to prescribe contraceptives or counsel about contraceptive usage. In St. Paul, Minnesota, a nonprofit organization runs the clinics and does not dispense contraceptives. General health exams and treatment are provided with parental permission; family planning services are confidential and follow Minnesota's Minor Consent Law. Reviews of evaluations of school-based clinics do not show any declines in pregnancy rates. Concern is raised for the safety of promoting condom use among teenagers; research studies indicate that condom failure rates are 18% among youth. Dr. Samuels also raises the issue of barrier contraceptives not protecting against Chlamydia, which is reported by Dr. Archer as so infectious that there is a 50% chance of infecting someone on first contact. Some believe that all programs must emphasize abstinence. Examples are given of effective abstinence or stopping sex programs, or values programs.