Friday, February 5, 2016

Birth Control in the Schools?

Many parents have asked why there is so much controversy about potentially supplying birth control in the School Based Health Centers (SBHCs).     It looks to me like the main reason is the lack of parental notification:  if I understand correctly, under Oregon state law, anyone aged 15 or older can request these types of services from any medical facility, with a guarantee that their parents will not be notified.   Thus, a high school student will be able to obtain such services during the school day with complete secrecy from their family. To illustrate some of the biggest concerns, let’s envision a couple of scenarios.

  1. You get a call from the principal at Century High School, to inform you that your daughter was caught engaging in sexual activity with her boyfriend behind the bleachers during lunch.   Concerned, you head to the school to pick her up, planning to engage her in a long conversation about whether she is ready for sex.   When you start to talk, she interrupts you:  “It’s no big deal mom, I already talked to the school health center about this, and they have had me on birth control for six months.”
  2. A group of 19-year-old senior boys identify a shy, vulnerable-looking 15-year old girl who sits alone in a corner of the cafeteria every day at lunch.   They immediately begin sitting by her, paying her lots of attention, and pressuring her to engage in sexual activity.   When she tries to resist using her concerns about pregnancy, the boys say “Don’t worry, just go to the school health center during lunch, they can put you on birth control.”   The girl compiles, gets on birth control, and the boys proceed to take advantage.   Since this is entirely happening during school hours, the parents never have a clue about these events.

Both of these cases would represent failures at multiple levels, of course— but I think it’s clear that both would be exacerbated, and be more likely to escape parental detection, if birth control is easily accessible without parental notice at the SBHCs.  

I’ve heard a few responses to this concern, but do not find them fully convincing:
  • “The lack of parental notification is just state law, same as at other doctors’ offices.”   The key difference here is that we are talking about services offered on school grounds, during the school day.   Parents drop off their kids at school with an expectation that for the next 8 hours or so, the kids will be in a safe environment focused on providing educational services— not on birth control or on replacing the family in reproductive discussions.
  • “We will also provide counseling, and try to encourage kids to involve their parents, as well as detecting if they are subject to peer pressure.”    It’s great that this effort will be put in— but we all know that teenagers are very skilled at being deceptive and secretive when they are embarrassed about a topic, or suspect their parents would disapprove.  In addition, the students most vulnerable to peer pressure will also be vulnerable to pressure “not to snitch”, and thus will resist revealing the pressure to the counselors.
  • The school board shouldn’t interfere with a medical decision”.    This is a nice-sounding soundbite that completely misses the point.   Nobody on either side claims the school board is qualified to make medical decisions.   However, the question of whether a teen begins sexual activity involves moral and ethical questions that belong in the family rather than the school.
  • “Birth control pills have other health uses, such as regulating hormone problems.”   Nobody objects to this kind of medical usage; if we could legally allow our SBHCs to provide prescriptions for these cases but not for elective use, it would probably get wide support.
  • “Accessing health facilities outside the school is very inconvenient for the poor.”   I have some sympathy with this argument, but it’s really a community issue rather than a school issue:   what about dropouts, or young adults who are several years out of school?   The community should work on the general problem of health care access for the poor, but I don’t see any critical reason for commingling it with the schools, especially given the issues discussed above.

So, on balance, it looks to me like adding birth control services to the SBHCs would not be a very good idea at this time.    If you have strong opinions either way on this issue, be sure to show up at one of my constituent coffees (first Saturday of every month, 10-11 am, Human Bean at 10th & Oak), contact the superintendent and board, or come and speak up at the public comment period of the next school board meeting.