On the Importance of School-Based Health Centers

By Emma Straus

In Maryland, there are 84 school-based health centers, many of which offer a spectrum of safe and effective contraceptive options. Flickr image by kardboard604.

Many minors will have sex no matter what their parents say or do. Hopefully, they will know to use — and will be able to access — contraception. Because minors engage in sexual activity, Maryland law permits minors to receive confidential reproductive health care services without consent from their parents or guardians, including services from their school-based health center (SBHC).

In Maryland, there are 84 SBHCs, many of which offer a spectrum of safe and effective contraceptive options. According to a 2015 report by Meredith Cohon and Andrea McDaniels, SBHCs have contributed to a significant decrease in the teen pregnancy rate in Baltimore City as reported by The Baltimore Sun. One of these contraceptive options is NEXPLANON®, an etonogestrel implant that has a 99% effectiveness rate of preventing pregnancy according to the CDC and has been shown to be a safe form of protection. Access to contraceptive options is essential to the well-being of Maryland students, and utilizing school-based health centers gives students a private and secure option to choose to protect themselves against unintended teen pregnancy and sexually transmitted infections (STIs).

There are many reasons why a minor might seek contraceptives without parental consent or knowledge. Some students may feel uncomfortable telling their parents that they are sexually active or that they want to be; or, some young people might know that their parents are against birth control but recognize that effective contraception is essential to avoiding unwanted pregnancy. Other students might be scared of the repercussions they could face if they ask their parents for contraceptives, be it emotional, mental, or physical abuse or distress; perhaps they are even in a living or social situation in which they are trying to protect themselves from unwanted sexual harassment or abuse. Regardless of the reason, respecting the needs and privacy of minors is crucial to creating a safe space for students to receive the health care that they need. Just like other providers, practitioners in SBHCs should be able to construct trusting relationships with the students that they treat.

The incident reported by Ms. Lambert is an unfortunate event and the safety of her child is understandably her priority in this situation. However, if anything, this incident highlights the importance of strengthening SBHCs rather than reducing their ability to work privately with students. Reducing or removing SBHC services would only diminish the trust that students have built with their school’s practitioner and, in turn, potentially prevent minors from accessing the sexual and reproductive health care that they need — and correctly sought.

Minors will be sexually active regardless of if they have access to contraceptives and/or if their parents are aware. The focus, therefore, should be on ensuring that young people can engage in safe sexual activity. Additionally, it is socially and economically beneficial for minors to have access to contraceptive services rather than have to access abortion care or carry an unwanted pregnancy to term. In order to do this, students should continue to be able to seek confidential reproductive health care services at school. If parents want to be more involved in those decisions, I encourage them to have honest and nonjudgmental conversations with their children about sex and sexual health.

Postscript: Last week, NARAL Pro-Choice Maryland caught wind of a Baltimore-based story surrounding contraception. A mother is suing the city for allowing a public school’s health center to implant a contraceptive device in her daughter’s arm without her permission.

This is legal. In the state of Maryland, physicians may, but are not required to, inform the parents of minors about the services provided. The state law permits minors to receive contraception services, STI testing and prenatal care without parental permission. The privacy of contraception was confirmed in the 1977 Supreme Court decision of Carey v. Population Services International.

After this knowledge, it’s easy to assert that the mother, in this case, is overstepping. However, more details came out as the week continued, including the fact that the NEXPLANON® implant was placed incorrectly (which is known to cause complications). We also learned that the mother was removed from the school when she expressed concern about her child’s health after the student complained about pain in her arm. According to the local news, the mother is not opposed to preventing pregnancy, she just feared for her daughter.

One of our great interns, Emma, wrote the piece above about the benefits of School-Based Health Centers (SBHCs). However, I want to frame the article in the proper context. Too often, women of color (and in this case, Black women) are ignored when it comes to their mental, physical and reproductive health. Black women have higher rates of complications during pregnancy and when giving birth. They’re three times more likely than white women to die from these complications.

This goes to say that our primary concern rests with the young woman who received the implant. Luckily, the advocate for her health happened to be her own mother. It’s in very poor taste that the mother was removed from the student’s school when asking questions about a potentially life-threatening situation for her child. While, no, the school isn’t legally required to speak to her, the student still has the right to receive proper healthcare.

We want to step up to the plate to support, not only the existence but also, the improvement of SBHCs. This student should have received a properly placed implant. Her health advocate should have been the very providers who reside in the school system. We urge the state of Maryland to make healthcare investments in its youth, so that all young people have access to quality reproductive healthcare — and an unfortunate situation like this never has to happen again. Fight for all children to have proper healthcare as if they were your own.

We at NPCM hope to continue our fight for reproductive justice within a framework that recognizes the complexities that women of color face every day. With enough attention to contraceptive care, Maryland can remain a national leader in reproductive health for everyone, including our Black youth. — Danielle Brown, Communications Manager

The political leader of the pro-choice movement in Maryland.