Teens face birth control barriers at school-based health center

By Samantha Swindler | The Oregonian/OregonLive   March 30, 2016

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A tour of the school-based health center on Beaverton High’s campus. Like the clinic at Century High School, Beaverton’s school-based health center is operated by Virginia Garcia Memorial Health Center. (OS-)

 

 

In Oregon, you can make your own primary care medical decisions at age 15, without parental consent or notification.

Yet in school districts across the state, teens are likely to need a note from Mom just to get an aspirin from the school nurse.

These two very different views of healthcare are now clashing in Hillsboro, where the nonprofit Virginia Garcia Memorial Health Center wants to offer birth control services on the Century High School campus.

The Hillsboro School Board is in the uncomfortable position of figuring out what role it has – if any – in teens’ options around safe sex.

Century’s school-based health center opened in 2013 to provide primary care and mental health services for interested students or nearby residents 20 years old or younger. The school district received a federal grant to construct the building; Virginia Garcia staffs and manages the clinic. No one is denied services if they can’t pay.

Most visits are for mental health counseling; vaccines; well-child checks; ear, nose or throat issues; and sports physicals.

The district benefits because on-campus clinics cut down on absenteeism, and healthy students are better learners.

Students – particularly those who don’t have or have limited insurance coverage – benefit from convenient access to healthcare.

Parents benefit because they don’t have to miss work to take a child to a doctor’s appointment.

Win, win, win, right?

Oregon has 76 school-based health centers in 24 counties across the state. Virginia Garcia operates six, including five in Washington County.

When the Century clinic opened three years ago, the school district had an informal understanding with Virginia Garcia – no offering birth control. But Virginia Garcia spokesperson Olivia MacKenzie said the policy isn’t written anywhere in the clinic agreement between the district and the nonprofit, which puts physicians in a bind when students ask about contraceptives.

Olivia said Virginia Garcia would like to offer those services, but only if “it’s a priority to the district and families, as well.”

The clinic does offer reproductive health services, which includes things like pap smears, screening for sexually transmitted diseases and pregnancy tests, but not “family planning services” – aka, birth control.

So, a patient at the school-based health center can find out after sex if she’s gotten pregnant, but she can’t get contraceptives to prevent it in the first place.

Within Hillsboro’s two zip codes, the Oregon Health Authority reports there were 238 teen pregnancies between 2012 and 2014. Century High even has an on-campus daycare program for students who have had a child; it’s not that far from the clinic where they can’t get preventative reproductive services.

Century’s health center does provide referrals to other clinics that can provide contraceptive prescriptions, but it’s not always easy for teens to travel for help off-campus. Last year, Washington County closed its health department clinics and contracted out for care services. The clinic in Hillsboro is now only open two days a week, and without the teen program that specifically addressed contraceptive questions.

That’s part of why Virginia Garcia is now asking to be able to prescribe birth control.

Earlier this month, the Hillsboro School Board spent an hour listening to public comment about whether birth control prescriptions should be offered at the Century clinic. Eleven residents testified in favor of offering services; six testified against. At least one woman questioned why the district was involved in student healthcare at all.

That’s something school board member Erik Seligman questions, too.

“I feel bad that there’s a problem with community access to health care in Hillsboro, but the schools aren’t chartered to address that,” he said. “The intermingling with school and health care, that’s what really concerns me … but it’s a community concern, not a school concern.”

Whether a school district should help students get access to primary healthcare is an entirely different question than whether a school district should determine what kinds of primary healthcare students have access to.

Let’s start with the first question: Is is appropriate for schools to have clinics at all?

Yes. It definitely is.

No one is in a better position to help students access healthcare than the school district where they spend most of their time. That’s why this model works so well, especially for the most vulnerable populations. About a quarter of the Century clinic’s patients come from families at or below the federal poverty line; 66-percent are covered by either Medicaid or the Oregon Health Plan.

In a state survey last year, nearly half of school-based health center patients said they either wouldn’t have another place to go, or weren’t sure where they could go, for medical services outside the school clinic.

In many ways, the district is already in the healthcare business. It addresses nutrition by choosing school lunches. It address mental health with bullying and suicide outreach programs. If it’s going to provide a daycare for students with children, it shouldn’t stand in the way of services to prevent teen pregnancy in the first place.

Which brings us to the second question, about contraceptives. School boards shouldn’t be a roadblock to teens’ access to preventative care.

The district can best serve the clinic and its patients by simply being a landlord. Birth control – not abortion, mind you – is considered a function of a primary care facility. How, what, and why it is prescribed should not be influenced by a school board.

In an ideal world, you know who would be making decisions about teens’ bodies? Teens. With the guidance of a physician, and the support of a parent.

Sadly, that doesn’t always happen. Not all students have easy access to medical care. Not all students have good relationships with their parents, or have parents who know how to help them.

Those are the students who need full primary care services from the school-based health center most of all. And the last thing they need is a lecture from the school board about what kind of health care services they should be receiving.

— Samantha Swindler

@editorswindler / 503-294-4031

 

F.D.A. Eases Requirements on Abortion Pill Label

The Food and Drug Administration stepped into the politics of abortion on Wednesday, relaxing the requirements for taking a medication that induces abortion, a move that is expected to expand access to the procedure.

The move was a victory for abortion rights advocates who had been fighting laws in states like Texas, North Dakota and Ohio that required providers to follow the requirements on the original F.D.A. labels for the drug when conducting abortions by medication. Many doctors say the original labels, based on clinical evidence from the 1990s, were outdated and that the state laws requiring doctors to adhere to them went against accepted medical practice and made it harder for women to get abortions.

The changes announced on Wednesday reduce the number of trips women have to make to a doctor from three to two in most states, and also increase the number of days that she has to be able to use medication to induce abortion from 49 to 70 days after the beginning of her last menstrual period, experts said. The new label also reduces the dosage of the drug, called mifepristone, from 600 milligrams to 200. Most medical societies had said the previous dosage was too high, and abortion rights advocates said it increased the cost and the side effects of the procedure.

“This is a huge step in increasing access to medication abortion and it comports with the scientific evidence,” said Elizabeth Nash, a senior state issues associate at the Guttmacher Institute, which tracks women’s reproductive health issues. She said that medication abortions accounted for about a quarter of all abortions in 2011, the last year measured by the institute.

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Mifeprex, a medication that induces abortion. The F.D.A. on Wednesday relaxed the requirements on use of the drug.

In most states, doctors had been following the medically-accepted regimen, despite the fact that the label advised otherwise — a practice that is fairly common in medicine and is known as off-label use. But in recent years legislators in a number of states have sought to impose legal requirements that doctors follow the F.D.A. label for abortion medication, saying they were trying to protect womens’ health.

Such restrictions have passed but then been blocked by court order in Arkansas, Oklahoma and Arizona. Arizona legislators have passed yet another measure that tries to maintain the original F.D.A. protocol, but it has not yet been signed into law.

The F.D.A. first approved the drug, formerly known as RU-486, in 2000. It works by blocking receptors of progesterone, an important hormone in pregnancy. When taken with another drug, misoprostol, it induces miscarriage. It is different from the so-called morning after pill, which prevents pregnancy.

But the rules on the label were based on clinical trials completed in the late 1990s, according to advocates, and new evidence had emerged showing that taking lower doses was preferable and that a woman could take the medication safely up to 70 days from the beginning of her last menstrual period.

The American Congress of Obstetricians and Gynecologists said in a statement that it was “pleased that the updated FDA-approved regimen for mifepristone reflects the current available scientific evidence and best practices.”

The group added that “medication abortion has been subject to legislative attacks in various states across the country, including mandated regimens that do not reflect the current scientific evidence. We hope that these states take the FDA label into account.”

Planned Parenthood, which has fought the state laws, said in a statement: “The benefit of this announcement will be most immediately felt by women and providers in Ohio, Texas and North Dakota,” states that have laws requiring medication abortion to be provided according to the original label.

Since the F.D.A. approved the medication, states have passed a number of different laws to restrict its use. Some require medical professionals who administer the drug to be licensed physicians, and not nurses or physician assistants. Other states require the prescribing doctor to be physically present with the patient, a rule that abortion rights advocates say blocks rural women from receiving the medication through telemedicine.

Dr. Raegan McDonald-Mosley, chief medical officer of Planned Parenthood Federation of America, said the change would reduce confusion among patients who had to sign two sets of consent forms, one with the regimen recommended by much of medical science and one that detailed the requirements on the F.D.A. label.

“Now those two things are in sync,” she said.

Dr. McDonald-Mosley said that medication abortion is an increasingly popular method: About half of women in Planned Parenthood clinics who fall within the time limit choose it.

BARRIERS & BIAS, The Status of Women in Leadership

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WHAT IS THE GENDER LEADERSHIP GAP? Women are much less likely than men to be in leadership positions. In universities, businesses, courts, unions, and religious institutions, male leaders outnumber female leaders by wide margins.

There is no lack of qualified women to fill leadership roles. Women earn the majority of university degrees at every level except for professional degrees, and more women are in the workforce today than ever before. There must be something inherent in the system that’s working against them. Blatent sex discrimination is still a problem, as data from the U.S. Equal Employment Opportunity Commission show. But subtler problems like hostile work environments, negative stereotypes about women in leadership, and bias also keep women out of the top spots. Unconscious or implicit bias can cloud judgment in ways people are not fully aware of.

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Read the full AAUW report: Barriers and Bias, The Status of Women in Leadership