Abstinence is not enough: city students rely on high school clinics

Birth control is available -- after counseling and a physical

Recent National Institutes of Health studies indicate that the Minnesota Department of Health's five-year abstinence-only sex-ed program didn't prevent Minnesota teens from having sex. That came as no surprise to Donna Amidon. The Fulton resident oversees teenage medical clinics in each of seven Minneapolis high schools.

"They spent a ton of money on abstinence-only education ($5 million to educate 45,000 students) where nothing was said about contraceptives or the transmission of sexually transmitted disease," Amidon said.

"There are a lot of scary reasons for teens to say no to sex, but that approach -- while endorsed by a lot of the political leaders in this state -- isn't as effective as a comprehensive approach which addresses all of the issues," she said.

At Minneapolis school-based clinics, that comprehensive approach is the norm. Of the 400 students who use the Washburn High School clinic each year, about one-third come for birth control, Amidon said.

The clinics should not to be confused with the nurse's office where an anxious freshman might escape an algebra quiz with a sudden headache. The clinics are independent offices staffed by nurses, nurse practioners and doctors who address students' major medical issues.

The clinics are free and help teens navigate the healthcare system. Of the students using them, 60 percent have no health insurance and 20 percent are on Medical Assistance, Amidon said. Only 20 percent have private health insurance.

Southwest High's clinic is run by Children's Hospital; North High's is run by Pilot Cities. The five others -- at South, Washburn, Henry, Roosevelt and Edison -- are run and paid for by the Minneapolis Department of Health and Family Support.

School-based clinics opened in 1979 and began distributing contraceptives in May 1998. Originally, students received birth control vouchers that they would take to clinics or pharmacies to fill. Unfortunately, only 42 percent of those who received vouchers redeemed them, Amidon said. During the 1999-2000 school year, when clinics began distributing birth control on-site, the completion rate jumped to 99 percent.

It also allowed clinics to monitor girls on birth control closely -- perhaps closer than any outside clinic because it is located in a school where students spend dozens of hours a week.

According to Sara Mullet, director of Health Related Services for the Minneapolis Public Schools, the city has a higher rate of teenage pregnancy than the rest of the state and the nation. In 1997, the pregnancy rate for Minneapolis 15-17-year-olds was 79.4 per thousand. Statewide, that number was 32 per thousand and the national rate is 57.1 per thousand.

Minneapolis schools enrolled 725 pregnant and parenting teens during the 2000-2001 school year.

Mullet said that the need for city clinics today is greater than in the past because more students in the city live in poverty and have no healthcare.

"If a teen is going to be sexually active, the responsible thing to do is to seek birth control" Mullett said. "It's a touchy subject. But from a school's perspective, I think it would be a catastrophe if we didn't have clinics.

"Teenage sex is risky behavior," she said. "We know that one risk behavior goes with other risk behaviors. If kids are using drugs and alcohol, they are more likely to be engaged in sex as well."

According to a 1998 survey, 34 percent of Minneapolis 9th-graders engaged in sexual intercourse and 55 percent of the seniors. Only 46 and 63 percent, respectively, used any kind of birth control.

Amidon said the high Minneapolis teen pregnancy rate results from a North side census tract and consisted mostly of young African-American women.

At the beginning of every school year, high school principals send home permission forms for parents to sign, including information related to its clinic. Three options are offered:

  • No use of clinic services;

  • Permission to come to the clinic but not for reproductive health services; or

  • Permission to use all clinic services.

    "If we get a directive from a parent, we will absolutely follow it," said Gretchen Musicant, director of Public Health Initiatives for Minneapolis Department of Health and Family Support. "If we don't get a directive, then the [state] minor consent law allows the student to get birth control without parental consent."

    Angela Robbins, Washburn's clinic manager, teaches students to manage their sexuality. "But no one comes in and gets birth control on demand," Robbins said.

    Each request requires an initial counseling session with Robbins. She gives students an introduction about the different medical methods available, talks to them about the side effects and reviews their personal medical history.

    Contraceptives include Depo-provera, which requires a shot every three months; a hormone patch changed once a week; and an array of birth control pills and condoms. Side effects include weight gain, headaches, mood changes, high blood pressure and, on rare occasions, blood clots.

    Robbins also discusses the emotional aspects. Are girls really ready to be sexually active? Are their boyfriend or their peers pressuring them? Do they realize that sex will change their relationship? Are they ready for the fact that after intercourse the boyfriend may never call again?

    "Often, they are pale when I finish talking to them about the consequences," Robbins said.

    The next step is a physical exam with a nurse practioner or a doctor, including a pap smear and a pelvic exam. A third counseling session, a few weeks later, makes sure that the contraceptives are working well.

    When teens seeking birth control walk through the clinic door, other issues are often uncovered, including eating disorders, abuse, suicidal inclinations, bad grades and problems with parents. Chronic diseases such as diabetes, Graves' disease and other thyroid problems, anemia, asthma, and ovarian cysts and sexually transmitted diseases are often discovered following their physicals.

    "The most important thing students like about the clinics is the confidentiality," Amidon said. "For some kids, their attitude is that 'there are some aspects of my life that I want kept private.' And 'I don't want to tell my parents now.'"

    She added, "Some people think that we are a wedge between the parent and the kids, that we are protecting the kids and encouraging them not to go to parents. It's just the opposite. Things move very slowly and carefully with kids. We can't lecture them, or they'll never trust us."

    While some parents find it difficult to discover that their kids are going to other adults to discuss issues such as sex, the clinic staff said kids fear their parent won't understand, which may spark a violent confrontation where they could be kicked out of the house or have their activities limited.

    "Teens who have babies often drop out of school, which increases their chances of living in poverty," said Mullet. "One of the best teen antipregnancy things is to have students engaged in school. Research shows that when a student is engaged in school, is involved in other activities and sports, they are less likely to engage in risky behavior. They are more future-oriented and because of that, they make better decisions."

    Some Web sites to for parents and kids to consider are: www.shouldertoshoulderminnesota.org or www.saynotyet.com.