Judith Herrman has studied public opinion concerning reproductive health services in schools.

Health policy

New study looks at reproductive health services in school wellness centers

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10:15 a.m., Sept. 3, 2015--High rates of teen sexuality, pregnancies, births and sexually transmitted infections have prompted a serious discussion on the desirability of providing or expanding reproductive health services in school-based health centers in Delaware and across the nation.

A recent study by Judith Herrman, professor of nursing at the University of Delaware, shows that while public opinion generally favors offering such services, not everybody is on board.

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Herrman detailed the study results in an article, “Stakeholder Perceptions of the Provision of Reproductive Health Services by School-Based Health Centers as They May Inform Public Policy,” which appeared in the journal Policy, Politics and Nursing Practice.

Research interests for Herrman include public policy and health; teen pregnancy and sexual behavior; teen cognitive development and high risk behaviors and decision making; and creative teaching strategies. 

Based on interviews with 50 consenting participants, the study was funded by the Division of Public Health in the Delaware Department of Health and Social Services.

Among the interview subjects were wellness center staff members, including nurse practitioners, physician assistants, social workers, counselors and nutritionists.

Also included were public health clinicians and administrators, individuals working in reproductive health, advocates, community members, vendor administrators, physicians, school nurses, school administrators, teachers, school resource officers, school board members and parents.

“There are 29 school-based health centers in Delaware, and 15 offer reproductive health services,” Herrman said. “Part of my research was to find out what the public thinks about having these services in the schools.” 

Wellness centers in schools traditionally provide sports physical examinations, nutrition and mental health counseling, oral health care, and primary care screening and treatment.

Reproductive health services offered in wellness centers may include pregnancy testing, education about and referral for prescription for oral contraceptives, education about and distribution of condoms, and classroom education programs.

Such services also may include testicular and gynecological examination, provision of emergency contraception, education about and prescriptions for other birth control methods, sexuality counseling and education, testing and treatment of sexually transmitted infections, and testing and treatment for human immunodeficiency virus (HIV).

While the First State mirrors the nation in the percentage of school-based health centers providing reproductive health services, teen pregnancy rates, HIV rates and incidences of sexually transmitted infection in Delaware are high compared to other states, Herrman said.

“Delaware is one of the most sexually active states for teens, and this is something we need to address,” Herrman said. “This is a compelling reason to have reproductive health services in these centers.” 

The study notes that proponents believe that wellness centers provide health care that is medically sound, developmentally appropriate, easily accessible and youth- oriented. 

“Such access, supporters contend, helps students surmount barriers that include cost, transportation, embarrassment, confidentiality and complexity,” Herrman said. “Perhaps the greatest value of wellness centers may lie in their ability to offer high levels of education and follow-up while providing ongoing monitoring and encouragement.”

Access to family planning services in school wellness centers also is considered vital in continuing the efforts to decrease teen pregnancy rates. Such services are seen as being especially critical for selected groups of teens, including those of minority backgrounds or those with special needs, the study noted. 

The opposition

Opponents of reproductive health services in schools say that contraception for teens encourages sexual promiscuity, promotes abortion and undermines parental authority. 

Offering such services, opponents say, also oversteps the role of schools in the private lives of children and families, puts forth political agendas and opposes fundamental religious beliefs.

“Community members opposed to reproductive health services in schools say that these services are being provided without notice to parents, and that parents should know whenever health care is rendered,” Herrman said. “At the same time, when students sign up for such services, that is confidential.” 

The study notes that some policy makers and stakeholders consider schools inappropriate sites for the provision of any health services. Providing reproductive health services in the schools is the most debated element of wellness care, setting the stage for opposition, which can be passionately vocal.

The most visible opponents of having reproductive health services in the schools are school boards and, to a lesser extent, school administrators, driven chiefly by fears of public rebuttal and parental opposition. 

“Some school board members interviewed believe that providing these services might actually increase teen sexual activity,” Herrman said. “There is no research that actually supports the fact that providing reproductive health services in schools has this effect; in fact, education and access to reproductive health services may reduce or delay sexual initiation.”

The interviews generated considerable discussion about parent-child communication and the need for both parents and children to be educated about sexuality and sexual activity, Herrman noted. 

In general, Herrman said, parents are supportive of both school-based health centers and of providing reproductive health services in these centers. 

“Wellness centers do not want to usurp parental guidance,” Herrman said. “Wellness centers are also there for students who don’t have parents or transportation.”

Student views

For their part, students view the idea of reproductive health services in school wellness centers as a holistic part of care and don’t see what the controversy is all about, one respondent noted.

“Teens are more pragmatic,” Herrman said. “I have done research with adolescents, and teens are much more rational than we give them credit for.” 

The study also acknowledges that while schools have many concerns to address, school-based health centers may actually help with perennial issues including high drop out rates.

“Sexually healthy teens are in the classroom,” Herrman said. “Keeping them in the classroom actually supports the school’s educational mission and is not something apart.”

Herrman also noted that working with students in a teen-specific school setting is part of the required training for students in UD’s School of Nursing.

“It’s part of their community clinical rotations,” Herrman said. “Some train and work in wellness centers and non-profits.” 

While opposition to the idea of providing reproductive heath services in schools is visible and vocal, Herrman said she believes that the trust in the nursing profession by the larger community can help find areas of agreement in discussing and generating public policy decisions regarding teen health issues. 

“We have to sit around the table and see if we can find some common ground,” Herrman said. “That is where we are going to create some consensus building about the provision of reproductive health services at school-based health centers.” 

Article by Jerry Rhodes

Photo by Kathy F. Atkinson

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