Addressing teen pregnancy in a school-based health center

A new program that focused on education both male and female patients about contraception decreased pregnancy rates in an inner-city school.

Addressing teen pregnancy in a school-based health center
Addressing teen pregnancy in a school-based health center

I am a PA in a school-based health center (SBHC) in an inner-city high school in Chicago. When I started this position four years ago, I was made aware of the high pregnancy rates.

In the first six weeks after the winter break in 2010-2011, there were 12 new pregnancies among the students. I did some further research into the numbers, and noticed in the previous seven years, there were on average 35 to 45 pregnancies per year at the SBHC, and the lowest in any one year was 29.

I gathered my staff, which also included the medical and administrative directors of the SBHC program in our federal qualified health center (FQHC).

I showed them the numbers and set a goal and laid out a strategy to reduce those numbers. Specifically, I set a goal of getting down to zero pregnancies in the following school year.

What was interesting is the resistance I received from the team (who were all women). They said that it is impossible, unrealistic, and paternalistic. Needless to say, that provided me with even greater incentive to make a change.

My strategy included the following:

  • Provide outreach to students/sports teams/faculty by identifying key opinion leaders and allies
  • Ask about sexual activity at almost every patient encounter, and educate on Plan B and our confidential services under minor consent in the state of Illinois
  • Encourage STI testing and birth control counseling to both male and female patients
  • Persuade students to bring their partners in to discuss abstinence, emergency contraception, condoms, and birth control
  • Refer female patients Planned Parenthood for IUDs
Our FQHC now has a Title X program, and a Title X/Women's Health Nurse comes in twice a month for consultations. Since this started in January, I have had over 20 adolescent female patients follow up with the Title X program to receive IUDs.

What am I most proud of about this initiative:
  • The pregnancy rate in 2012-2013 school year went down to five pregnancies, and in 2013-2014 there were seven
  • There had been a Catholic Charities program for pregnant teens at the high school for 17 years. We put them out of business at this school in the middle of the 2012-13 school year. They moved on to a school with greater need!
I have spread my philosophy that for years, so much attention has been placed on the female side of the sex equation, while very little attention was paid to males. During the last two years more male patients have been bringing in their girlfriends for "couples visits" to get educated on the risks of being sexually active and reducing the negative consequences.

I am so proud of my passion, creativity, problem solving, and drive, but most of all I am proud of the kids for being open to lead healthier lives!

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