Faced with high rates of teen-age pregnancy and venereal disease, Baltimore's Health Department has quietly begun dispensing birth control pills and condoms to students who say they need them at seven city schools.
Health clinics at selected high and middle schools have counseled sexually active city students and prescribed contraceptives since 1985, as part of providing a broad range of medical care to youngsters who might not otherwise get it.
But the clinics began dispensing contraceptives last month because students could not be counted on to pick them up elsewhere, putting them at risk for pregnancies and sexually transmitted diseases including acquired immune deficiency syndrome, said Elias Dorsey, acting city health commissioner.
"With kids 14 or 15 years old, you have to do it right now," Mr. Dorsey said.
Abstinence from sex is an option discussed with students at the clinics and in health classes, said Dr. John Santelli, the Health Department official who runs the program.
"We don't just hand out contraceptives, even condoms. We do so only after counseling," he said.
The distribution of condoms has become the subject of a major policy debate this fall for school boards in Talbot County and New York City, but the Baltimore school board did not consider the issue because it was a Health Department matter, said Joseph L. Smith, board president.
Mr. Smith said he would like to know more about parents' attitudes before asserting an official position. He said no one had complained to him or brought the issue before the board.
About 5,000 students -- about two-thirds of the total at the seven schools -- are enrolled in the clinics, Dr. Santelli said.
Parents must sign a consent form before their children are enrolled in the clinics for most types of medical care.
However, the form adds: "Maryland law does not require parental consent for treatment of or advice about drug abuse, alcoholism, venereal disease, pregnancy or contraception."
Students may enroll themselves for those types of care without parental consent, Dr. Santelli said, but only about 1 percent of those treated do so.
A survey of parents this spring found "overwhelming support" for dispensing contraceptives at the clinics, Dr. Santelli said. Both he and school officials said the policy change had not been controversial.
"I think the general public is beginning to view the distribution of contraceptives in schools as a necessary means of trying to prevent teen pregnancy," said Frank Z. Thomas, principal of Patterson High School, where a clinic opened this fall.
Paul Johns, president of the Dunbar High Parent-Teacher-Student Association, said condom distribution there met "no resistance. . . . I don't think that it will encourage people who are not sexually active to become sexually active."
J. Donald Murray, principal of Harlem Park Middle School, where about 1,100 of the school's 1,400 sixth- through eighth-graders are enrolled in the clinic, said he had gotten "absolutely no reaction at all."
The Health Department also runs clinics at Southern and Southwestern high schools, Paquin Junior-Senior High and Lombard Middle School. Community health centers operate similar clinics at Cherry Hill and Herring Run middle schools, Dr. Santelli said.
Baltimore led the nation's big cities in the percentage of babies born to teen-agers in 1988, the most recent year for which figures are available, and teen-agers accounted for 30 percent of the city's gonorrhea cases last year, according to the city's Health Department.
A Johns Hopkins University study done in Baltimore in the early 1980s showed that a school-linked clinic that distributed contraceptives caused a 30 percent drop in the pregnancy rate and a decrease in teen-age sexual activity, said Laurie S. Zabin, who headed the study.
Dr. Zabin said on-site distribution of condoms in city schools was long overdue.
"This is an essential part of preventive health," she said.
About one-fifth of the nation's 178 school-based health clinics distribute contraceptives, said Elizabeth Armstrong of the Center for Population Options in Washington.
"Opponents like to portray them as standing in the lunchroom and putting a condom on the tray as it goes down the line," she said. "Their real value is in providing comprehensive, primary health care to young people who in many cases wouldn't receive any."
Bronwyn Mayden, executive director of the Governor's Council on Adolescent Pregnancy, said distributing condoms in school clinics ensured that youngsters would deal with adults trained to provide good information about sex.
"Now that they've taken a stand, I'm hopeful we don't get a huge outcry of 'Let's shut 'em down,' " she said.