St. Paul, Minn., school clinics said to have little success against teen pregnancy

February 19, 1993|By Knight-Ridder Newspapers

For years, the school-based health clinics of St. Paul, Minn., were touted as a success. They nipped teen pregnancy in the bud, claimed proponents -- and those reports influenced the growth of school-based clinics in cities across the country.

But a study released yesterday says the clinics never accomplished what they set out to.

In fact, say researchers, teen birthrates in St. Paul schools have not declined in the 20 years since the clinics opened. At one school, birthrates actually rose.

"Unfortunately, people look for magic bullets, and this seemed to be a magic bullet. There are no magic bullets," said the study's chief researcher, Douglas Kirby, whose work was published in ++ the journal Family Planning Perspectives.

What the new research indicates, said Mr. Kirby and others, is that the rates at which teen-agers have sex and have babies are influenced by so many different things that a single initiative -- such as a school clinic offering reproductive counseling -- does not make a big difference.

"One of the important findings is that pregnancy rates and birthrates fluctuate dramatically in schools from year to year just by chance," said Mr. Kirby, a researcher with ETR Associates in Santa Cruz, Calif. If half a school's female students are having sex, he said, "by chance, 10 percent might get pregnant, and the next year, 3 percent will."

Introduced in 1973, the St. Paul Maternal and Infant Care Project was the first school-based clinic program in the nation established solely to give advice about contraception, pregnancy and sexually transmitted disease. The clinics, which never dispensed condoms or other contraceptives, were later expanded to offer a wide range of health care services.

At first, the clinics seemed a dramatic success. St. Paul officials reported that in one high school the birthrate dropped 56 percent within three years. At two other schools, the rate plunged from 60 births per 1,000 students before the clinics opened to 27 births per 1,000 six years later.

"Those statistics . . . undoubtedly helped motivate additional communities to open school-based clinics," said the study, co-authored by researchers at the University of Minnesota and the St. Paul school district.

What St. Paul clinic operators did not realize, said Mr. Kirby, is that they should not have compared post-clinic birthrates to a single pre-clinic year. This was an error, since student birthrates always fluctuate from year to year. Also, St. Paul officials were not including student births that occurred after girls had left school.

To get to the true birthrate figures, Mr. Kirby and other researchers painstakingly compared the names of female students from school records with the names of teen mothers on county birth records. Student birthrates were found to either fluctuate wildly or, in one school, actually rise -- a change researchers attributed to the schools' population becoming poorer.

"We found . . . no clear impact of clinic presence," the researchers reported. In fact, they suggested, the clinics, which did not refer students to abortion providers, "may have made continuing a pregnancy more acceptable, desirable or feasible" because they offered prenatal care and referred pregnant girls to many social services.

St. Paul's supposed success was reported across the nation.

"You couldn't go to a school health conference or pick up literature without reading about their success or what they were trying to do," said Herbert Hazan, director of school health services for the Philadelphia School District.

Messrs. Hazan and Kirby said it would be a mistake for schools to abandon school-based clinics based on the new findings. For one thing, Mr. Hazan noted, most students who go to the clinics do so because they have health problems -- not because they are seeking reproductive counseling.

School clinics should keep doing reproductive counseling, Mr. Kirby said. "We would give young people a terrible message," he said, "if we tell them we will treat flu and sexually transmitted diseases and pregnancy yet won't do anything to help prevent you from getting flu or STDs or pregnancy."

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