Everyday Scientist (NotScience)

Birth Control – the New School Supply

Portland, Maine recently decided to make birth control available to its middle school students. So long as parents sign a waiver granting access to the school clinic, the teens have access to the pill.

Back in the day

Back when I went to school, schools were not allowed to provide students any drug, even down to an aspirin. And when a student had a prescription to a drug, the nurse had to administer it to the student. The reasoning behind these draconian measures was: (a) some students are not responsible enough to know how/when/and what kind of drug to administer to themselves; (b) other students might get a hold of the drug and use it improperly; and (c) the school, its staff and faculty do not want to be liable to the parents for drug-related problems (e.g., overdose, allergic reaction, other side effects, etc.). Makes sense to me.

Nevertheless, I think Portland has pretty much taken care of these concerns by making the clinic administer the pill and by making the parents sign a general waiver if they want their kids to have access to the clinic.

Facing reality

So if teens are having sex — and they are, even if we don’t want them to — then it’s a good idea to provide them contraceptives or birth control…because the risk of teen pregnancy is worse than the risk of teen sex. Notifying parents sends a chilling effect over the sexually-active students who prefer to keep their sex lives on the down low…and the risk of teen pregnancy is worse than the risk parents not knowing about their offsprings’ sex lives.

The big opposition to Portland is mostly pushing what I’d consider a side issue. They’re worried that giving birth control to teens will increase sexual activity among teens. Does anybody have statistics on this? Regardless, I can’t see that it matters. It seems safe to conclude that even if more teens have sex more often, fewer will get pregnant if they have easy access to birth control. And I’ll say it again: dealing with teen pregnancy is worse than dealing with teen sex.

Swallowing the Portland Pill

Whether schools should prescribe birth control to middle-schoolers without notifying their parents is a tough issue. But I think framing it in the following manner makes it easier to swallow.

First, the pill prevents all pregnancies (or 99.9% or something), not just the ones attributable to consensual sex. Consider the number of teen girls who are victims of sexual assault:

• “15% of victims are under age 12
• 29% are age 12-17
• 44% are under age 18
• 80% are under age 30

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• Seven percent of girls in grades five to eight and twelve percent of girls in grades nine through twelve said they had been sexually abused according to the 1998 Commonwealth Fund Survey of the Health of Adolescent Girls.

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• 93% of juvenile sexual assault victims knew their attacker; 34.2% were family members and 58.7% acquaintences. Only seven percent of the perpetrators were strangers to the victim, according to the 2000 Sexual Assault of Young Children as Reported to Law Enforcement. This study is available at the Bureau of Justice Statistics website.
• In 1995, local child protective service agencies identified 126,000 children who were victims of either substantiated or indicated sexual abuse; of these, 75% were girls. Nearly 30% of child victims were between the ages of 4 and 7. This is according to the 1995 Child Maltreatment study, US Department of Health and Human Services, Administration for Children and Families.
• 12-34 are the highest risk years. Risk peaks in the late teens: girls 16 to 19 are four times more likely than the general population to be victims of rape, attempted rape or sexual assault. This is according to the 2000 National Crime Victimization Study (PDF, 131KB).”

(http://www.rainn.org/statistics/victims-of-sexual-assault.html .)

In short, lots of teen girls are victims of sexual assault. Birth control keeps that bad situation from getting worse. With this in mind, I think we could view birth control as a shield wielded by a responsible girl who wants to protect herself from unwanted pregnancy, particularly when it would be attributable to non-consensual sex.

Viewing the pill as a tool for responsibility, rather than as a band-aid for irresponsibility, definitely makes me feel more comfortable about the lack of parental notification. It’s not so vital to tell parents when their offspring are being responsible, even though it might be nice to do so. Moreover, because 93% of juvenile victims knew their assailant, telling parents might increase the rate of sexual assault against teens because the parents, or those they tell, might think they can “get away with it” if their victim is on the pill.

Second, this a small point, I understand the pill can reduce pain during menstruation. Keeping puberty as painless as possible sounds like a good idea to me! Physicians already prescribe the pill for such conditions. So viewing the pill as a pain reducer, rather than primarily as a pregnancy preventer, sounds like a friendly way to view it.

Some questions – mostly about the waiver

If a parent refuses to sign a waiver, then is the student altogether barred from accessing the clinic? That would suck. Apparently, the clinic provides dental care and eye care. I’d hate to think a student would have to go blind and plaqueee just because her folks don’t want her on the pill. Also, that would likely have the effect of discrimination on the basis of sex.

Next, what happens if something goes wrong with the pill and it’s the clinic’s fault? Can the parents or the student sue the clinic to redress the grievance, or are they waiving their right to sue? I think such a waiver would be found legally unconscionable, but it might nevertheless deter otherwise meritorious lawsuits. (I can’t help it; I’m a lawyer; I want to see the darn waiver.)

How much does the clinic tell the parents about what services are being provides to their offspring? I have to say I’m not comfortable with the idea that the clinic can do whatever they want to the student—once the waiver is signed—without parent notification, much less parental consent. I’m not sure the clinic should be usurping the health decisionmaking process from parents.

Lastly, is there really an important difference between waiving notice of providing birth control to a teen versus waiving notice of providing a teen a dental check-up? Why should birth control be a special case? I mean, clean teeth are important, too! Cavities stink. And who knows — maybe routine dental cleaning increases the risk of candy consumption. But shouldn’t they go to the dentist anyway?