A spike in teen pregnancy at Gloucester High School has renewed a fierce debate over contraceptives in public schools and put its school-based health center in the spotlight.
Gloucester High, where 17 pregnancies were diagnosed at its clinic this year, is one of 47 Massachusetts schools with a health center licensed by the state Department of Public Health. The centers, which are run by local healthcare providers, aim to expand access to medical care, particularly for students in low-income and urban areas.
"The focus is to keep kids healthy so they can stay in school," said Dr. Lauren Smith, medical director at the Department of Public Health. "They see kids for a whole lot of things. They really are doing yeoman tasks, reaching out to kids who may not seek healthcare in another setting."
The centers - which also operate at high schools in Chelsea, Lynn, Revere, and Salem - provide the same care that is available at a doctor's office or medical clinic. But they are open only to students whose parents sign an enrollment form. A parent or guardian's health insurance pays for the visits, but students who do not have coverage are still treated.
Liability, an issue raised in the Gloucester contraceptives controversy, lies with the healthcare provider, not the school district, Smith said.
"The sponsoring agency has malpractice insurance, which covers the clinics," Smith said. "To our knowledge, no lawsuits have ever been filed against a school-based health clinic."
But while the clinics are independent from a school district, approval by a school committee is required before a center prescribes or dispenses contraceptives, Smith said.
"The decision about what kind of comprehensive reproductive healthcare to provide is made in concert with a local school committee," Smith said. "It's an area that is not universal across the board."
Of the state's 47 school-based health centers, 43 provide reproductive health services. Of those, 21 refer students to an outside provider for birth control; 14 give out condoms; five dispense birth control on site; and three provide prescriptions, according to the state Department of Public Health.
The agency does not keep data on which schools provide which services, said Donna Rheaume, a department spokeswoman.
Addison Gilbert Hospital in Gloucester runs the center at Gloucester High; Massachusetts General Hospital runs the clinics at Chelsea and Revere High; Lynn Community Health Center runs clinics at English High School and Lynn Vocational Technical Institute, and North Shore Community Health Center in Salem runs the clinic at Salem High.
Officials at those healthcare providers either did not return calls seeking comment or declined to discuss their policy on contraceptives, citing privacy issues.
Some school officials said they play no role in the operations of school health centers. In Revere, students are able to access any service offered as long as their parents have signed a form.
"As a School Committee, we decided to put the decision into the hands of the parents," said Paul Dakin, Revere superintendent of schools. "The only way a kid can get services is if their parents have made arrangements."
Dakin said he is not sure if prescription birth control is available at the high school center. "To my knowledge, there is no distribution of condoms out there," he said.
Chelsea Superintendent Thomas Kingston said contraceptives haven't been an issue since the School Committee approved condom distribution in the early '90s at the request of students. "As far as I know now, they provide counseling and support in confidence, according to the law," Kingston said.
Tom Iarrobino, spokesman for Lynn Superintendent Nicholas Kostan, said he does not believe contraceptives are prescribed, or given out, at the city's two high school health centers. "If they are, we don't know about it," he said.
At Gloucester High, the contraceptives controversy prompted top medical staff at the health center to resign. An advisory committee for the clinic included prescription birth control in a proposal outlining steps to address soaring teen pregnancy. The 17 pregnancies among the students this year are about four times higher than average at the 1,200-student high school.
Addison Gilbert officials said they wanted School Committee approval before making a decision. But Dr. Brian Orr, the center's medical director, and Kim Daly, the chief nurse practitioner, resigned because they said they doubted the hospital would allow them to prescribe birth control to students. The resignations took effect on June 12.
Gloucester Mayor Carolyn Kirk has called for outside advice. Specialists in adolescent healthcare, along with public health officials from other communities faced with high teen pregnancy rates, have been asked to advise the School Committee.
"This is a complex issue," Kirk said. "I'm trying to lay out the process by which the School Committee can come to a policy decision."
A special School Committee meeting will be scheduled in the next month to present the issues. A decision will be made by the time school opens in September, Kirk said.
"There is a lot of frenzy about this," she said, adding that the School Committee has to do its own research. "I have great faith the committee will arrive at a decision that is in the best interest of the students."
Smith, the DPH medical director, believes Gloucester is on the right track.
"We still really encourage the whole community to take a comprehensive approach to responding to what is a very important public health issue," she said. "They're trying to do just that."
Kathy McCabe can be reached at firstname.lastname@example.org.