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School-based health care services improved outcomes for teen mothers
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Availability of reproductive health care services at high schools may prevent adverse birth outcomes among adolescent mothers, including low birth weight, according to study findings.
“In 2011, there were 31.3 live births for every 1,000 women aged 15 to 19 in the United States,” Aubrey S. Madkour, PhD, associate professor in the department of global community health and behavioral sciences at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote. “Infants born to teen mothers are at an increased risk of both low birth weight and preterm birth compared with infants born to adult mothers. For instance, in 2010, the proportion of infants born with low birth weight was 12.08% among mothers aged less than 15 years, 9.63% among mothers aged 15 to 19, and 8.15% among all mothers.”
The researchers pooled data from Waves I and IV of the National Longitudinal Study of Adolescent Health to assess whether reproductive health services offered at high schools were linked with infant birth weight. Adolescents and women in Wave I were younger than 20 years (n = 402) when they gave birth in the 1994-1995 school year. Participants were interviewed in 1996 (Wave II), 2001 (Wave III) and 2007-2008 (Wave IV). School administrators from the institutions the girls attended at the occurrence of Wave I reported on whether onsite family planning counseling, diagnostic screening, STD treatment and prenatal and postpartum care were available.
Few high schools offered onsite reproductive health care services in Wave I; 8% offered diagnostic screening, 3% STD screening, 9% family planning and 4% prenatal and postpartum health care. Multilevel analyses indicated the availability of prenatal and postpartum health care (est. ß = 0.21, 95% CI 0.02%–0.40%; P < .05) and family planning counseling (est. ß = 0.21, 95% CI 0.04%–0.38%; P < .05) correlated with increased infant birth weight. There was no significant difference linked with an increase in gestational age.
“Attending schools that provided onsite reproductive health services was related to better subsequent birth outcomes in subsequent pregnancies among this nationally representative sample of adolescents,” the researchers said. “In particular, availability of family planning counseling and on-site prenatal/postpartum care were related to increase birth weight, and availability of family planning counseling was borderline associated with increased gestational age.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Perspective
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Andrea J. Hoopes, MD, MPH
School-based health centers (SBHCs) provide convenient, accessible and comprehensive health services for children and adolescents where they spend the majority of their time: in school. The range of services offered by SBHCs varies widely, typically including basic primary care and preventive interventions like immunizations, as well as urgent care services, integrated mental health, nutrition, and sexual and reproductive health (RH) services. They can also be involved in schoolwide education and health promotion campaigns, and they often are linked to other health care organizations in the community.
The Affordable Care Act appropriated $200 million from 2010 to 2013 to expand SBHCs, and currently more than 2,400 SBHCs are serving students and communities in 49 states and Washington, D.C. As SBHCs have doubled during the past 15 years, there is a tremendous need for further research informing best practices and health impacts of SBHCs. A persistently controversial question about SBHC care has been whether RH services should be provided on school grounds.
Madkour and colleagues highlight the public health potential for SBHCs to not only prevent early and unplanned pregnancies, but also to avoid poor obstetric outcomes among pregnant adolescents.
The scope of RH services offered by SBHCs varies widely depending on regional policies and sponsoring organizations. More than 80% of SBHCs self-report offering abstinence counseling while less than 50% offer contraceptive services.
In the last decade, first-line contraceptive options for adolescents have expanded to include highly effective, long-acting reversible contraceptive (LARC) devices — specifically intrauterine devices and subdermal contraceptive implants. Thus, some SBHCs have begun to implement LARC placement, management and removal services, reducing adolescents’ barriers to LARC access. Unfortunately, in many regions, SBHC administrators continue to cite barriers to provision of contraceptive services, including school district or building policies, restrictions from sponsoring health care organizations, or restrictive state laws.
A small, but growing body of evidence supports SBHCs as a key strategy to improve access to RH services and reduce teen pregnancy rates. Broader provision of RH services in SBHCs is warranted, yet these initiatives may need to be combined with other health education interventions to achieve desired health outcomes. Importantly, studies have shown that offering RH services in SBHCs does not increase rates of sexual activity among adolescents, but rather is associated with increased reports of abstinence and less unprotected sex.
Beyond expanding their scope of services, an important priority for SBHCs is to address the current gaps in SBHC coverage found in rural school districts and schools for special populations, and in all schools during summers and holidays when services are severely limited. Strategies are needed to consistently measure service utilization and health outcomes among adolescents with access to SBHCs and understand barriers to utilization. RH services are a key component of preventive health interventions for adolescents, and expanding access within SBHCs should be a priority to ensure better health and social outcomes for our nation’s adolescents.
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