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Students Air Views on School Clinics

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WASHINGTON--Tom Sexton, a high-school senior from Portland, Ore., told a House subcommittee this month that the health care he received at his school's clinic was the first such care he had had in years.

"I've been bounced around a lot as a foster child,'' Mr. Sexton said. "So a lot of the care that [the school clinic] provided had been put off for a long time.''

The senior, who is legally blind without his glasses, said the clinic furnished him, free of charge, with an updated prescription and a new pair of glasses. In addition, he said, the clinic doctor treated a toe infection that, if left unattended, would have required hospital care.

They were services, he said, that he never could have afforded on his own.

"I probably would have worn the glasses until they fell off my face,'' he said.

Mr. Sexton was among five teen-agers who testified on June 5 on the subject of school-based clinics before the House subcommittee on health and the environment.

With an eye more toward political theater than legislation, the hearing was intended to dispel some of the misinformation surrounding the clinics and to illuminate the need for the kind of inexpensive, convenient, and comprehensive health care that such clinics provide to young people.

Against a backdrop of public opinion that has ranged from vehement opposition to the kind of enthusiastic support expressed by Mr. Sexton, the number of school-based health clinics has grown from 8 in 1973 to 85 this year, according to the Center for Population Options.

Though most of the clinics provide a wide range of health care, only one service--family planning--has attracted widespread attention and criticism, primarily from parents and religious groups who say they fear that such easy access to birth-control counseling and devices may encourage young people to become sexually active.

Around the Nation

In recent weeks, as legislators and school officials began planning their budgets for the 1987-88 fiscal year, school-based clinics--and the controversies that they sometimes inspire--have once again moved into the public spotlight. For example:

  • In New York City, Schools Chancellor Nathan Quinones has recommended that the health services provided by the eight state-funded clinics in the city's schools--except for the distribution of contraceptives--be expanded and extended.

Mr. Quinones's recommendation came after Welfare Research Inc., an independent group hired to study the clinics, reported that 99 percent of the parents interviewed for the study wanted a clinic in their children's schools. The survey also found that 61 percent of the parents said the clinics should dispense birth-control supplies or prescribe them for sexually active students.

Seven months ago, the New York clinics were at the center of a heated public debate that erupted when it was revealed that some of the clinics had been dispensing contraceptives to students. (See Education Week, Oct. 22, 1986.)

The city's school board next week may put the matter to rest when it votes to establish a policy on the range of reproductive-health services that are to be provided in the city schools.

  • The Robert Wood Johnson Foundation, in a long-awaited announcement on May 27, awarded initial grants of up to $200,000 each to 13 high schools in New York City, Manhassett, N.Y., Jersey City, N.J., Newark, Memphis, Greensboro, N.C., Baton Rouge, La., Santa Clara, Calif., and Los Angeles.
  • The Michigan Senate last week approved a bill that would impose a stiff penalty on schools with clinics that dispense or prescribe birth-control devices. Under the proposal, such schools would risk losing 25 percent of their state aid.

The measure is expected to face tough opposition in the state's Democratic-controlled House, legislators said.

"I'm not against the clinics,'' said Senator Dan DeGrow, the Republican chairman of the committee in which the measure originated. "I'm just concerned about the message we're sending to young people.''

'Mixed Messages'

At the hearing in Washington, Lynellen Perry, a sophomore from Annandale, Va., told legislators that she opposes the clinics because of the "mixed message'' that emanates from those offering pregnancy-prevention services.

'I hear, 'Don't become sexually active, but, if you do, here's how to avoid the consequences,'' she said.

"It didn't encourage me in my decision to be sexually active,'' countered another witness who used a clinic for both family-planning services, and, later, when she became pregnant, for prenatal and postpartum care.

"When you go in there,'' said Sheri Lynn Rhyan, a former high-school student from St. Paul, "there are about five posters, and they're all saying the same thing: 'It's O.K. not to have sex.''

Teen-Agers Dying

While arguments over family-planning and birth-control services add emotional fuel to the debate over the clinics, the fact is that teen-agers need better health care, said Robert Johnson of the University of Medicine and Dentistry of New Jersey.

Dr. Johnson noted that 55,000 adolescents die violently each year--either from suicide, in car accidents, or because they are murdered. Acquired immune deficiency syndrome also presents a threat to teen-agers, he said, explaining that they engage in behavior, such as intravenous drug use or sexual activity, that puts them at a high risk of contracting the disease.

Committee members were also told that an estimated one in 10 adolescents suffers from behavioral or emotional disorders.

"Without a clinic, if you need counseling, you have to make an appointment to see the school counselor,'' Ms. Rhyan said. "Then what are you supposed to do? Wait two weeks to see them?''

And, witnesses noted, the most-debated services provided by the clinics--family-planning advice and the dispensing of contraceptives--make up only a small percentage of services typically provided.

The New York City study, for example, indicated that only 7 percent of the students who used the clinics there received contraceptives.

House Bills

The majority of the teen-agers and clinic directors who spoke at the hearing expressed support for two House bills introduced this year that would establish a program of federal grants for school-based clinics.

In his bill, HR 1609, Representative Henry A. Waxman, Democrat of California, has proposed that $200- million be appropriated over four years to help provide funding for the clinics.

HR 324, a similar measure introduced by Representative Cardiss Collins, Democrat of Illinois, would authorize the Secretary of Education to set aside 5 percent of his discretionary fund for grants to school-clinic programs.

Though both legislators introduced similar bills during the last session of the Congress, neither measure had received a hearing until this month.

Some proponents of the plans said last week that, despite being given a hearing, the controversial bills were not expected to win Congressional approval any time soon.

Among those who strongly oppose such measures is Secretary of Education William J. Bennett. During a luncheon with education writers on the day of the hearing, he reiterated his long-standing opposition to school clinics that offer family-planning services.

"I will cite you studies that show that, yes, the clinics caused fewer births,'' he said. "But they also caused more abortions; that cannot be comforting to everyone.''

Conservative Congressmen, including members of the subcommittee chaired by Mr. Waxman, have expressed similar sentiments, House staff members said.

Concluded Denise Wilson, an aide to Representative Collins: "It may be enough for now that we had a hearing. The question is: Where do we go from here?''

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