Health-Clinic Debates Flare in Legislatures
Copyright 1987 Controversy over family-planning services continues to dog the movement to open health clinics in public schools, with debate flaring this summer in more state legislatures than ever before.
The rift in public opinion was exemplified in Michigan, where the legislature passed a law making it a misdemeanor for clinic workers to counsel teen-agers on abortion, or to dispense or prescribe contraceptives on school grounds.
At the same time, lawmakers appropriated $1.25 million to establish additional clinics in or near schools; that measure gave local officials the authority to decide whether the clinics will provide family-planning services.
"I guess you could say the state seems to have been sort of schizophrenic around the family-planning issue," observed Paul Shaheen, executive director of the Michigan Council on Children and Maternal Health, a group that supports the provision of such services in schools.
Action in Other States
Public officials in a number of other states were also divided on the matter. For example:
In Illinois, Gov. James R. Thompson, over the objections of anti-abortion groups and conservative organizations, vetoed a measure that would have prevented teen-agers from receiving contraceptives at school-based clinics. The bill was approved by a vote of 30 to 29 in the Senate and 67 to 51 in the House.
Gov. Tommy Thompson of Wisconsin used his veto authority to eliminate a line item in the fiscal 1987-88 budget that would have provided $1.28 million to establish eight school-based clinics across the state over the next two years.
In his veto message, Mr. Thompson said he opposed some of the family-planning services that the clinics might have provided to students.
"These clinics are highly controversial ... and would lead to polarization in communities and defeat the purpose of the program," he said.
In Florida, Gov. Bob Martinez ordered state officials to turn down a grant from a private foundation that would have funded a clinic at a Dade County high school--an action that was sharply criticized by local school-board members who had approved the project.
"At least the politicians aren't running away" from the debate over clinics, said Jodie Levin-Epstein, who tracks the issue for the Center for Population Options. "But it's premature to see any trends at this point."
Despite the attention given to the debates, Ms. Levin-Epstein said, a number of clinics are scheduled to open quietly around the country this school year--up from 13 in 1985 to an estimated 115 by Sept. 1.
New Jersey officials, for example, are launching a $6-million statewide program to open "youth centers"--a concept that adds a new dimension to traditional comprehensive health clinics. In addition to typical health services, the centers will provide mental-health counseling, job training and employment services, and in some cases day care.
The Robert Wood Johnson Foundation--the organization whose grant offer was rebuffed in Florida--awarded funds to 10 more clinic projects nationwide this summer, bringing to 23 the total number of clinics funded by the organization.
"No one else has turned us down," said Dr. Philip' Porter, director of the foundation's school-based, adolescent-health-care program.
Ironically, proponents of clinics note, less than 30 percent of the existing clinics dispense contraceptives--the most controversial of the family-planning services being debated. About 40 percent of the clinics prescribe them, according to the Center for Population Options.
Far more commonly offered clinic services include blood-pressure screening, routine physical examinations, and counseling to help teen-agers lose weight or cope with stress.
"I think there is a great deal of misinformation about what these clinics do," Dr. Porter said. "In 35 states and the District of Columbia, all you have do is go to a public health clinic to get contraceptives without parental approval and without parental knowledge. Maybe people don't know about that."
To the clinics' opponents, the distinction between providing family-planning services at public-health clinics and providing them at school is an important one.
"I think you have to understand that it's a little different than setting them up at school where you have immediate access to the child and the child is where you want him to be," said Barbara Lyons, president of the Wisconsin chapter of Right to Life, a group that was widely credited with persuading Governor Thompson to veto the appropriation for school clinics.
Phyllis Schlafly of Eagle Forum, a conservative group that has led opposition to clinics nationwide, said: "The difference is that it's legitimizing promiscuity by having it in a public school."
But that very feature--easy access to teen-agers--is also what makes the clinics effective, proponents say.
"Someone asked Willie Sutton, the famous bank robber, why he robbed banks and he said, 'Because that's where the money is,"' Dr. Porter said. "Adolescents, as a group, have difficulty making appointments and keeping appointments for primary health care."
Clinics that provide family-planning services may not be appropriate for every community, proponents concede. Mr. Shaheen of the Michigan Maternal and Child Health Council recounted a conversation with a school superintendent who said that clinics were needed in his community because of widespread drug-abuse problems. "But the superintendent told me, 'If you try to force family-planning on us, we won't take one,"' Mr. Shaheen said.