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Q&A: Comprehensive Reproductive Health Care at Clinics Advocated

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In the current issue of Family Planning Perspectives, Douglas Kirby, the former re search director at the Center for Population Options, co-authored a study evaluating the impact of six school-based clinics. Three distributed contraceptives, and a fourth is sued birth-control vouchers that could be used at a nearby family-planning clinic.

Mr. Kirby, research director at etr Associates in Santa Monica, Calif., spoke with staff writer Ellen Flax.

Q. Is merely offering free contraceptives at a school enough to get students to use them?

A. Yes. But ... we shouldn't exaggerate the impact of that. What we've found in several school-based clinics around the country is that, when they do provide contraceptives on site, many students do use [them], and, consequently, there is some increase in their use. But some of the students who obtain the contraceptives from the school clinic or health center would have gotten [them] elsewhere.

Q. Given this effect, why should schools distribute contraceptives, whether through a school-based clinic or another mechanism?

A. In the context of the school-based clinic, it is appropriate and important to provide comprehensive reproductive health care as a part of an overall comprehensive health program. It seems illogical to treat students who have already gotten pregnant, or to give them pregnancy tests, or to treat them for [sexually transmitted diseases] after they've gotten an std, but not to provide them with contraceptives which might help them to prevent becoming either pregnant or getting an std.

In other schools ... providing, say, condoms through the nurse's office or through a health center or any other fa cility in the school, or maybe even in vending machines, will increase their use somewhat, and it's very inexpensive to do that.

[But] it's advisable to have a more comprehensive program which not only im proves access to contraceptives, but also ... more effectively motivates students to use contraceptives or to delay having sex.

Q. Does offering contraceptive services increase sexual activity among teenagers?

A. The answer is very clearly no. There have been at least three studies that have been done at school-based clinics that have provided contraception, or prescribed contraceptives, and all three of those studies are unanimous: They all indicate that there was no in crease in sexual activity in those schools, whether measured in terms of whether or not the students had ever had sex, or, if they had had sex, at what age they first had it, or the frequency of sexual activity.

Q. Does it cut pregnancy rates?

A. Providing contraceptives probably reduces the number of pregnancies by a small amount. Pregnancy is a protected sexual activity, [but] also ... frankly, of chance.

We know that effective programs can somewhat increase the use of contracep tives without increasing the frequency of sexual behavior, and, consequently, they probably reduce pregnancy rates. In the study that I completed, we did not find evidence that pregnancy rates had statistically, significantly declined as a result of the program.

Q. Will New York City's condom distribution plan make a difference?

A. I think New York City's plan will definitely not increase sexual activity as some opponents of it fear. It probably will not dramatically increase the use of contraceptives, either, as some people hope it may. On the other hand, it probably will increase the use of condoms some, and, thereby, to a small extent, reduce both std's and unintended pregnancies.

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