About two-thirds of K-12 school health workers say their schools or districts don’t provide students with, or refer them to, any sort of contraceptives, including condoms, a new national survey found.
Ideally, schools would provide “both information and access to services as well as a supportive, non-stigmatizing, confidential environment,” said Laura Lindberg, a professor at Rutgers School of Public Health who researches sexual and reproductive health and rights.
But that’s not usually the case, school health workers said in an EdWeek Research Center survey. Sex education is inadequate or nonexistent in many places, and sexual and reproductive health services in schools are few and far between. The end result is that teenagers are often left to navigate preventing pregnancy and sexually transmitted infections without any help or guidance from educators.
The EdWeek Research Center surveyed 3,480 school health workers in March. The sample included about 2,300 school nurses, 350 social workers, 245 school psychologists, and 120 health or sex education directors, among other health-related job titles.
The EdWeek Research Center survey encompassed school health workers of all grade levels, including elementary. More than half of school health workers serve all or multiple grade levels in their districts.
Teen pregnancy is on the decline
Thirteen percent of all school health workers said the number of pregnant students at their school or district has increased since 2019, while 9 percent said it had decreased since then. Seventy-nine percent said there was no change.
The U.S. teen birth rate has declined over the past three decades, although it’s still higher than in many other developed countries, including Canada and the United Kingdom. In 2022, the U.S. birth rate for 15- to 19-year-olds was 13.5 per 1,000 females. (In 2021, the Canada birth rate for the same age group was 4.9 per 1,000 females.)
Those declines are primarily driven by improvements in contraceptive use, Lindberg said: Young people are both more likely to be using a contraceptive method than they did in the past, and they’re more likely to use them effectively.
There have also been some declines in teen sexual activity, particularly among young men, she said.
Yet the U.S. Supreme Court’s reversal of Roe v. Wade in June 2022 could threaten to disrupt some of this progress, Lindberg said. In Dobbs v. Jackson Women’s Health Organization, the court held that there is no constitutional right to abortion.
Since then, 14 states have banned most abortions, according to the New York Times. (Georgia has also banned abortion at about six weeks of pregnancy, which is before many women know they are pregnant.)
Lindberg noted that there’s also been some opposition to birth control methods in the aftermath of the ruling: “We have a lot of concerns that contraceptives might [become] less available.”
In December, a U.S. district judge in Texas ruled that Title X—a federal program that provides confidential and free birth control to anyone, regardless of age—violates parents’ rights and state and federal law. Parents must be informed about their children’s request for birth control, the judge said. The ruling is being appealed by the U.S. Department of Justice.
The ruling echoes concerns among some parents and educators that schools are not appropriate places to be counseling students about birth control or providing contraception, and that those conversations should be left up to the parents.
Another commonly cited concern is that sex education programs should emphasize and focus on abstinence, not the use of birth control. (Experts say comprehensive sex education programs should include information about both.)
Reproductive health services available at schools
The most common form of birth control provided by schools or school-based health clinics is condoms, the survey found—although only 8 percent of all school health workers said that was offered at schools in their districts.
School health workers in middle and high schools were about twice as likely as those in elementary schools to report having condoms on site—12 percent in high schools, for example, compared to 6 percent in elementary schools. (Very few school health workers who worked exclusively in elementary schools said their school provided any other form of contraception on site.)
About 3 in 10 school health workers said district employees were allowed to give students referrals to outside providers for a variety of contraceptives. In elementary schools, that number went down to fewer than 2 in 10.
Lindberg said most schools don’t have the capacity to provide birth control on-site, but they should be able to establish a strong referral network. Rather than passing on a list of providers or “telling students to Google,” the school health personnel should have established relationships with other clinics so they can do a “warm handoff” of the student, she said.
Otherwise, students could end up with inadequate or low-quality contraceptives—or foregoing them entirely.
“Theoretically, anyone can buy condoms at a drug store, so we like to think that it’s widely available,” Lindberg said. But that’s not always true, she added: Some students might not have access to transportation, and in a smaller community, there could be a real stigma to buying condoms.
In open-ended responses to the EdWeek Research Center survey, some school health workers indicated that there was a need and a demand for these services, but their hands were tied due to district policies.
“I am in a very difficult situation,” a school health worker wrote. “Abstinence is strongly encouraged [in my district], and the view is not to offer condoms or other prophylaxes in school because that ‘promotes sex.’ I don’t agree and have tried to change this common misconception. ... If my students come to me for help, I will do what I can to help them and guide them in the right direction.”
Said another: “I have a lot of students pregnant or with children. I would like to be able to give out condoms. I would like to have a mentoring program to help students not get pregnant again.”
More than half of all school health workers said employees at their school or district did not provide or refer students to pregnancy testing, prenatal care, or testing and treatment for sexually transmitted diseases. (Very few elementary school workers said their site offered those services on site.)
The lack of on-site services aren’t entirely surprising, Lindberg said, given the increasing demands on school nurses’ time.
No effect yet from Supreme Court abortion ruling
An overwhelming majority—99 percent—of school health workers said their districts did not stop providing any services to students as a result of the Dobbs ruling.
And just 6 percent of school health workers said parents and community members complained about reproductive counseling options that were offered at the school.
That might be an indication of the slim offerings available. Said one school health worker: “We do not dispense anything at school. ... If we did, parents/community members would likely be outraged.”
Among the school health workers who reported parent complaints, 43 percent said they had to do with counseling and information about birth control. Fourteen percent said parents or community members complained about the district providing a referral to a physician or for services off-site, and 8 percent said their district had experienced complaints about the dispersal of condoms.
When parents did complain, 42 percent of school health workers said nothing happened. Eleven percent said their school or district stopped offering the service temporarily, and 10 percent said they stopped offering the service permanently.
Schools’ and districts’ sex education programs have also received a substantive amount of parental pushback, the survey results indicate.
“There’s always been complaints from a handful of parents,” Lindberg said, but the tenor of the objections is different these days, with schools at the center of political and cultural battles.
“It’s the fear of the consequences of those complaints that are driving educators,” she said. “It’s a very volatile and contentious space right now.”
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