School-based health centers (SBHCs) are critical access points to health care for adolescents, especially those who are low-income or uninsured and most at risk of unintended pregnancy and STIs. That is why policymakers and child health advocates must do more to ensure consistent funding for SBHCs and, in particular, work to overcome barriers that still keep many SBHCs from meeting students’ sexual and reproductive health needs, according to a new analysis in the Guttmacher Policy Review.
There are more than 1,900 SBHCs located in schools across the United States, most of them in urban (54%) or rural (28%) communities. Typically staffed by a mid-level provider such as a nurse practitioner, they offer preventive care and often a range of other services, such as mental health care. However, one crucial area where many SBHCs fall short is in the provision of sexual and reproductive health services. Fewer than four in 10 SBHCs dispense contraceptives on-site, in large part because half of them are prohibited from doing so due to state or local restrictions.
"School-based health centers can play a key role in addressing teen pregnancy, and failing to provide contraceptive services on-site, for whatever reason, is self-defeating," says Heather Boonstra, author of the new analysis. "We know contraception has been the main driver of the steep decline in the U.S. teen pregnancy rate, which is why it’s so important to give students easy access to the information and services they need."
In her analysis, Boonstra reviews how controversy around teen sexual activity and opposition to making contraceptive services available to teens have played major roles in blocking SBHCs from providing these services. The analysis also provides a model for SBHCs by detailing the experiences of centers in Colorado and Oregon that have successfully overcome various barriers to make such services available, including by developing societal and political leadership, engaging parents and teens, and using data to develop proposals and monitor progress.
Another key challenge many SBHCs face is a lack of consistent funding, according to Boonstra. These centers’ funding is often cobbled together from a range of sources, including from the hospital, health department or federally qualified health center that sponsors the SBHC, as well as from public and private insurance programs, and from government and private grants. A federal program created under the Affordable Care Act and dedicated to supporting SBHCs saw its funding expire in 2013.
"A lack of adequate and consistent resources can affect any of the services that school-based health centers provide, not just contraceptive services," says Boonstra. "Coupled with the seemingly ever-rising cost of contraceptive supplies to health care providers, it may make expanding the range of reproductive health services for students even more difficult."
Boonstra details several specific steps that policymakers can take to put SBHCs on a sounder financial footing. One such step is enactment of The School-Based Health Centers Program Reauthorization Act, put forth by Rep. Lois Capps (D-CA), which would allow funding to continue for another five years, providing stability for the program. The legislation is supported by leading medical, teacher, child welfare and public health organizations.