Sexual and Reproductive Health

SBHCs & Sexual Health | Sexual Health Education | Teen Dating Violence | SBHCs & TDV | Resources

 

Teen Pregnancy & STIs Have Long-Term Consequences

Each year, 750,000 American adolescents, aged 15-19, get pregnant.1 Although recent data show a decrease in teen births — driven by increased contraceptive use and increased use of effective contraception — there is still room for significant improvement.2 In California 32 of every 1,000 adolescent girls aged 15-19 have babies each year.3 Notably, this statistic masks persistent and troubling racial/ethnic disparities: annually, for every 1,000 adolescent girls aged 15-19 living in California, there are 51 births to Latinas, 37 to African Americans, 12 to whites, and 9 to Asians.4

Rates of the most common sexually-transmitted infections (STIs), including chlamydia and gonorrhea, peak in late adolescence. Youth aged 15-24 account for more than half of all STIs, including HIV, diagnosed annually.5

Despite their clear need for reproductive health care, adolescent girls access fewer reproductive health services, including contraception services, than young adult women.6 In fact, only 41% of adolescents have accessed reproductive health services.Research consistently shows that adolescents “face numerous barriers to accessing needed [reproductive] healthcare, including lack of familiarity with the healthcare system, limited ability to pay for services, fear of disclosure of confidential information to family and friends, and uncertainty about their ability to access [reproductive healthcare] services without the consent of a parent or guardian.”8

Recent research underscores the connection between adolescent reproductive health outcomes and educational outcomes. Nationally, while almost 90% of girls who do not give birth as teenagers earn a high school diploma by age 22, only slightly more than 50% of all girls who do give birth as teenagers achieve this milestone.9

SBHCs Provide Critical Reproductive & Sexual Health Care

Many school-based health centers (SBHCs) provide confidential, developmentally appropriate reproductive and sexual health services for adolescents. These services may include sexual health education, contraception, pregnancy and STI testing, counseling, and referrals to outside services. Research has shown that SBHCs effectively address reproductive and sexual health needs.

  • SBHCs provide STI screening/treatment to adolescents who often have no other source of care.10,11
  • SBHCs effectively deliver HPV vaccinations to adolescents, including those who are uninsured.12
  • Adolescent girls with SBHC access are more likely to get reproductive preventive care, use hormonal contraception, and to have been screened for an STI, than similar girls without an SBHC.13
  • SBHCs can reduce the unplanned pregnancy rate among adolescents.14,15

Sexual Health Education: California Healthy Youth Act

The California Healthy Youth Act (AB 329) went into effect in January 2016 and requires schools to provide all students in grades 7-12 with age-appropriate sexual health education that is comprehensive and medically accurate.

The law mandates that curriculum must be LGBTI inclusive so that no students are left out, regardless of their gender identity or sexual orientation. It also requires schools to provide information on sexually transmitted infections/HIV prevention, pregnancy prevention, consent, and healthy relationships (how to avoid adolescent relationship abuse and sex trafficking).

Teen Dating Violence: Prevalent & Disruptive

According to the CDC, teen dating violence (also known as adolescent relationship abuse, or ARA) is defined as the physical, sexual, or psychological/emotional violence within a dating relationship, as well as stalking.16 It can occur in person or electronically and may occur between a current or former dating partner.

The 2009 CDC Youth Risk Behavior Survey revealed that 9.8% of high school students report being hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend in the 12 months prior to the survey.17 The 2010 National Intimate Partner and Sexual Violence Survey, revealed even more alarming statistics: About 1 in 5 women and nearly 1 in 7 men who ever experienced rape, physical violence, and/or stalking by an intimate partner, first experienced some form of partner violence between 11 and 17 years of age.18

Teen dating violence is also referred to as adolescent relationship abuse because adolescence spans a long time (ages 10-24) and reference to abuse includes a range of abusive behaviors and not only physical violence.19

“Teen dating violence [is] far too prevalent and prevents far too many students from being able to focus on their education.”  Kevin Jennings, the Assistant Deputy Secretary, U.S. Department of Education

Research has shown a strong connection between teen dating violence and poor health outcomes.  For example, teens who are victims of physical dating violence are more likely than their non-abused peers to smoke, use drugs, engage in unhealthy diet behaviors (taking diet pills or laxatives and vomiting to lose weight), engage in risky sexual behaviors, and attempt or consider suicide. Note that some youth also experience reproductive coercion: abusive behaviors by male partners intended to promote pregnancy in females.20 Female public high school students who reported ever experiencing physical or sexual violence from a dating partner in a Massachusetts study were four to six times more likely than their non-abused peers to have been pregnant and eight to nine times more likely to have attempted suicide in the past year.21

SBHCs Prevent & Address Teen Dating Violence

Healthy relationships, particularly in the context of dating or sexual activity, play an important role in increasing the use of contraception and preventing teen pregnancy. Being located in schools, school-based health centers (SBHCs) are in close proximity to teens’ social environment and have a unique ability to assess adolescents for dating violence and reproductive coercion. SBHCs can also provide counseling support or referrals to address these issues, in addition to promoting respectful relationships through both clinical and classroom education.  Adolescent relationship abuse is common among adolescent seeking services, with one study reporting a 40% lifetime prevalence of physical/sexual violence victimization among adolescent females who use urban teen clinics.22 In an adolescent relationship abuse (ARA) intervention pilot study with two adolescent health centers (one of which was an SBHC), researchers found that clients welcomed providers discussing healthy relationships with them, and they saw significant increases in youth knowledge of ARA-related resources, and reductions in tech abuse.23

The California School-Based Health Alliance conducted a review of research and interviews with select SBHCs to gain a better understanding of interventions that are currently being utilized in the exam room and at school. Please see our new Addressing Teen Dating Violence at School-Based Health Centers resource highlighting key TDV strategies and interventions employed by SBHCs in California.

Resources for Practice

Citations
(1) Ralph, L.J & Brindis, C.D. (2010). Access to Reproductive Healthcare for Adolescents: Establishing Healthy Behaviors at a Critical Juncture in the Lifecourse. Current Opinion in Obstetrics and Gynecology. 22:369-374.
(2) Guttmacher Institute. (2012). New Government Data Finds Sharp Decline in Teen Births: Increased Contraceptive Use and Shifts to More Effective Contraceptive Methods Behind This Encouraging Trend. http://www.guttmacher.org/media/inthenews/2011/12/01/index.html
(3) California Adolescent Sexual Health Work Group. (2010). 2008 California Data for Adolescent Births, AIDS, STDs. http://www.californiateenhealth.org/uncategorized/now-updated-with-2008-data-ashwg-data-tables-and-charts-for-adolescent-births-aids-and-std.
(4) Ralph et al.
(5) Ralph et al.
(6) Hall, K.S., Moreau, C., Trussell, J. (2011). Discouraging Trends in Reproductive Health Service Use Among Adolescent and Young Adult Women in the USA, 2002-2008. Human Reproduction. 0(0): 1-8.
(7) Hall et al.
(8) Ralph et al.
(9) Child Trends. Fact Sheet: Diploma Attainment Among Teen Mothers. http://www.childtrends.org/Files/Child_Trends-2010_01_22_FS_DiplomaAttainment.pdf. Accessed October 2011.
(10) Braun, R.A. & Provost, J.M. (2010). Bridging the Gap: Using School-Based Health Services to Improve Chlamydia Screening Among Young Women. American Journal of Public Health. 100(9): 1624-1629.
(11) Crosby, R.A. & St. Lawrence, J. (2000). Adolescents’ Use of School-Based Health Clinics for Reproductive Health Services: Data from the National Longitudinal Study of Adolescent Health. Journal of School Health. 70(1): 22-27.
(12) Gold, R., Naleway, A.L, Jenkins, L.L., Riedlinger, K.K., et al. (2011). Completion and Timing of the Three-Dose Human Papillomavirus Vaccine Series Among Adolescents Attending School-Based Health Centers in Oregon. Preventive Medicine. 52: 456-458.
(13) Ethier, K.A., Dittus, P.J., DeRosa, C.J., Chung, E.Q., et al. (2011). School-Based Health Center Access, Reproductive Health Care, and Condom Use Among Sexually Experienced High School Students. Journal of Adolescent Health. 48: 562-565.
(14) Ricketts, S.A. & Guernsey, B.P. (2006). School-Based Health Centers and the Decline in Black Adolescent Fertility During the 1990s in Denver, Colorado. American Journal of Public Health. 96(9): 1590-1592.
(15) Koo, H.P.,  Dunteman, G.H., George, C., Green, Y., et al. (1994). Reducing Adolescent Pregnancy through a School- and Community-Based Intervention: Denmark, South Carolina, Revisited. Family Planning Perspectives. 26(5): 206-211.
(16) Centers for Disease Control, Injury Center: Violence Prevention site.
(17) Centers for Disease Control, Youth Risk Behavior Survey, 2009
(18) National Intimate Partner and Sexual Violence Survey, 2010
(19) National Institute of Justice, Office of Justice Programs, 2011
(20) Centers for Disease Control, Injury Center: Violence Prevention site.
(21) Silverman, J, Raj A, et al. 2001. Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. JAMA. 286:572-579.
(22) Roberts TA, Auinger P, & Klein JD. (2005): Intimate Partner Abuse and the Reproductive Health of Sexually Active Female Adolescents. Journal of Adolescent Health 36: 380-385.
(23) Miller E, Decker MR, Raj A, Reed E, Marable D, & Silverman JG. (2009): Intimate Partner Violence and Health Care-Seeking Patterns among Female Users of Urban Adolescent Clinics. Matern Child Health J.