School-based health clinics provide a variety of health care services to attending students. Many middle and high school-based clinics offer reproductive services, which generally include abstinence and contraception counseling, pregnancy and STI testing, and may also distribute contraceptives. Such clinics also sometimes offer prenatal care (Strunk 2008*). Clinics are most frequently located in urban and rural neighborhoods with residents of lower socio-economic status (NBER-Lovenheim 2016, CG-SBHC); in 2013-14, about 70% of students attending schools with clinics were racial or ethnic minorities (SBHA-SBHC).
Expected Beneficial Outcomes (Rated)
Reduced low birthweight births
Reduced teen births
Other Potential Beneficial Outcomes
Increased use of contraception
Increased reproductive health care
Reduced teen pregnancy
Increased preventive care
Improved student attendance
Increased high school graduation
Evidence of Effectiveness
There is some evidence that school-based health clinics (SBHCs) that provide reproductive health services reduce birth rates (NBER-Lovenheim 2016, Owen 2010, Ricketts 2006), especially among African American and Hispanic teens (NBER-Lovenheim 2016), and reduce the likelihood of low birthweight births (CG-SBHC, Strunk 2008*). However, additional evidence is needed to confirm effects.
SBHCs that offer contraception may increase receipt of reproductive health care (Ethier 2011*) and prenatal care (CG-SBHC) among teen girls. Overall, evidence indicates that SBHCs do not increase contraceptive use, though several recent studies suggest that in some circumstances they may increase use among teen girls (CG-SBHC, Keeton 2012*, Ethier 2011*). Clinics that offer contraception appear to increase contraception receipt among sexually active students more than clinics that offer health assessments or counseling only (Blank 2010*).
School-based clinics with reproductive health services may reduce absenteeism and dropout rates among pregnant and parenting teens (Strunk 2008*) but do not appear to have a significant effect on dropout rates overall (NBER-Lovenheim 2016).
Some school-based clinics may offer patients screening and advice about substance abuse, nutrition, physical or sexual abuse, mental health, and preventing repeat pregnancies more frequently than community clinics (Strunk 2008*). Ease of access (Mason-Jones 2012) and confidential services are often cited as incentives for teens to use these clinic services (Keeton 2012*).
Impact on Disparities
Many school-based health clinics (SBHCs) offer reproductive health services. Services provided vary, most often including pregnancy testing (80.2%), STI diagnosis and treatment (69.5%), and pap tests (45.3%). As of a 2013-2014 census of SBHCs, just over half of all SBHCs are restricted from dispensing contraceptives, most often by district policy. The portion of SBHCs that dispense contraceptives has been increasing for the past decade. As of 2013-2014, 96.8% of SBHCs that dispense contraceptives dispense barrier methods, 82.9% hormonal methods, 73.3% emergency contraception, and 39.8% provide implantable devices (SBHA-SBHC).
Citations - Evidence
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NBER-Lovenheim 2016 - Lovenheim M, Reback R, Wedenoja L. How does access to health care affect teen fertility and high school dropout rates? Evidence from school-based health centers. National Bureau of Economic Research (NBER). 2016: Working Paper 22030.
Owen 2010 - Owen J, Carroll C, Cooke J, et al. School-linked sexual health services for young people (SSHYP): A survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technology Assessment. 2010;14(30).
Ricketts 2006 - Ricketts SA, Guernsey BP. School-based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado. American Journal of Public Health. 2006;96(9):1588-92.
CG-SBHC - The Guide to Community Preventive Services (The Community Guide). Health Equity: School-Based Health Centers (SBHC). 2015.
Strunk 2008* - Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: An integrated literature review. The Journal of School Nursing. 2008;24(1):13-20.
Ethier 2011* - Ethier KA, Dittus PJ, DeRosa CJ, et al. School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. Journal of Adolescent Health. 2011;48(6):562-5.
Keeton 2012* - Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: Building on history. Current Problems in Pediatric and Adolescent Health Care. 2012;42(6):132–156.
Blank 2010* - Blank L, Baxter SK, Payne N, Guillaume LR, Pilgrim H. Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings. Journal of Pediatric and Adolescent Gynecology. 2010;23(6):341–51.
Mason-Jones 2012 - Mason-Jones AJ, Crisp C, Momberg M, et al. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews. 2012;1:49.
Citations - Implementation Examples
* Journal subscription may be required for access.
SBHA-SBHC - School-Based Health Alliance (SBHA). The 2016-2017 National School-Based Health Care Census: School-based health centers (SBHC).
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