Impact of contraception in school health center

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School-based health centers that offer comprehensive reproductive services benefit from substantially fewer teenage pregnancies, abortions and births, as well as lower costs to public health systems, according to a study in the journal Perspectives on Sexual and Reproductive Health.

The study accessed the impact of the School-Based Health Center Reproductive Health Project (SBHC RHP), which since 2008 has supported SBHC’s in New York City (NYC) to increase the availability of effective contraception.   

Methods
The investigators estimated patterns of contraceptive use and the numbers of pregnancies, abortions and births averted between 2008 and 2017 using program data and public data from the NYC Bureau of Vital Statistics and Youth Risk Behavior Survey.

Data from the Guttmacher Institute on the cost of publicly funded births and abortions were also used to estimate avoided expenses.

Findings
The study found a significant increase in the proportion of sexually active female clients in the SBHC RHP who used efficacious contraception.

The mix of contraceptive methods dispensed to or used by clients was defined as the SBHC RHP contraceptive mix, whereas the mix of methods estimated to have been used by those without access to the SBHC RHP was the non-SBHC RHP method mix.

Overall, 14% of clients in the SBHC RHP method mix used long-acting reversible contraceptions (LARCs) in the school year beginning in 2017, compared to only 2.4% in the non-SBHC RHP mix.

This led to an estimated fewer 5,376 pregnancies, fewer 2,104 births and fewer 3,085 abortions between the 2008 and the 2016 school years, resulting in an estimated savings of $30,360,352 for one-time costs of publicly funded births and abortions.

During the study period, New York was one of 15 states with nonrestrictive abortion policies that allowed state funding of abortions under Medicaid.

The averted events accounted for 26% to 28% of the decline in teenage pregnancies, births and abortions in NYC during the same period.

As of 2017, roughly 33% of the 325,000 NYC public high school students had access to 75 SBHCs, all of which participated in the RHP and representing an increase in student access from 2% in 2008.

In addition, 50 of these locations provided at least one form of LARC onsite.

Compared to NYC schools that lack SBHCs, those schools with SBHCs enroll a higher proportion of Black and Hispanic students, along with a higher proportion of students on Medicaid and Child Health Plus.

SBHCs in NYC are also concentrated in the Bronx, which has the highest teenage birth rates of the five boroughs.

Conclusions
“This analysis supports the potential of expanded access to SBHCs that provide comprehensive contraceptive services to further drive reductions in teenage pregnancies, birth and abortions,” the authors wrote. “Given the financial costs associated with both teenage birth and abortion, the results of our analysis are compelling from a societal and economic perspective.”

Providing comprehensive reproductive health services in schools for teenagers also avoids the barriers of cost and travel, thus is an effective mode of service delivery, according to the authors.

Furthermore, offering a full range of contraceptive methods, including intrauterine devices (IUDs) and implants, allows teenagers to choose more effective methods and take control of their reproductive health decisions and outcomes.