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Point / Counterpoint

The Issue: Dispensing Norplant to Teen-Agers From School-Based Health Clinics : FOR: MARGARET PRUITT CLARK. Margaret Pruitt Clark, 47, is executive director of the Center for Population Options, a private nonprofit agency based in Washington. The center develops sex-education programs and AIDS-prevention curricula and operates a support center for school-based health care programs.

April 12, 1993|Tracey Kaplan

San Fernando High School is believed to be one of only a handful of school-based health clinics in the nation to offer teen-age girls the contraceptive Norplant. What makes Norplant unique is that the system requires no effort on the recipient's part. Six matchstick-sized plastic capsules implanted under the skin of the upper arm release birth-control chemicals into the bloodstream for up to five years. The school gives parents the option of refusing reproductive services for their children. But under state law, once parents allow such services, they are not told what type of care the student receives.

Q. Why do you support the use of Norplant?

A. The bigger question is whether school-based health clinics should offer kids contraceptives, including Norplant, and the answer is yes. Teens are sexually active, and pretending they're not is naive. And if they are going to be sexually active, they should be responsible about it. That means providing them with information and services they need to act responsibly on their choice.

Q. How many school-based health clinics offer contraceptives to students?

A. To our knowledge, only about 10% of the 500 school-based health clinics in the country offer contraceptives at all. Some will refer students to other clinics, but most don't offer on-site contraceptives. As for Norplant, the only school we know of (to offer it) besides San Fernando is the Laurene Paquin School in Baltimore, which is for young mothers.

Q. How do you respond to critics who say offering teen-agers Norplant and other contraceptives encourages them to have sex?

A. There's no evidence to that effect. Instead, we have studies that show that kids have been sexually active for six to 12 months before getting any contraceptive.

Q. Is it the role of schools to supply students with contraceptives when they are available elsewhere?

A. There's some interesting data that shows that the farther a female student has to travel to obtain contraceptives, the less likely she is to use them. So given that school is where most teens are during the day, it makes sense to have them available on site or nearby.

Q. Does Norplant have greater side effects on teens than on older women?

A. No, not as far as we know. I don't think there have been studies with good controls on that. But nothing suggests the side effects are worse. Interviews with Baltimore teens indicate they are personally very pleased with it.

Q. Are teens mature enough to weigh the risks of using Norplant?

A. Yes, if the information is given in a developmentally appropriate way. The point is the parents have already signed a consent form saying the child is old enough to make decisions about reproductive health care. Kids are already making tremendous decisions with long-term effects on their lives--the choice to bear a child, to be sexually active with a partner they don't know. To not make those services available is what is unethical because they're at risk for unwanted pregnancies and sexually transmitted diseases.

Q. Yet Norplant does not prevent the spread of sexually transmitted diseases, including AIDS. Isn't that a problem?

A. Yes, it's a very fair concern. It's very difficult to get kids to use two methods of contraceptives, a barrier method and non-barrier method. There's also a risk of sexually transmitted diseases with the Pill.

Q. Then what accounts for the particular concern over Norplant?

A. Some people have talked about Norplant in a relatively coercive manner, as a means of temporary sterilization. It is relatively expensive, about $300 or more to have inserted. It may also be that some adults are placing their values on young people. Kids make a moral choice whether to be sexually active, and unlike some people, I don't think that's a decision they have to make every day as they would with other contraceptives.

As far as forcing young women to experience the consequences of their actions by becoming pregnant, we don't punish the young man by making him spend nine months in confinement, so why should we do it with the girl?

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