Until now, the Indian River School District was the only school district in Delaware that didn’t offer reproductive healthcare in its high-school wellness centers. That will change now, as the IRSD school board this week agreed to add those services (roughly about 9 percent of overall services) in order to keep federal funding for all of the other 91 percent of health services already provided at its wellness centers.
According to the CDC, Delaware ranks 10th in the nation for teen pregnancy, and 13th and 15th percent respectively for gonorrhea and chlamydia infections. Sussex County is No. 1 among Delaware’s three counties in the rate of teen pregnancies.
The overall goal is a comprehensive health plan at Indian River and Sussex Central high schools, part of which will now include sexual education, family planning, and sexually-transmitted infection testing and treatment.
“It’s not just about contraception. It’s about preventing pregnancies and giving these kids a better future moving forward,” said Dr. Bobby Gulab, vice president and chief medical officer for the Beebe Medical Group.
“Sex isn’t going anywhere, unfortunately, but think the more educated students are about it … the more it can prevent some of the detrimental effects in those who make poor decisions,” Gulab said.
The IRSD high-school wellness centers are different from the traditional school nurse’s office because the centers are run by Beebe Healthcare, and have both treatment and prescribing powers.
The school board wouldn’t even discuss this topic publically until this month. Previous boards had only debated the topic in executive session (at least twice since 2015) before vaguely voting down “the Wellness Center presentation,” although it lost by a narrow margin each time.
Political support finally tipped in favor this month when Gulab, who is himself a Sussex Central High School graduate, presented information to the board on the benefits of educating students on sexual health.
He said it’s an overall benefit for everyone — especially those in a lower-socioeconomic bar, because they want the access, and they’re more likely to face teen pregnancy. The access can help the people who want it and need it, he said.
“One percent of what we do is pregnancy-related; 3 percent is STD-related; and 5 percent is family planning. The rest of it is everything else,” said Gulab. “Illness, immunization, sports physicals, mental-health services and anything else that comes up...”
And the school district risked losing its federal funding for all of it. Wellness centers provide free or discounted health services through the U.S. 340B Program. But that means the federal government can withhold money if IRSD excludes students from any part of that program.
“Because you’re not doing 9 percent of something currently, you will lose 91 percent of what you do do,” Gulab said.
While it is a concern that has often been expressed by opponents of such access, it’s never been proven that offering these kinds of services will increase sexual activity. But wellness centers have been proven to lower pregnancy rates.
And school-based wellness centers are a choice. Parents must specifically opt in to allow their children that healthcare.
Sussex leads in teen pregnancies
Anecdotally, at least 20 to 30 recent pregnancies have been IRHS and SCHS students, Gulab said.
Meanwhile, at Cape Henlopen High School, “They went from nine pregnancies before the approval to one pregnancy last year,” Gulab said.
“I see it as a way to combat teen pregnancies. You’re the only school district in the state of Delaware that doesn’t have contraceptive services,” Gulab said. “We’re a nonprofit and … we’re here to service the community.”
In Delaware, more than 50 percent of juniors and seniors are sexually active, as are many freshmen and sophomores. Sussex County has a higher rate of teen pregnancy than the other counties in Delaware and than the national average, Gulab said.
Student privacy versus parental rights
In Delaware, teenagers can request that medical information be kept from their parents regarding mental health, sexual infections and pregnancy. Gulab personally admitted it’s not his favorite law, but it is the law. And there is only a small percentage of that sort of privacy occurring, versus the broad benefit for all students for all health services.
But the doctors noted that family communication has been shown to increase and improve when students go to wellness centers. That’s because the wellness staff aren’t just handing out medicine — they are discussing health. They are encouraging healthy behavior (which includes safe sex). Moreover, they are encouraging students to have a dialog with their parents on issues of their own personal health.
The staff “don’t just prescribe and treat. They also talk about prevention all the time. It is one of the requirements the Division of Public Health imposes,” said Dr. Gloria James, chief of Delaware’s Bureau of Adolescent & Reproductive Health.
“Children are having sex. They’re being sexual. We can’t stop it one way or another. But what we can do is educate them, allow them, and allow their parents, to know the choices they have in school-based wellness center,” James said. “The providers encourage the students to have more two-way communications with the parents.”
Again, parents must opt-in to even allow their students to visit a wellness center.
Board members share their yeas and nays
“I’ve been very impressed with the wellness benefits at Indian River High School,” said Board Member W. Scott Collins, a parent of teenagers. “It’s been a great program, and I will gladly motion to accept the enhanced healthcare program.”
The final vote was 7-2-1, with dissent from Board Members Charles Bireley and James “Jim” Fritz.
Board Member Donald Hattier abstained from the vote, as he has during past discussions.
No one denied that the wellness centers do good work. But the more conservative board members have said they don’t like that students could keep medical information from their parents, or the funding mandate.
“I see it as government coercion to peel families away from their kids,” said Hattier. “While it may be well-meaning, the government does a lot of things well-meaning that don’t turn out too well.”
“The wellness center does offer so many great things to the students, and especially the families that may not have access to that outside the school,” Fritz said, adding that he doesn’t want the government “strong-arming” these services into the school. “That’s too much control. Also, a lot of constituents in my district [do not favor] handing out condoms and contraceptives.”
Board Member Derek Cathell supported the services whole-heartedly, especially when he heard about the pregnancy statistics and the benefit to low-income families.
“I think it’s something we need to look into. I did not realize how prevalent it was,” Cathell told the Coastal Point. He said he supports “anything we can do to provide some services to these students.”
He acknowledged the teen privacy issue, but said that, ultimately, it’s the law. “There’s nothing we can do about that. So, to me, is that a reason not to provide those services? I don’t think it is. … We were the only school in the [state] that doesn’t provide the services.”
Wellness centers fill the gaps
The IRHS nurse practitioner and SCHS physician assistant can diagnose and treat medical issues, as well as encouraging healthy diets and lifestyles.
They wouldn’t just hand a kid condoms or birth control pills, and send her back to class. The adults actually sit the students down to discuss their problems and their lives. They will test for STDs and pregnancy as needed.
The wellness centers were designed to promote a healthy lifestyle and link students and their families to ongoing sources of care in their community.
Students should not expect contraceptive access on the first school day in September, officials noted. Beebe and the IRSD will take their time to implement a solid program. For instance, they’ll need to write and send home new information, and collect new parental consent forms.
IR students praised the centers at a 2016 wellness event. One athlete said he appreciated the easy access to getting sports physicals. Another thanked the staff who helped talk her through some tough family times.
“Most adolescents don’t really have a primary-care doctor,” having outgrown the pediatrician, but not really settled at the family doctor yet. “They need that link” to primary care, said Valerie Woodruff, a former Secretary of Education, in 2016.
By Laura Walter