Middle School Birth Control: Too Far?

The contraceptive controversy may have died down somewhat at the King Middle School in Portland, Maine, but now another storm is brewing at the school-based health centers over their failure to report underage sexual activity to the authorities.

Just over a week ago, the Portland School Committee voted 7 to 2 in favor of a plan to offer the "pill" as part of an expanded contraceptives program for King Middle School students at the school-based health center. Students as young as 11 will now have access to birth control pills at the school.

The proposal sparked a national debate about whether or not it's appropriate to give contraceptives to kids at school -- and at what age.

Local Republicans are still resisting the policy, gathering signatures for a petition, hoping to turn things around.

"I'm just against the awarding of 11 year olds with birth control -- a precedent we should not be setting," said Sandy Sibson at a local GOP event.

And now it turns out that health care providers at King Middle School and Portland's five other school-based health centers may not have been in compliance with the state's mandatory reporting laws that cover sexual activity with minors. That discovery has fired up the critics all over again.

"It shouldn't have to take national outrage to force the school to comply with the law. There's no just oversight and that's a problem," said Rita Feeney, president of the Maine Right to Life Committee, and an outspoken critic of the health center's activities.

Legal experts say the law is clear. If a child under the age of 14 is suspected of having sex, a health care provider must report it to the Department of Health and Human Services. And the local district attorney's office must also receive notice of all cases of abuse -- including underage sexual activity -- not perpetrated by a parent or guardian. No exceptions.

But until the Cumberland County District Attorney's office initiated a recent inquiry, health care providers at the school-based health centers believed they had a right to report underage sexual activity on a case-by-case basis.

"I welcome the clarification of the law," said Amanda Rowe, head nurse for Portland's schools. "This is an issue across the state, not just with us. It's a problem for all health care providers."

A problem, because many health care providers argue that strict adherence to the law is just unrealistic when you're dealing with difficult patients like teens and awkward subjects like sex.

"You're looking at criminal statutes that say this is what is considered a crime and this is the way it should be reported," said Cyndi Amato, the executive director of Sexual Assault Response Service of Southern Maine. "But sexual abuse doesn't always fall directly into what any law actually says -- nor does burglary for that matter. And people who are on the front lines are faced with getting information and faced with trying to do the right thing."

Amato has more than 15 years of experience working with young people and talking to them about their sexual experiences and issues.

"No one is ever going to call our hotline and say, 'I was sexually assaulted, or I had sex, and these are the people, and this is what happened and this is what I want to do,'" she said. "It just doesn't happen that way. ... People need to trust who they're talking to, and if they think that person is going to go to the police or the D.A., then they're just going to keep it to themselves."

And there seems to be some argument about just how clear the law really is.

Andy MacLean, a lawyer and deputy executive vice president of the Maine Medical Association, said he fields questions all the time from physicians and health care providers confused about just what to report and to whom.

"What is a healthcare provider to do if it's two 13-year-olds who are consensual and competent?" he asked. "It does sort of freak me out that that kind of thing might be happening today but I don't think most people would think that was appropriate to prosecute as a crime."

And many health care providers believe strongly that strict adherence to mandatory reporting laws will have a chilling effect on the doctor-young patient relationship and could compromise care.

"I think our members would say, with all due respect to our district attorney, that she should butt out of the physician-patient relationship," said MacLean.

Cumberland County district attorney Stephanie Anderson was unavailable for comment Friday.

Although Portland school officials have insisted that they will now follow the letter of the law, the mandatory reporting disclosures have sparked more of the polarizing debate that occurred in the days leading up to the agreement to offer the "pill" at King Middle School.

Rita Feeney has "no confidence" the school officials will now follow the law. And she reiterated her argument that offering the "pill" to the 11-to-15-year-old set is morally wrong. Feeney pointed out that because of Maine's confidentiality laws, parents might not even know if their child gets a prescription for birth control -- although students do need parental permission to use the school-based health center.

"They're usurping parental authority ... and now this. What is it going to take to get this to stop," said Feeney.

But John Coyne, chairman of the Portland School Committee, said he didn't think the votes are there to change the new "pill" policy at the King Middle School -- although he added that the committee may consider inserting "new language" in the permission slip signed by parents to "restrict the age of the students or add the word contraceptives."

Amato seemed slightly bemused by all the attention the public is now paying to the subject of teens and sexuality.

"Now it's a public dialogue, but this is stuff we deal with all the time," she said. "We all want to protect children and, of course, we want to make sure the centers and everyone else is held accountable. But there's not a lot of guidance with how to do that within the letter of the law. ... We're all just trying to do the right thing."