Bitter Pill: School Board OKs Birth Control for Middle School

In the end, it wasn't even close. The Portland School Committee voted 7 to 2 last night to allow the health center at the King Middle School in Portland, Maine, to offer birth control prescriptions to its students, who range in age from 10 to 15. Dr. Pat Patterson, the medical director of School-Based Health Services in Portland said she was "thrilled" with the vote. "The past few days have been very distressing and very difficult for the school. People have been really charged up against us. But I'm happy with the vote."

"Charged up" may be an understatement. The storm started brewing in Portland and across the country shortly after the proposal was announced. And last night, tensions boiled over at the school committee hearing held at a local Portland High School.

Proponents of the proposal tacked up black-and-white posters of a baby, contrasting the cost of raising a child with the cost of birth control, while several opponents bowed their heads in prayer. National and local media jostled for positions at the front of the room.

The possibility that young teens could be getting birth control at school incensed resident Diane Miller. "We are dealing with children ... the ramifications are mind boggling to me. How could we even be considering this?" After she spoke at the hearing, Miller sat down and closed her eyes. "I was praying. My heart just aches over this," said Miller.

Mary Ibrahim, another Portland resident, said that just because kids may be having sex doesn't mean they should be having sex. And offering birth control services is a form of encouragement. "Let's be leaders. Let's be parents. Let's be grownups," said Ibrahim.

And Peter Doyle, a former middle-school math teacher now living in Portland, argued that the privacy component "is really a violation of parents' rights."

But there were just as many vocal proponents of the measure. The father of a King Middle School student stood up and said, "I recognize the value of parental involvement. But not every child is getting that parental involvement. If, for some reason, my daughter couldn't come to me, I would want to make sure that she had someone she trusts and that she could get care."

And Kelley McDaniel, a school librarian, stood up and talked about being sexually abused as a child and raped as a teenager. McDaniel said her mother was a "good mother," but McDaniel couldn't confide in her. And that, McDaniel argued, is why these kinds of services are needed at school-based health centers.

Throughout the 2 ½ hour hearing, the nine-member panel asked questions and listened to clarifications from health officials.

Balancing Parent and Student Concerns

Amanda Rowe, the head nurse in Portland's school health centers, emphasized that students must have a signed parental permission slip to use the student health center. Although, by state law, if a student requests confidentiality, health care workers must honor it. Meaning birth control pills could be prescribed without a parent knowing.

Rowe said that patients fill out an 18-point health history form and risk questionnaire. If a student indicates that they are having sexual relations, the "discussion begins and includes a strong counseling component" said Rowe.

"We talk about consequences of early sexual activity on bodies and minds. We argue strongly that the kids should talk to a parent or an adult that they trust." Nevertheless, despite all the talk, some kids are unwilling to listen. "There are a small number of students that persist in being sexually active. If they're pregnant or worried about being pregnant, they're not going to be in school learning," said Rowe.

The health center would not offer birth control pills to girls who have not gone through puberty. And, as with any medical office, the center would monitor students who had been prescribed medication. "We're not saying, here's a prescription, have a good life," said nurse practitioner Lisa Belanger. Health center professionals also work closely with the students' primary care providers.

Many of the school committee members said they struggled with their decision.

Sarah Thompson said she is "completely uncomfortable" with it but voted to support the proposal nonetheless. Peter Eglinton, a school committee member and father of a fourth-grader, said "reading the proposal was a bit of a shock," because of the young ages involved. And Lori Gramlich "personally struggled with the parental consent piece" but added that "we're naive to think that our children are not sexually active."

The proposal has sparked a national debate about just how "young is too young" for contraceptive services. In recent days, media outlets from coast to coast have picked up the story. And talk radio shows have done their bit to stir the pot. School committee members said they have been deluged with e-mail messages expressing outrage against the proposal. One resident said she heard about the controversy because Liberty University in Lynchburg, Va., founded by the late evangelist Jerry Falwell, had organized a prayer circle to pray against the proposal.

Rita Feeney, president of the Maine Right to Life Committee, argued that while health officials talk about 14- and 15-year-olds, it is possible that children as young as 10 or 11 could receive prescriptions for the pill. "An 11-year-old who is sexually active is suffering from abuse they are just not emotionally capable of having sex," said Feeney.

But school officials point out that the young patients who opt for care at the middle school health center are more likely to come for sore throats than sexual issues. Last year, there were a total of just five students -- out of 138 visitors to the health center -- who reported sexual activity, and they were all 14 or 15 years old. There was also more than one positive pregnancy test at King, according to Patterson.

Filling an Unserved Need

Overall, over the past four years, there were a total of 17 pregnancies at Portland's three middle schools. And that's why the caregivers felt so strongly that offering birth control prescriptions would fill a desperate need. "Many parents are not being honest with themselves. They just don't realize the extent of risky behaviors these kids are engaged in," said Amanda Rowe.

There are about 1,700 school-based health centers across the country, according to the National Assembly on School-Based Health Care, of which "very few" currently offer access to birth control prescriptions at the middle school level. But the fact that other schools across the country might already be offering these services has not capped the controversy in Maine.

Although the vote is now over, the controversy may not be.

Rita Feeney was unable to attend the meeting but said, "obviously, we're going to protest this."

And Charla Bansley, the state director of Concerned Women of America for Maine said, "We have sent out an e-alert to our 2,300 members in the state. Our members have expressed a lot of concern about this issue."

Bansley is currently deciding what action, if any, her group will take next.

As for King Middle School, today is just another day for the 500 students there.

The school's Web site says nothing about a national controversy but does remind students that time to sign up for basketball is running out and Ms. LeClair is on detention duty.