Parents’ rights, students’ nee

King Middle School in Portland became the center of national controversy last week when the school board voted 7-2 to allow its school-based health center to dispense prescription contraception. School health workers and administrators advocated for the decision in response to a spate of middle school pregnancies. Opposition has poured in from across the nation.

The school board decision centered on service to a small group of at-risk children. But the controversy surrounding the decision focuses on the vague anxieties of adults. We must return students to the center of the debate by dispassionately assessing patterns of adolescent behavior, sympathetically addressing adult anxieties and resolutely dismantling the barriers to appropriate health care faced by vulnerable children.

Concern for students singularly motivated the school board’s decision. Students at King are more diverse and financially disadvantaged than others in the city; 28 percent are foreign born and 55 percent qualify for free or reduced-price school lunches. Five of the 134 students who visited the King clinic last year reported being sexually active. The city’s three middle schools reported 17 pregnancies over the past four years.

These data document the presence of above-average barriers to health care access, the prevalence of sexually active middle school students, and the failure of existing pregnancy prevention efforts. Our debate should focus on assisting the students represented by these statistics and intervening in a way that secures their futures.

Instead, the Portland School District’s pragmatic effort has been raided by adults whose attacks center on parental rights, their own discomfort with the topic, and worries that providing contraception encourages experimentation.

Some worry about appropriation of parental rights and responsibilities by the state. Ideally, no one is more intimately acquainted with and ardently defensive of a single child’s potential than her parent. Society must invest parents with the power to protect those interests. Indeed, parents must provide consent to allow their child access to school based health clinics.

Consistent with state law and medical practice governing confidentiality, the services accessed by a student during a clinic visit might not be disclosed to the parents. The scenario of an 11-year-old acquiring oral contraception without the knowledge of her parents agitates objectors. But this is not a novel scenario created by the policy change at King Middle School. Standards of pediatric care require confidential screening of all children nearing puberty, provision of sexual health education and contraception as indicated.

Offering sexual health counseling at school does not relieve parents of the responsibility to counsel their children at home. Rather, it supplements these conversations in critical ways. In their interviews with students school nurses may ask more pointed questions and evoke more candid responses. They may offer support to students who are neglected or abused at home.

The policy targets students who are already sexually active. But, opponents, including the Roman Catholic Diocese of Portland, and TV commentator Bill O’Reilly, fear that it sanctions teen sex.

This logical reasoning is disproved by previous studies. The provision of condoms has not been shown to increase sexual activity. Seattle and Baltimore, where birth control is provided in a total of 10 middle schools, credit the policy with declines in teen pregnancy rates. Baltimore had a 73 percent drop.

The consent mechanisms and confidentiality policy do not divest parents of their rights or responsibilities. The provision of contraception is unlikely to increase teen sex but may decrease teen pregnancy. The worries of adults should be allayed.

By putting students first, King Middle School eradicated barriers to appropriate care for some or our most vulnerable citizens.

We should follow, not decry, this example.

Elizabeth Cote of Bangor is pursuing a joint medical and master of public policy degree at Harvard Medical School and the Kennedy School of Government. She plans a career as a pediatrician and child health advocate in Maine.