title: Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers.
abstract: OBJECTIVE
  To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States
  
  
  METHODS
  We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies.
  
  
  RESULTS
  Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access.
  
  
  CONCLUSIONS
  SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, K22, Atlanta, Georgia 30341, USA. jsantelli@cdc.gov
authors.forename: John S
authors.initials: JS
authors.lastname: Santelli
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nystrom
authors.forename: Claire
authors.initials: C
authors.lastname: Brindis
authors.forename: Linda
authors.initials: L
authors.lastname: Juszczak
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Klein
authors.forename: Nancy
authors.initials: N
authors.lastname: Bearss
authors.forename: David W
authors.initials: DW
authors.lastname: Kaplan
authors.forename: Margaret
authors.initials: M
authors.lastname: Hudson
authors.forename: John
authors.initials: J
authors.lastname: Schlitt
mesh_terms: D000293:Adolescent; D019352:Censuses; D002648:Child; D003267:Contraception / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006266:Health Education / Q000706:statistics & numerical data / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D034121:Reproductive Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000600:supply & distribution; D012572:School Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000600:supply & distribution; D012736:Sex Education / Q000706:statistics & numerical data / Q000639:trends; D011795:Surveys and Questionnaires; D014481:United States