Young people face many barriers to accessing sexual and reproductive health care, including confidentiality concerns,and lack of financial resources and transportation, among others. As a youth-friendly and accessible setting, school-based health centers (SBHCs) are uniquely positioned to deliver quality and confidential sexual and reproductive health services that can equip adolescents with the necessary information, tools,and support to be healthy, safe,and ready to learn.
Reproductive and Sexual Health Education
What is Sexual Health?
Sexual health is a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction that is free of coercion, fear, discrimination, stigma, shame, and violence. It includes: the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts—including policies, practices, and services—that support healthy outcomes for individuals, families, and their communities.1
National School-Based Health Alliance Position Statement
National Organization for Women New York City
Menstural, Reproductive, & Sexual Health Products
New York State requires all school districts, serving students grades six through twelve, to provide free feminine hygiene products in restrooms. This new law will ensure all young people across the State have equal access to these essential products. Below are some resources for donating and finding products as well as information on how to safely use these products
- Woman to Woman: Food Bank’s Woman to Woman campaign helps raise awareness and financial support to ensure all women and girls in our city have access to the products they need with dignity.
- NYC’s Condom Availability Program: gives away more than 30 million free safer sex products every year to over 3,500 locations throughout the five boroughs. These free products include male NYC Condoms, internal condoms (FC2) and lubricant.
- Where to Get PrEP and PEP in New York City: There are several ways you can get pre-exposure prophylaxis (PrEP) and emergency post-exposure prophylaxis (PEP) in the city which helps prevent HIV even after exposure.
- Planned Parenthood: provides services such as birth control, emergency contraception, HIV services, pregnancy testing, and STI testing, treatment and vaccines.
Resources for SBHCs and Staff
- New York State
- NYS Department of Health:
- NYS Center for School Health: Sexual Health and Safety
- NYS Education Department: Guidance for HIV/AIDS Prevention Education
- New York City
NYC Department of Health:
- CDC
- Adolescent Health Working Group:
- “Be Real. Be Ready” Curriculum: this curriculum increases high school students’ knowledge and skills around relationships and sexuality
- Adolescent Provider Toolkit – Sexual Health: this toolkit embraces adolescent sexuality as a positive and normative stage of development. It also focuses on healthy sexuality and healthy relationships. This was designed for primary care providers but is applicable to many other providers including school-based and youth program providers. This toolkit was written with a national perspective and includes many unique resources in the format of handouts.
- GLSEN: Inclusive Sexual Health Education for LGBT+ Students
- Academy for Education Development: Building Emergency Contraception Awareness Among Adolescent: A Toolkit for Schools and Community Based Organizations
Resources for Students
- Advocates for Youth: Advocates for Youth works alongside thousands of young people here in the U.S. and around the globe as they fight for sexual health, rights, and justice.
- Long-term Birth Control Methods: information on different forms of birth control to inform students decisions
- Bedsider Health Center Locator: Bedsider has a website for youth which explains the various birth control methods, where to get them, reminders to take birth control, and frequently asked questions.
- Sex, etc.: a website created by teens, for teens. It has various sexual health resources.
- I Wanna Know: a website on sexual health for teens and young adults. Topics covered include: sexual health, STIs, relationships, and LGBTQ youth.
- The Door: The Door’s mission is to empower young people to reach their potential by providing comprehensive youth development services in a diverse and caring environment.
Resources for Parents/Caregivers
- #TalkingIsPower Campaign: a national effort with a toolkit and resources to spark meaningful conversations between young people and the champions who care about them most
- Planned Parenthood: Resources for Parents
- Answer: Sex Ed Resources for Parents
Literature on SBHCs and Reproductive Health
For a full database on published literature related to School-based health centers and Reproductive Health visit the SBHC Literature Database built by the National School-Based Health Alliance. Below are some papers we believe highlight the important role of SBHCs in Reproductive and Sexual Health Education
Reproductive Health Impact of a School Health Center
Finding: Students in the SBHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SBHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SBHC. Most students in grades 10-12 using contraception in the SBHC reported receiving contraception through the SBHC. Comparing students in the nonintervention school to SBHC nonusers and SBHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SBHC, and contraceptive use.
Oregon School-Based Health Centers and Sexual and Contraceptive Behaviors Among Adolescents
Objective: To investigate the association between school-based health centers (SBHCs) and sexual behavior and contraceptive use among 11th graders.
Finding: Multilevel logistic regressions found positive associations between SBHC presence and healthy sexual behavior (OR _ 1.23, p < .05) and contraceptive use (OR _ 1.31, p < .01). Associations were stronger at schools with at least 50% of students receiving free or reduced price lunch. Among SBHC schools, prescribing and dispensing contraceptives onsite was positively related to contraceptive use among students who had sex within the past 3 months (OR _ 1.77, p < .01). Findings suggest that exposure to SBHCs in general, and availability of specific reproductive health services, may be effective population-based strategies to support healthy sexual behaviors among youth.
Provision of Contraception in New York City School‐Based Health Centers: Impact on Teenage Pregnancy and Avoided Costs, 2008–2017
Since 2008, the School-Based Health Center Reproductive Health Project (SBHC RHP) has supported SBHCs in New York City (NYC) to increase the availability of effective contraception. The project averted an estimated 5,376 pregnancies, 2,104 births and 3,085 abortions, leading to an estimated $30,360,352 in avoided one-time costs of publicly funded births and abortions. These averted events accounted for 26–28% of the decline in teenage pregnancies, births and abortions in NYC.
“When comprehensive reproductive health services are available in SBHCs, teenagers use them, resulting in substantially fewer pregnancies, abortions and births, and lower costs to public health systems.”
Effect of an iPad-Based Intervention to Improve Sexual Health Knowledge and Intentions for Contraceptive Use Among Adolescent Females at School-Based Health Centers
CLICK HERE FOR ACCESS TO ARTICLE
Objective: To examine the effectiveness of an iPad-based application (app) on improving adolescent
girls’sexual health knowledge and on its ability to influence their intentions to use effective contraception
Finding: A total of 120 racially/ethnically diverse participants used the iPad app; 54% were sexually active, with only 26% using effective contraception at baseline. The average score on baseline sexual health knowledge assessment was 58%. After using the app, 68% of the sexually active participants reported intention to use effective contraception in the future, and sexual health knowledge improved significantly to 79% (P < .001). Conclusions: This iPad-based app is a promising intervention to educate adolescents about sexual health and support them in selecting an effective contraception method.
Emergency Contraception Use in School-Based Health Centers: A Qualitative Study
Objective: To understand contraceptive behaviors and decision-making in school-based health center (SBHC) female patients who have used emergency contraception (EC).
Finding: Reasons for using EC include not using another contraceptive method, using another method incorrectly, or in combination with another method for added protection. Reasons for EC preference include ease of administration, ease of access, minimal side effects, perceived high efficacy, and because it can be used discreetly. Use of NEC was supported by identifying it as more effective, increased sexual experience and anticipation of sex, belief that excess EC decreases efficacy or is detrimental to health, and social interactions. Participants reported having used EC a mean of 3.5 times. Eighteen of 28 participants (65%) incorrectly believed that EC is 90%-99% effective, and 15 of 28 participants (53%) correctly identified ovulation inhibition as the mechanism of action.
Teen Acceptance of an Intrauterine Device (IUD) Service Within a School-Based Health Center
Objective: To evaluate adolescents’acceptance and use of IUD services on-site at a school-based health center (SBHC) in the Bronx, NY.
Finding: IUDs remain an important method of contraception, especially for adolescents, but these services may be difficult to obtain for many young people. Offering IUD insertions in school-based health centers was found to be acceptable to the teens surveyed and most chose their school health center site out of convenience.
Stakeholder Perceptions of the Provision of Reproductive Health Services by School-Based Health Centers as They May Inform Public Policy
Objective: The purpose of this study was to determine the perspectives of key stakeholders related to access to reproductive health services (RHS) in school-based health centers (SBHCs).
Finding: Participants in this study agreed that RHS must be: 1) teen friendly, 2) convenient, 3) confidential, 4) low- or no-cost, 5) developmentally appropriate, 6) evidence-based, 7) medically accurate, and 8) part of holistic care. Subthemes and exemplar quotes also revealed important insights into public opinion about RHS at SBHCs. Overall, findings reflect strog stakeholder support for the inclusion of RHS in SBHCs as a way to promote teen sexual health.
Improving HPV Vaccine Delivery at School-Based Health Centers
Objective: To identify characteristics associated with human papillomavirus (HPV) vaccination rates, describe barriers and facilitators to vaccine uptake and the potential role for clinician-to-clinician Assessment, Feedback, Incentives, and eXchange (AFIX) visits in school-based health centers (SBHCs).
Finding: Baseline initiation and completion rates were 76% and 43% for high schools, and 81% and 45% for middle schools. SBHCs that allowed adolescent self-consent or did not require separate vaccine consent had higher baseline rates, but was not statistically significant. Barriers to series completion included challenges with scheduling and appointment compliance. At follow-up, high school SBHCs increased HPV vaccine initiation by 2.9 percentage points (p < 0.01) and series completion by 2.7 percentage points (p < 0.05). There was no statistically significant increase at middle school SBHCs. Most
SBHCs (88%) chose reminder/recall systems as a QI strategy. Fewer than half (42%) implemented their QI strategy.
