Dispensing Birth Control in Public Schools
This article focuses on the controversial practice of dispensing birth control in public schools. Minors' constitutional right to contraception is described. This article explores the way in which the federal government frames teen pregnancy as a public problem with a public policy solution. The differences in state laws governing the practice of dispensing birth control in public schools are described. The history, funding, and scope of school-based health centers is explored. The debate over promoting the Title V abstinence education program versus dispensing birth control in public schools is included.
Keywords Abstinence; American Civil Liberties Union; Birth Control; Comprehensive Sex Education; Public Policy; Public Problems; Public Problem Solving; Public Schools; School-Based Health Centers; Supreme Court; Values
Adolescents are a population at high risk for pregnancy and sexually transmitted disease. The Guttmacher Institute, a reproductive health advocacy group, reported that in 2008, there were nearly 750,000 pregnancies among women younger than 20 in the United States. The pregnancy rate among women aged 15 to 19 was nearly 68 pregnancies per 1,000 women — a decline of 42 percent from its high of nearly 117 in 1990 (Kost & Henshaw, 2012, p. 2). Researchers associate the decline with teenagers' decision to delay sex and an increase in contraceptive use. Despite declining teen pregnancy rates, the United States still has one of the highest teen pregnancy rates among major industrialized nations. In addition to the high risk and likelihood of pregnancy resulting from sex between teenagers, sexually transmitted diseases are common. In 2003, the American Civil Liberties Union reported that approximately half of all new HIV/AIDS infections in the United States occur in teenagers. In the United States, three million teenagers contract a sexually transmitted disease annually. Possible consequences of sexually transmitted diseases include infertility, infection, and death. Legal and medical advocates argue that limiting students' access to contraceptives puts students at risk for disease and pregnancy.
Society debates the role that public schools should play in dispensing birth control to students. Health and sex education became common in public schools in the 1960s. School-based health clinics began to appear in public schools in the 1970s. Pregnancy and sexually transmitted diseases among teens became recognized as a public problem in the 1970s. The first school-based comprehensive health clinics, which included family planning services, were established in St. Paul, Minnesota, in 1972. Schools began teaching and advocating abstinence decades before discussing and promoting contraception. While state, federal, and church-funded abstinence education programs continue, numerous public schools now dispense contraceptives to sexually active teens. Supporters of the practice of dispensing birth control in the public schools cite studies that illustrate how schools that dispense or prescribe birth control lower their student pregnancy rates significantly. Opponents of the practice of dispensing birth control in the public schools argue that providing birth control to students promotes promiscuity (Ruby, 1986).
In the United States, federal and state governments approach teen pregnancy as a public problem with a public policy solution. When teen pregnancy is recognized as a public problem, birth control becomes official public policy. Government-funded contraceptive programs, in schools, community clinics, and throughout society, provide and promote contraception to avoid unwanted pregnancy and to lower the risk of contracting sexually transmitted diseases. A limited number of school-based health centers dispense birth control, such as condoms, oral contraceptives, patches, and emergency contraceptives, to students. Despite the relationship between dispensing birth control in the public schools and lowered teen pregnancy rates, significant religious, legal, and moral opposition remains against this practice.
The following section provides an overview of minors' constitutional right to contraception. This section serves as a foundation for later discussion of the way in which the federal government frames teen pregnancy as a public problem with a public policy solution. The differences in state laws governing the practice of dispensing birth control in public schools are described. The history, funding, and scope of school-based health centers is explored. The debate over promoting abstinence versus dispensing birth control in public schools is included.
Minors' Constitutional Right to Contraception
The U.S. Supreme Court has ruled that minors do not need to get permission from parents to attain contraceptives. In 1977, the court heard Carey v. Population Services International. In this case, the Supreme Court overturned a New York law that forbade the sale of nonprescription contraceptives to adolescents under 16. The Supreme Court found that both minors and adults have a right to privacy in situations that affect procreation.
In 1983, a U.S. District Court heard Planned Parenthood Association of Utah v. Matheson. In this decision, the U.S. District Court overturned a Utah statute that required parents or guardians to be notified before contraceptives could be dispensed to a minor. The District Court found that the Utah law was unconstitutional in that it infringed on the right of a minor to decide whether to bear children. Minors and adults alike have a constitutionally protected right to determine whether they want to have a child or use contraceptives. Ultimately, the federal government protects the constitutional rights of minors and does not require minors to attain parental consent and notification for contraceptive services. Title X and Medicaid, the two major sources of federal family planning funds in the country, provide contraceptive services to all teens in these programs without parental permission or notification.
Teen Pregnancy as a Public Problem
Teen pregnancy is a religious, ethical, social, and economic problem for stakeholders in society. The financial and social costs of teen pregnancy affect everyone in society. As a result, the federal government treats teen pregnancy as a public problem with a public policy solution. Public problems, such as teen pregnancy, are characterized as undesirable conditions that impinge on a society. All undesirable conditions within society do not become classified as public problems. Citizens and their elected officials establish their public problem agendas based on their levels of tolerance for specific adverse conditions. Theoreticians use decision or choice theory, which studies how real or ideal decision-makers make decisions and how optimal decisions can be reached, to explain how public problems are solved in ideal circumstances. In reality, historical, social, and economic variables make many public problems difficult to solve if not intractable. Declining teen pregnancy rates suggest that teen pregnancy is not an intractable public problem.
The U.S. government addresses public problems, such as teen pregnancy and teen parents, through multiple means and strategies. In government, public administrators and politicians are responsible for solving many types of public problems. A common, generally applied problem-solving or decision-making model includes the following steps:
• Determine whether a problem exists;
• State decisional objectives, alleviations, or solutions;
• Identify the decision apparatus and possible action options;
• Specify alternatives;
• State recommendations;
• Ascertain ways to implement recommendations.
Public problems may be routine, out-of-the-ordinary, small-scale, or large-scale. Teen pregnancy is a large-scale public problem that occurs in each geographic sector of the nation. Systematic decision-making processes may or may not be used in their entirety to solve or alleviate the public problem. Factors influencing the formal adoption and use or a problem-solving process or model include agency or department regulations, personal preference of public administrator, and the variables of the public problem at hand (Hy & Mathews, 1978).
While teen pregnancy rates are declining, the public problem of teen pregnancy still requires multiple types and categories of problem-solving techniques. Problem solving strategies are often situation or condition-specific requiring carefully selected problem-solving strategies and techniques such as the multiple criteria decision making model (MCDM), consensus or group decision making, ethical decision-making, and finance-based or budget-maximizing decision making. The federal government's problem-solving process involves activities such as intergovernmental collaboration, public budgeting, public policy, public education, and regulation (Andranovich, 1995). Important trends in public problem solving include increased community participation in government decision-making and collaborative public decision-making (Irvin, 2004). The political economy of public problems, and closely related public policy, is a long-established area of study and interest. The federal government uses economic tools of analyses to determine the economic effects of public problems and their solutions. The economic problem of teen pregnancy, possibly more than any other factor, drives the federal government to promote contraceptive and abstinence programs and policies in public institutions such as schools.
State and federal governments work cooperatively on education and health policy for minors. States differ significantly in their laws and guidelines for sex education, health services,...
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