As the Trump administration proposes new restrictions on the federal family planning program known as Title X, we’re exploring how the landmark federal law works in local clinics.
Today, Rhode Island Public Radio’s health reporter, Lynn Arditi, brings us to Central Falls High School, where a health clinic is helping to reduce the highest teen pregnancy rate in the state.
At Central Falls High School, Dr. Beata Nelken is on a mission to prevent teen pregnancies. So she goes through the same drill with every student who visits her clinic.
“I’m going to ask you about drugs, I’m going to ask you about your mood, and I’m going to ask you about sex every visit,’’ she said. “No matter what.”
The school clinic is operated by the Blackstone Valley Community Health Center. Nelken, a pediatrician, runs the clinic in the school’s basement. And if you’re a student visiting the clinic, you can be sure Nelken is going to talk to you about birth control.
“You know, teen years are high risk period and they make a lot of mistakes,’’ she said. “We just don’t want one of them to be a baby.”
The teen birth rate in this one-square mile city is the highest in Rhode Island — and nearly four-times the statewide average. The city is also the poorest in the state. And nearly two-thirds of the students at Central Falls High School are Latino, many of them immigrants. Nelken describes the city as “a little Central America in the middle of Rhode Island.”
Nelken, who is fluent in Spanish, says about a third of her students are undocumented, so they don’t qualify for health insurance. They and other low-income students get free medical care here, under the federal program known as Title X. And under Title X rules, minors have the right to confidential birth control. No parental approval required.
That’s key, said Liza Fuentes, a research scientist at the nonprofit Guttmacher Institute in Washington. She co-authored a study that found 20 percent of teens would go without reproductive health services if they thought their parents might find out. “We also found out that girls who had these confidentiality concerns, she said, “were three times less likely to have obtained a contraceptive service in the last year.”
But at Central Falls High School, students are guaranteed confidentiality. And as of last June, Dr. Nelken said, 156 students were using birth control.
Since Nelken arrived at the clinic in 2016, teen pregnancies in Central Falls have declined at twice the rate as they did over the last decade, according to preliminary data from the state health department.
It’s about more than numbers for students like Jacquie, one of Dr. Nelken’s former patients. (We’re not using her full name to protect her privacy.) Jacquie is now starting her sophomore year at the University of Rhode Island. One recent afternoon, she showed this reporter the Multicultural Student Center, where she often goes to study. She wore bright orange Nike basketball sneakers and walked with a bounce in her step.
Jacquie was 16 when she showed up at the health clinic at Central Falls High School. She was having painful periods and wanted try going on the pill. She also had a boyfriend and didn’t want to get pregnant. She wanted to finish high school.
“It was very important to me,’’ she said, “because I wanted to go off to college.”
Jacquie’s parents had never gone beyond middle school. She was 12 when she moved with her dad to Central Falls from the Cape Verde islands, off the west coast of Africa. Jacquie knew a baby could derail her college plans. In fact, studies show only about one half of teen mothers earn a high school diploma by age 22. And Jacquie said if she got pregnant, an abortion would be out of the question.
“The way I was raised it’s a sin, according to my mom,’’ she said. “So I feel if I ever got pregnant it was on me, it was my fault, because I didn’t take the steps to prevent it.”
But birth control was something her parents wouldn’t approve of either.
“From our background, birth control is not allowed,’’ Jacquie said. “We’re from Cape Verde and my dad thinks it will cause infertility problems in the future…So he didn’t want that to happen even after I tried explaining it to him.”
So she didn’t tell her dad when she decided to use the pill.
“I was scared that my dad was going to find out,’’ she said. “His only daughter is over here doing things. That was my only problem; I didn’t want him to find out.”
But her dad didn’t need to know because of the confidentiality rule under Title X. In 1977, the U.S. Supreme Court affirmed the privacy protections under Title X for young people seeking access to contraceptives. Nationally, studies show that improved use of contraceptives — especially the long-acting kind– is the primary reason why the teen pregnancy rate in the U.S has fallen by more than half since its peak in 1990, according to federal data. Now, the Trump administration is looking to place new restrictions on clinics funded by Title X — though the confidential birth control guarantees have, so far, remained intact.
As for Jacquie, by the time she left high school she was on a long-acting contraceptive that Dr. Nelken prescribed at the school clinic. The drug involves an implant in the arm that can last for three years .
“I thought it was best because I was going off to college,’’ Jacquie said, “and freshman year is when everything happens. So she wanted me to be prepared.”
Jacquie is about three years away from earning her bachelor’s degree. She’s interested majoring in women’s studies. Her plans after graduation?
“I’m not sure yet but I want to help others, because others had helped me,’’ she said. “And I don’t know how I’m going to do that but I still have time to figure it out.”
That, she says, is what Dr. Nelken and the school’s health clinic gave her: time to figure things out until she’s ready to think about starting a family.
