School Policy

PORTLAND, Me., Oct. 19 — Carissa Porcaro, a student at King Middle School here, did not hide her feelings about the Portland school board’s decision to let the independently operated clinic at her school provide girls access to prescription contraceptives.

Wearing a sticker with the words “I’m against giving out birth control” written in black marker, Carissa, 13, said she did not think the school should make the drugs available. Her mother disagrees.

“She thinks it’s really good,” Carissa said after school on Friday. “I think it’s stupid because what people are saying is that it’s O.K. to be sexually active.”

Two days after the school committee voted 7 to 2 in favor of adding prescription contraceptives to the services offered at the health clinic, the issue continues to draw fervent support and ardent opposition in this city of 64,000, the largest in Maine.

“I think it’s a great idea,” said Cathleen Allen, whose son is enrolled at King. “Someone is finally advocating for these students to take care of themselves.”

Ms. Allen added, “It’s an eye-opener for all of us, but when you look at the facts, why not?”

Bishop Richard J. Malone of the Roman Catholic Diocese of Portland is calling on the school committee to rescind its decision, as have the state and city Republican Parties. The city party is also pushing a recall for members who voted in favor.

Nick McGee, the city’s Republican Party chairman, said of the policy, “It is an attack on the moral fabric of our community, and a black eye for our state.”

On Friday, John Coyne, chairman of the school committee and one of the two members who voted against the plan, said he wanted the panel to reconsider the program. Mr. Coyne said that parents should have the option to enroll their children in all aspects of the clinic except reproductive health treatment, and that parents should be made more aware of the state’s confidentiality laws.

“I still don’t feel comfortable with this,” Mr. Coyne said. “There’s no talk about the health issues and the possible long-term ill effects on these young ladies.”

The school’s clinic functions much like a physician’s office and has been offering condoms and testing for pregnancy and sexually transmitted diseases since 2000. It also offers dental, mental health and basic care.

The clinics at Portland high schools have offered oral contraceptives for years, said Douglas S. Gardner, the city’s director of health and human services. Health officials decided to extend the policy to middle school after learning that 17 middle school students had become pregnant in the last four years, seven of them in the 2006-7 school year.

“These kids are far too young to be sexually active,” Mr. Gardner said. “You can’t argue that any differently. But there is a small group of kids, and thankfully it’s a small group, who are reporting that they are sexually active, and we need to do all we can to protect them.”

The Portland clinic is not the first in the country to offer such services. Four middle schools in Seattle offer reproductive health care through city-administered health centers, said James Apa, communications manager for Public Health-Seattle and King County. Clinics in six Baltimore middle schools offer access to oral contraceptives, said Dr. Joshua Sharfstein, the city’s health commissioner, who said the program had helped to decrease teenage pregnancy rates.

Nationally, about a quarter of school-based clinics, most of them in high schools, provide some type of contraception, according to the National Assembly on School Based Health Care. Less than 1 percent of schools provide prescription contraception, said a spokeswoman for the organization, Divya Mohan, who said most were high schools. She declined to give the number of middle schools that provided prescription contraception.

Parents in Portland who want their children to have access to the clinic must sign a waiver each year that details the services it offers. Under state law, reproductive health, mental health and substance abuse issues are confidential between medical provider and patient, regardless of the patient’s age.

Of the 500 students at King, 135 have permission to use the clinic, said Principal Michael McCarthy. Of those, five students, all of whom were 14 or 15, reported being sexually active in the last school year. One became pregnant. King is the only one of the city’s three middle schools that has a health clinic.

Postpubescent girls will be able to gain access to prescription contraceptives only after undergoing counseling and being examined by a physician or nurse practitioner who can prescribe oral contraceptives, Mr. Gardner said. The clinic is likely to start prescribing contraceptives at the end of the year, officials said, after parents sign a new waiver.

Students will then be written a prescription for oral contraceptives or be given them at the clinic, depending on each student’s situation. For students who are written a prescription, the school will often try to find a financing source, such as the state’s Medicaid program.

Kitty Purington, whose daughter attends King, says she had mixed feelings about the decision to provide contraceptives to middle school students but thought it was the right one.

“It brings home the fact that my 13-year-old daughter has friends and people around her who are sexually active,” Ms. Purington said. “But at least it’s a good alternative in a not-so-good situation. No one is going to stand up and cheer that 12- and 13-year-olds are having sex, but it’s not anything new.”

How do the cities of Baltimore, Portland, Seattle and NYC differ in their policy in regards to matters of birth control?

Find policies of the cities, and compare to Maine's Middle School policy.