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As other cities wrangle, Baltimore quietly distributes condoms in school clinics

In New York, school board members battled one another for more than a year over the issue of distributing condoms to students. In Boston, the mayor is being criticized for his intransigence. In Los Angeles last week, 1,500 people packed a high school auditorium to trade insults with one another.

In Baltimore, the seniors who showed up at Southwestern High School's health clinic one day last week were wondering what all the commotion was about.

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"It's a great idea that we can come to the high school to get information and the different kinds of birth control," says Keisha Fields, a 17-year-old student who says she is using contraceptive pills distributed at the clinic. "If people are going to be sexually active, they need to be able to protect themselves."

And at Southwestern, as at many other high schools, the students are sexually active.

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"About 90 percent," says Stan Davis, an 18-year-old senior.

"At least," agrees Danielle Baskerville, 18, another clinic patient who became a mother when her birth control method failed.

"You could say that you should wait [to have sex]," says Miss Fields. "But we're living in a society where sex is a dominant fact."

That is precisely the view of Baltimore's Health Department, which has been counseling students and dispensing contraceptives at school clinics since October 1990. For five years before that, school clinics were prescribing -- but not dispensing -- birth control devices and pills.

The clinics -- eight of them city-operated, two run by private companies -- now provide comprehensive health care for Baltimore adolescents. "Acne and headaches are what we deal with most," says Patricia Papa, supervisor of the city's school health services. "Family planning is third on the list."

The clinics serve about 60 percent of students at their schools, officials say, and it is often only after students come in with other ailments that sexual activity or pregnancy becomes an issue. Still, about 600 girls are currently relying on the clinics for birth control. The clinics are also giving out about 1,000 condoms a month.

Officials say they used a grass-roots approach to avoid the controversy that has plagued other cities dealing with the issue of giving youngsters contraceptives. In New York, for example, which has a high rate of AIDS among adolescents, school officials began a massive condoms-on-demand program two weeks ago only after a year of rancorous debate that involved the mayor and Roman Catholic leaders and included threats of lawsuits. In Boston, Mayor Raymond L. Flynn has touched off a furor by opposing distribution of condoms in school.

"It's true we've avoided that kind of controversy here," says Dr. Nira Bonner, Baltimore's assistant commissioner of health for child, adolescent and family services. "And one of the reasons is that we've been very careful to work hand-in-hand with parents and with the community."

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Health Department officials made a point of surveying parents to ensure that there would be widespread support for sexually active youths' obtaining birth control; the result was an approval rate of more than 70 percent, according to Mrs. Papa,the adolescent supervisor.

Armed with those numbers, Mayor Kurt L. Schmoke quietly made the decision in fall 1990 to begin directly dispensing condoms and birth control pills in the schools. At the time, he told his health officials that he feared controversy over the issue in the coming election. Nothing happened.

Instead, health officials say, the school clinics have made inroads in the battle against teen pregnancy, and with each successive year, more and more students are being reached. "There was an issue of credibility and legitimacy," says Dr. Bonner. "Students were being asked to listen to our messages about disease and pregnancy, while at the same time they could see that we were not dispensing contraceptives. There was a schizophrenia here."

The success of such direct intervention at the school clinics is hard to measure.

Last month, state officials could hardly contain themselves when they announced that the 1990 data showed a 10.6 percent decline in teen-age births in Baltimore over two years, which for years held title to the highest teen pregnancy rate in the nation. The statewide rate also declined.

Saying they hope the data represent a real trend, health officials attribute the gains to a wide array of programs and strategies, but in-school contraceptive distribution in Baltimore least among them. After all, direct distribution of contraceptives only began in late 1990.

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"We're real pleased," says Marisa Mirjafary of the Governor's Council on Adolescent Pregnancy. "Maybe, just maybe, something that we're doing is working, though what elements it's hard to say because it's a long-term, multiple approach to adolescent pregnancies."

As for sexually transmitted disease rates among Baltimore teen-agers, the message is mixed: The incidence of gonorrhea among 15- to 19-year-olds in Baltimore is twice as high as in any other county, while the rate for early-stage syphilis -- which makes people more vulnerable to AIDS -- is relatively low.

Infection with the human immunodeficiency virus, which causes acquired immune deficiency syndrome, is harder to measure in teen-agers because the numbers are relatively small and most of those infected as teen-agers don't become ill for years. Still, the number of diagnosed AIDS cases among 15- to 24-year-olds in Baltimore has remained constant for three years, even as rates in other age groups continue to rise. In 1988, there were 19 such cases; last year, there were 18.

"We're clearly seeing more male students coming in to ask for condoms," says Mrs. Papa. "With pregnancies, we're generally dealing with the girls. But now, particularly after Magic Johnson, we're seeing boys who are worried and even scared."

Statewide, Baltimore school clinics are alone in permitting the direct dispensation of contraceptives. In fact, the issue has been rarely raised elsewhere in Maryland, perhaps because the rates of teen-age pregnancy and venereal disease are not as formidable as in Baltimore. In October 1990, school board members in Talbot County voted against allowing school nurses to distribute condoms to sexually active students.

"What message would we be sending to the 65 percent of the kids practicing abstinence?" asked County Council President Thomas G. Duncan.

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State education officials note that even in those county school systems that are resistant to the direct distribution of contraceptives, many principals or assistant principals are choosing to work closely with off-campus health clinics that provide counseling, treatment and birth control to students.

Still, the students at Southwestern High School believe that on this issue, at least, they have an advantage over students in the more affluent suburban school systems.

"A lot of times kids won't go to an outside clinic for help because they are afraid of being seen, and they're scared that a family doctor will tell their parents," says Keisha Fields. "Here you just walk in and you know what's going to happen."

Pregnancy and disease rates

Maryland teen-age pregnancy and sexually transmitted disease rates, per 1,000 population, ages 15-19:

XL .. . . .. . . . '90 gonorrhea. . . .. '90 syphilis . . .. .'89 pregnancy

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. . . . ...... . ... . rate. . . . . . . . . rate. . . .. . . . .. rate

Maryland. . . .. . . 21.6. . . . . . .... .1.0. . . . . . . . .. 92.9

Anne Arundel. . ... . 6.6. . . . . . .. . 0.0. . . .. . . .. . . 84.2

Baltimore City. .. . 70.5. . . . . . .. . 1.2. . . . . .. .. . .170.7

Baltimore County... . 5.1. . .. . . . ... 0.1. . . . . . . .... .88.9

Carroll. . . . .. .. ..1.8. . . . . . . . .0.0. . . . . . . . .. 62.3

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Harford. . . . .. . .. 3.8. . . . . . . . 0.0. . . .. . . .. . . 66.3

Howard. . . .. . .. .. 2.3. . . . . . . . .0.1. . . . . . . ... . 54.8

Montgomery. . .. .. .. 4.2. . . . . . . .. 0.6. . . . . ... ... . 46.6

Prince George's. .. . .29.1. . . . . ..... 3.2. . . . . . ..... . 73.2

Eastern Shore. ... ... 15.9. . .. .. . . ..1.0. . . . . .. .. .. .72.1

Southern Maryland. . .. 8.4. . .. ... .....0.7. . .. . . .... . 70.0

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Western Maryland.. ... .6.4. . . .. . . .. 0.4. . . .. .... ... 67.3


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