While much of the nation debates a Maine school board's vote to let school-based clinics give young teens contraceptives without parental consent, Baltimore girls as young as 12 have had access to birth-control pills from such clinics for more than 20 years.
Advocates say making contraceptives available has played a large role in the city's declining teen birth rate - especially in the past decade, when it has been cut in half for girls younger than 15.
It's not just in Baltimore. A Maryland law that dates to the 1970s allows a minor confidential access to contraception, meaning any adolescent girl can ask her doctor for birth control - knowing that information will not be shared with her mother or father.
Most girls will tell their parents, health officials said, but the girls have a right to privacy here, as in 20 other states and the District of Columbia.
"We promote abstinence as the best choice for teenagers," said Bonnie S. Birkel, director of Maryland's Center for Maternal and Child Health, "but we don't deny services to anyone."
The only schools in Maryland that can dispense birth-control pills and other prescription contraceptives are those with health clinics on site. The Baltimore Health Department has 15 clinics in school buildings - including three in middle schools and two others in K-8 schools. Montgomery and Prince George's counties also have a handful of clinics.
In the fiscal year that ended in June, the 80 clinics in Maryland's statewide family planning program collectively saw 80,500 clients seeking birth control, mostly girls and women. Among them, 991 were under age 15, and 10,400 were between the ages of 15 and 17.
But before any minor receives contraception, they are referred to counseling. "They don't just come in and get birth control without any questions asked," Birkel said.
Dr. Peter L. Beilenson, who served as health commissioner for more than a decade in Baltimore and now holds a similar post in Howard County, said the goal is to get parental approval, but that is not always possible. "Requiring parents to be involved can often be a real barrier to care," he said.
Baltimore had a contraception controversy in the early 1990s, when its school system was the nation's first to offer Norplant, a contraceptive injected under the skin and designed to last five years.
Critics were outraged by the news that it was being prescribed, while advocates said it was necessary to fight a teen pregnancy epidemic. The drug was taken off the U.S. market in 2002 after thousands of women filed lawsuits over its side effects.
Robert C. Embry Jr., president of the Abell Foundation and a major backer of the Norplant program, said he doesn't think enough is being done to address the sexual health needs of city students. He said he would like to see health clinics in every school.
Carl Stokes, a former city councilman and vocal opponent of Norplant injections without parental consent, had a similar reaction to the school policy in Portland, Maine.
"I think it's social engineering at its worst," he said. "It is not a solution to 11- and 12-year-olds having sex. It may prevent a pregnancy, but that is not the biggest issue around an 11- or 12-year-old having sexual relations. Intervention in other ways is a better way to begin."
Stokes also objects to Maryland's law. When a child tells a medical professional that she is having sex, he said, confidentiality laws should not prevent that adult from talking to the child's parent - or to legal authorities, if abuse is suspected.
Dr. Laurie S. Zabin, a professor at the Johns Hopkins Bloomberg School of Public Health, said she hates to hear complaints that contraception equals a free pass when it comes to becoming sexually active.
"I don't really think that the primary objection that the public has holds any water - that it encourages sex," she said. "It's sort of like [saying] the availability of seat belts causes more traffic accidents. The availability of contraception does not cause risky sex."
Some argue that the availability of contraception is a major reason teen pregnancy rates are falling locally and nationally. In Maryland, the number of births to mothers under 15 dropped from 225 in 1995 to 113 in 2005, the most recent year available.
In Baltimore, there were 113 births to girls under 15 in 1995, and 44 in 2005.
Health care experts say that during a visit to a pediatrician, it's routine for the doctor to take time with an adolescent patient without the parent's being present.
"Of course, a major topic of conversation is sex and sexual activity, as well as substance abuse and other issues they do not want to talk about in front of their mothers," said Dr. Virginia Keane, a pediatrician at the University of Maryland's Hospital for Children.
But she says it has also become much more common in recent years for parents to request birth control for their daughters. "I have parents of kids as young as 12 and 13 ask for birth control for their kids. I think parents are remarkably practical, and many parents have the sense they won't be able to keep their daughters from having sex but [want to] protect them from a major side effect of sex - i.e., getting pregnant," Keane said.
Some have expressed concerns about the possible side effects of the hormones in birth control pills among developing girls, but several doctors said they're not worried.
"It is certainly one of the safer medications," Beilenson said. "One could argue condoms and pills are vastly more safe than getting HIV/AIDS or getting pregnant at age 12."
Baltimore County has no school-based health clinics. Still, Jean Pfister - the mother of an 11-year-old daughter who attends Lansdowne Middle School - said she strongly opposes, on moral and religious grounds, schools providing contraception to students.
"Are they going to take responsibility when the birth control doesn't work?" she said. "Are they going to take responsibility since they have told these kids that it was OK to get birth control without their parents knowing?"
Pfister said she hasn't taught her daughter, Kaitlyn, about birth-control pills or condoms because she doesn't think her daughter is ready. She described her daughter as intelligent but not "street smart." Kaitlyn prefers to spend her time playing with a GameCube video game or reading a book, she said.
"I'm not a naive mother. I know my daughter knows about boys. She knows people have sex. She knows you have to have intercourse to make a baby," Pfister said. "But we have raised her to know that sex is when you make love with a male partner when you are married."
stephanie.desmon@baltsun.com sara.neufeld@baltsun.com
Sun reporters Laura Barnhardt, Gina Davis and Ruma Kumar contributed to this article.
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