An examination of Bachmann's misleading statements on school-based 'sex clinics'

WASHINGTON, D.C. — Minnesota's conservative firebrand Rep. Michele Bachmann grabbed headlines last week when she claimed from the House floor that health-care reform legislation would establish school-based "sex clinics" and allow students to have abortions without notifying their parents.

Bachmann also said that the first school-based clinic in St. Paul increased student pregnancies and sexually transmitted diseases.

Although abortion issues have surfaced in the ongoing fight over health care reform — with opponents seeking to block subsidies on plans that cover the procedure — Bachmann's statements present a different and misleading twist on the debate.

"…Written into this bill is a provision whereby Planned Parenthood could become the proprietor for school-based clinics in every school across the United States," Bachmann said in her speech.

"And this health clinic, parents won't have access to," she continued. "How do we know that?

"Parents are going to be excluded from Planned Parenthood as they write these clinics because the bill orders that these clinics protect patient privacy in student records," Bachmann said. "What does that mean?

"It means that parents will never know what kind of counsel and treatment that their children are receiving," she continued.

"Does that mean that someone's 13-year old daughter could walk into a sex clinic, have a pregnancy test done, be taken away to the local Planned Parenthood abortion clinic, have their abortion, be back, and go home on the school bus that night? Mom and dad are never the wiser. They don't know any different."

Bachmann's assertions, assumptions and insinuations are misleading on multiple counts.

The health care reform bills would provide grants so clinics can continue providing "comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions and referrals to, and follow-up for, specialty care."

Bachmann confounds the legislation with laws governing parental involvement in minors' abortions and also fails to acknowledge that none of the health care bills would change how school-based clinics currently handle reproductive care or what types of organizations can sponsor them.

Planned Parenthood
For example, Bachmann makes a big deal about Planned Parenthood being allowed to take over school-based clinics under health-care reform legislation. While Planned Parenthood is not mentioned in the provision, it is true that it falls under the definition of a "sponsoring facility."

But this is not new.

Planned Parenthood can already sponsor school-based clinics under current law if the community and school district agree to the arrangement, according to Planned Parenthood and the National Assembly on School-Based Health Care.

Some local Planned Parenthood affiliates are already partnering with school-based clinics to provide reproductive health care, said to Tait Sye, a spokesman for the Planned Parenthood Federation of America.

The health care legislation would do nothing to explicitly increase or decrease Planned Parenthood participation, according to Linda Juszczak, executive director of the National Assembly on School-Based Health Care.

"There is nowhere in this language [in the bill, H.R. 3200] where it says that Planned Parenthood is expected to be a provider," Juszczak said.

Juszczak added that it would also be unlikely for Planned Parenthood to take a leading role in sponsoring school-based health centers around the country.

"It is not part of their mission, for one," said Juszczak. "Also, communities may not be likely to allow them to be sponsors, and nobody can force that down anybody's throat. Even if there is a federal law allowing it, the community has to step in and allow [the creation of the school-based health center] and frame it."

This speaks to Bachmann's second point, when she claims that the legislation will exclude parents from school-based clinics and "parents will never know what kind of counsel or treatment that their children are receiving."

This statement misrepresents the legislation.

The House bills explicitly state that the clinics must follow federal, state and local laws governing patient privacy, student records, and parental or guardian consent.

Thus, if parents are restricted from school-based clinics or their child's reproductive decisions, that is due to state and local laws on these issues and not the health-care reform legislation, which simply states that the clinics must follow the law as they already do.

There are currently about 2,000 school-based clinics in the United States, according to the National Assembly on School-Based Health Care. School-based clinics have been around for over 30 years. The centers mostly provide primary care for underserved minority populations, but the laws and regulations governing them vary widely by location.

For instance, more than two-thirds of school-based health clinics surveyed by the National Assembly on School-Based Health Care are prohibited from dispensing contraception, a policy that is most often determined by the school district. About 62 percent provide on-site treatment of sexually transmitted diseases. Meanwhile, clinics in some states like Louisiana are not allowed to counsel students on abortion, while other states like Minnesota do allow counseling in certain situations.

(The majority of services provided [PDF] at school-based health care centers have nothing to do with reproductive health issues and can include dental care, immunizations, nutrition counseling, screenings, asthma treatment, sports physicals, and mental health care).

Additionally, 35 states require parental involvement [PDF] in a minor's decision to have an abortion, according to the Guttmacher Institute. Six states have passed laws that have subsequently been blocked by the courts and nine states have no laws on the book.

In Minnesota, both parents must be notified of the abortion before it happens unless a judicial bypass is obtained, according to the Guttmacher report. Exceptions are made for medical emergencies and minors facing abuse, assault, incest or neglect.

Moreover, school-based clinics are usually even more restrictive than the state law, according to Gloria Ferguson, program director of Health Start, which is part of a larger nonprofit that runs most of the school-based clinics in the Twin Cities.

"We are more conservative than the law in how we approach parents," Ferguson said.

The Health Start school-based clinics send consent forms to parents every year to explain their services and give parents a choice of what services they want their children to use. The choices include these options: student may receive any and all services, student may receive all services except contraceptive counseling and birth control prescriptions, or the student can't receive any services.

If a parent does not return the consent form and the student is a minor, then the clinic can only provide services that are specified under Minnesota’s minor consent law. Those include pregnancy testing and prenatal care, sexually transmitted disease testing and treatment, birth control and some specified mental health services, according to Ferguson.

Legally, school-based clinics in Minnesota can give students referrals for an abortion or prenatal care without parental consent.

"But, again, if any parent is concerned that we would do that, all they would have to do is let us know," Ferguson said.

"Any parent could say, 'Don't see my kid,' and then we would not provide child services."

Even with the referral, a minor would still be legally bound to notify both  parents before proceeding with the abortion.

The case of a 13-year-old
In her speech, however, Bachmann suggests a scenario in which a 13-year-old goes into a school-based center, has a pregnancy test done, is taken to a local Planned Parenthood clinic, has an abortion, is taken back to school, and rides the bus home that night without her parents knowing what has happened during the day.

Again, this statement is misleading because Bachmann implies that the health-care reform legislation will somehow create this situation when, in fact, current state and local laws determine if this can legally happen or not.

In Minnesota, for example, if the student had not already obtained a court bypass, this could not legally happen, according to Ferguson. And even if the student had obtained the court bypass, Ferguson added, an employee of the school-based clinic would not be allowed to transport a student off school grounds to an abortion clinic during the school day because of agency policy and school rules.

"We would never put a kid in our car and take them to an abortion clinic," Ferguson said. "That is our agency policy. We do not drive students anywhere. We [also] can't dismiss students from school. That has to be done by the school nurse or by an administrator, [according to] school rules."

If, however, a student already knew she was pregnant and had obtained a court order, Ferguson said that the school health-care center could help her to arrange transportation to the abortion clinic and that the school could potentially allow her to leave during the school day.

Therefore, there may be specific circumstances where the basic premise of Bachmann's statement could hold true under current laws and regulations in the country. But Bachmann failed to provide those details in her speech, implying something much broader instead.

MinnPost asked Bachmann this week to explain the rationale behind this series of statements.

Bachmann spokesman Dave Dziok said that since parental notification is not required in at least 13 states, "a pregnant 13-year-old could visit her taxpayer-funded school health clinic and they could refer her to Planned Parenthood, receive an abortion and her parents would never be notified."

"The problem is that there are no federal parental notification rules currently on the books," Dziok said.

What Dziok said is true: In certain states it would be possible for a pregnant minor to receive a referral to have an abortion from a school-based clinic and then have the procedure done without notifying her parents, as long as there were no local laws or regulations restricting that process.

It is also true that there are no federal parental notification rules on abortion.

But Bachmann did not present her argument this way on the House floor. Instead, she suggested that health-care reform legislation would somehow change current law governing school-based clinics and then illustrated this with an extreme example that she failed to put in context.

St. Paul example
Bachmann also criticized the first school-based clinic in St. Paul, which was started in the 1970s at the former Mechanics Arts High School.

Bachmann said: "One of the very first school sex clinics that was put into this country was in St. Paul, Minnesota. And it was told to the families and the parents that this would actually reduce pregnancy. Of course we knew it wouldn't reduce pregnancy. It increased pregnancy. It increased sexually transmitted diseases. It was a disaster for young women in St. Paul public schools."  


That statement can't be supported by research.  

In 1980, a study done on the Mechanic Arts High School reported that pregnancies declined the year after the school-based clinic launched.

However, a subsequent 1993 study critiqued the methodology and conclusions of the 1980 study. Essentially, the 1993 study found that the 1980 study had used a crude counting method, leaving the possibility that some pregnancies were not counted. It also did not prove that the counted pregnancies decreased because of the school-based center, according to Dr. Christopher Reif, the former medical director of Health Start.

Since then, there have been studies in other school systems looking at the effect of school-based clinics on birth rates, sexual activity and contraception use. The research shows that school-based-clinics do not typically increase sexual activity (according to self-reported student data) and lead to an increased use of contraceptives and the detection and treatment of sexually transmitted diseases, according to a comprehensive 2007 study on the topic. Reif said it's unclear what effect clinics have on student birth rates, with some studies [PDF} showing decreased teen birth rates and others showing no significant impact.

"Most studies in adolescent reproductive health — including those in schools — cannot document that pregnancy rate or birth rate were reduced or increased as a result of the clinical activity alone," Reif said.

Additionally, studies on teen pregnancy and sexually transmitted disease rates are not comprehensive because schools do not require testing of students.

"Thus, to base any argument about the effectiveness of school clinics on a single research paper from 1980 is misleading, unscientific and capricious," said Reif.

Bachmann spokesman Dziok said Bachmann had based her statement on the 1980 study.

"Advocates of school-based clinics cite this school in particular in how clinics lower teenage pregnancy rates," Dziok wrote in an email. "They see this school as a success. However, the study they refer to called 'School-Based Health Clinics: An Emerging Approach to Improving Adolescent Health and Addressing Teenage Pregnancy' actually shows a drop in the teen birth rate rather than the teen pregnancy rate. In the study, school officials themselves said they could not document the decrease in pregnancies. It can be argued that the reduction in the number of births listed in the study can be attributed to more teenagers obtaining abortion services."

But the 1980 study did not measure abortion rates, and the 1993 critique reported that the 1980 study could not conclude why the birthrate dropped.

Additionally, the 1980 study did not measure the rate of sexually transmitted diseases or what might have affected those numbers.

Cynthia Dizikes covers Minnesota's congressional delegation and reports on issues and developments in Washington, D.C. She can be reached at cdizikes[at]minnpost[dot]com.