School-based clinics in St. Paul have provided comprehensive health services, including reproductive health care, for almost two decades. This study examines the effects of those clinics on the birthrates in their respective schools, using a newly developed methodology with numerous advantages over previous methods for estimating student birthrates. Confidentially matching the names of female students from school records with the names of mothers on birth records at the Department of Health provided birthrates for each of the St. Paul public high schools with clinics for each year between 1971 and 1986. The results show that birthrates fluctuated dramatically from one year to the next, but school-wide birthrates were not significantly lower in the years immediately following the opening of a clinic than in the years preceding it.
PIP: For more than 20 years, school-based clinics in St. Paul, Minnesota, have been associated with a means of reducing adolescent pregnancy rates and birth rates, as well as providing comprehensive health care. High rates of contraceptive use and continuation have been reported at the clinics. The St. Paul clinics have served as models nationwide. The figures on reduced birth rates have limitations however: comparisons were made in single baseline years, estimates of births were based on known information by clinic staff, and figures were not tested for statistical significance. In this study, birth rates were computed for each school year for only those female students whose names matched with county birth certificates. The denominator was all female students in attendance during the relevant years. Birth rates were computed for all St. Paul high schools with clinics from the 1971-72 through the 1986-87 academic years. The date of conception is used to place the birth in the appropriate academic year. Birth certificates were matched against student names. The results show wide fluctuation over time and between schools. Data is sometimes affected by school closings or increases in immigrant populations. Birth rates were compared before and after the clinics were open; the findings reveal that in Central., Washington/Como, and Humboldt High Schools the mean birth rates were very similar before and after clinics were opened. In Mechanic Arts High School, there was a statistically significant decrease in birth rates; this was also true for Johnson High School. In the analysis of the aggregation across all schools, the data show the weighted birthrate for the 5 schools to be 22 births/1000 students before the clinic opened and 29 births/1000 students after the clinics opened. The differences were statistically significant. Analysis of aggregated data by school before and after clinic openings showed no clear pattern. There was a tendency for birth rates to decline before clinics opened, increase the first year after opening, decline for several years, and then increase. Ethnic and racial analysis revealed no significant association. There is a discussion of the meaning of the fluctuations. The importance of the clinics now appears to be providing easily accessible, confidential primary care services.