Conversations about sexual health education for pre-teens and teens in public schools is often fraught with tension for parents and school districts. Between adults assessing how much information is necessary and disproven myths about access to contraceptives encouraging children to participate in sexual activity sooner rather than later, most Texas school districts stick to abstinence-only education.
The-less-we tell-them-the-better attitudes leave those emerging into adulthood at a disadvantage. For years, Texas has maintained a place in the top 10 of states with the highest teen birth rates. Eighteen-and 19-year-olds entering colleges and universities are left to navigate relationships, consent, sexual encounters, sexually transmitted infections (STI), and potential unintended pregnancies without a suitable foundation laid by comprehensive, evidence-based, sexual health education.
In San Antonio, 69 percent of teen births are to 18-and 19-year-olds, which is why almost a decade ago, the San Antonio Teen Pregnancy Prevention Collaborative and the San Antonio Metropolitan Health District, began working diligently with community partners to reduce the teen pregnancy rate in Bexar County by 50 percent by 2020. Within two years, they’d achieved that goal and decided to refocus their efforts to providing support services to decrease the repeat teen pregnancy rate.
These factors inspired Healthy Futures of Texas to apply for a Competitive Personal Responsibility Education Program (C-PREP) grant to fund BAE-B-SAFE. The program provides evidence-based sexual and reproductive health education to 18-and 19-year-olds at San Antonio College, St. Philip’s College, and Palo Alto College campuses. Federally funded through the Administration for Children and Families, Family and Youth Services Bureau, BAE-B-SAFE’s mission is to reduce unplanned pregnancies, STI, and HIV transmission rates among young adults.
“One of the main priorities we had in providing sexual health education to community college students is that we knew students were highly mobile,” Ginger Mullaney, program director for BAE-B-SAFE, says. “Students come-and-go on community college campuses. They may take a class one semester, they may transfer to a four-year university, and so on. We knew we would have to do something that would be conducive to that environment.”
The Community College Ecosystem
Higher education, and how we pay for it, is an on-going conversation. News organizations are writing about it, books are examining our relationships with it, and elected officials are talking about it.
Community colleges are essential to the academic ecosystem. They offer higher education access at lower prices, save students thousands of dollars, and act as feeders to four-year universities. Students from low-income or minority households often choose community colleges for those very reasons. These students are often more career focused according to Forbes contributor, Nancy Lee Sánchez. In a recent article she notes that, “75 percent [of students are] more likely to graduate, once they transfer to a four-year institution” and “almost 40 percent of all first-time students transferred at least once in a six-year time frame, according to a National Student Clearinghouse Research Center report.” But all that momentum can diminish significantly when a student experiences an unplanned pregnancy.
“We know that 61 percent of students that experience an unplanned pregnancy in college generally do not finish their education,” Mullaney says. “In Bexar county, 69 percent of all teen births are to 18-and 19-year-olds and we know there’s an increased risk in low- socioeconomic populations. The communities we’re serving are near community colleges where teen birth rate is either, two, three, or four times the national rate. And we know that our community colleges serve many low-socioeconomic populations giving them a start in college. Putting sexual health education programs on these campuses help students make better and healthier decisions to reach their educational goals.”
BAE-B-SAFE Arrives on Campus
Out of the three colleges – San Antonio College, St. Philip’s College, and Palo Alto College – BAE-B-SAFE serves, none of them offer an on-campus clinic for students. BAE-B-SAFE’s presence on the campuses bridges some of the gaps students experience while searching for resources and sexual health information.
BAE-B-SAFE participants must be 18-to 19-years-old, and 20-year-old students may participate if they are pregnant or parenting. Because all the campuses host early college programs for area high schoolers, BAE-B-SAFE requested and received approval to serve 14-to 17-year-olds on campus with parental consent. Once attendees sign up, facilitators guide them through the programs using one of two evidence-based curricula that can be completed in one session.
Seventeen Days is a web-based program for people who identify as female. Students follow Jessica and her friends as they navigate a potential pregnancy scare and discuss pregnancy prevention methods. Participants also practice cognitive rehearsal, condom negotiation, and get to watch a condom demonstration. They learn about basic anatomy, contraception options, STI transmission, and get to follow one of the characters on a first-time gynecological visit.
The second program, SHARP, is geared toward those who identify as male. Up to 10 people at a time may participate in the three-hour session. Attendees learn about STI transmission, condom negotiation skills, and watch a condom demonstration. They also review healthy and unhealthy relationship dynamics, basic anatomy, and all methods of contraception.
Empowered with new information, students began to ask more questions about accessing the things they were learning about. “Early on we started noticing students expressing fear and anxiety surrounding going to the doctor, the cost of things – contraception, family planning, and other services –, and a lack of insurance,” Mullaney says. “We want to do the best we could for the students, so we started reaching out to clinics in each community. We identified [clinics that] had low-cost or no-cost services available to the population we serve, found out about barriers students faced, and got the answers to those questions before [students] had to experience them. We sought to reduce barriers by linking and streamlining in-take processes with clinics we felt we could trust.”
Education + Empowerment = Access
As BAE-B-SAFE took off, members of the San Antonio Teen Pregnancy Prevention Collaborative were busy at work. After achieving their initial goal to reduce teen pregnancy rates in the county and focusing on reducing repeat teen pregnancy rates, “SA Metro Health stepped up and partnered with University Health System (UHS) to provide a grant that would provide 200 free Long Acting Reversible Contraceptives (LARC) to youth under the age of 18,” Mullaney says. “For young people who’ve already had one pregnancy, this free LARC would help them prevent a repeat pregnancy.”
LARC devices, the most effective form of birth control, can cost over one thousand dollars and typically requires patients to attend two appointments to be implanted, making access a challenge for young people. Suddenly, “there’s a grant that provides 200 free LARCs each year to UHS, and then disseminates these services to young people who are looking for them,” Mullaney says. “This is where BAE-B-SAFE decided to partner with UHS and SA Metro Health. Bringing the educational program to students, and linking students to clinical services, can reduce the likelihood of an unplanned pregnancy and keep them in school, so they can reach educational success. Since we’re aleady serving this population and the data [shows] they would use more effective methods like the implant and the IUD if they had access to them, we were able to coordinate and partner to bring the UHS mobile unit on campuses to provide [LARCs] through grant funds and public programs.”
After setting everything up with UHS and SA Metro Health, BAE-B-SAFE began keeping track of student interest in contraception and coordinated an end of semester event that would coincide with the UHS mobile unit’s attendance. “We recruit throughout the year and once the event is coming up, we call and let [those] who were interested [know] the event is going to occur,” Mullaney says. “If they’d like to schedule an appointment, we can help them do that. [Then] we confirm the list, send it over to UHS to finalize appointments, and let them know how many patients to expect that day.” The day before the event, students receive a text message noting their appointment confirmation, logistics, and other details. On the day of the event, BAE-B-SAFE staff is on-site to greet students and ensure a warm hand off to UHS.
And a warm hand off it is. UHS is Teen Friendly certified, which means they “create an environment in the waiting room and exam room that’s comfortable for teens and can enhance the visit experience. In addition to the physical environment, there are approaches providers take to discuss issues of importance to this population in a confidential and private manner.”
During the end of semester event, UHS will provide BAE-B-SAFE’s 18-or 19-year-old participants, who do not have insurance, with their previously selected implant device. If a student is 19 or older, UHS will provide the device through either HTW or Title X, the federally funded family planning program. If a student needs additional services, UHS screens them for eligibility in the Family Planning Program (FPP) or Healthy Texas Women (HTW), so they can receive treatment at a clinic.
Over three semesters and on two campuses, BAE-B-SAFE has assisted 44 young women in obtaining LARCs at no cost. “We’ve had two events on the Palo Alto campus, one event at San Antonio College, and this semester we hope to have events on all three campuses,” Mullaney says. The hope is to promote awareness of the program. “[We want to] Increase the number of participants. We know there are more than 15 people that have requested these services. [We are] also capturing more feedback from students accessing the services and following up about how it’s impacted their lives.”
The work BAE-B-SAFE does in the San Antonio community will have a long-lasting impact. “We engage more than 7,000 students each year on campus through events and presentations. We serve more than 900 students each year with evidence-based instructions,” Mullaney says. That’s a lot of students carrying a foundational understanding of sexual health out into the world. With that foundation, students can determine what healthy intimate relationships look like, how to set and maintain boundaries, and are a bit more knowledgeable about navigating family planning and the healthcare system. In the end, student academic and personal success is what it’s all about. Teen pregnancies, rising STI rates, and unhealthy relationships don’t happen in a vacuum. We all must do our part to make sure everyone in our communities has access to the resources and services that will help us all succeed. BAE-B-SAFE is just one of the many organizations setting the example.