Association Between Availability and Quality of Health Services in Schools and Reproductive Health Outcomes Among Students: A Multilevel Observational Study

Abstract

School health services are associated with fewer pregnancies among students, but only when the availability of doctor and nursing time exceeds 10 hours per 100 students per week.

School-Based Health Centers to Advance Health Equity

“…Only three studies 51,75,92 evaluated hybrid school-based and school-linked centers, and no studies evaluated exclusively school-linked centers or mobile clinics. Results of this review are largely applicable to the urban context, as only ten studies in 11 papers 51,52,58,70,72,75,76,79,90,92,96 were conducted in mixed rural and urban or suburban areas, and none in predominantly rural areas. Applicability to younger grade levels is limited, as most studies (26 studies in 28 papers 46–49,52,54,55,59,62,65,66,68–74,81,82,85,87,89,91,92,94,96,97 ) evaluated high school SBHCs, whereas one study 83 assessed middle school SBHCs, seven studies 57,58,67,77,83,93,95 evaluated pre-Kindergarten or elementary school SBHCs, and the remaining 12 studies 51,56,60,61,75,76,78,79,84,86,88,90 assessed combinations of grade levels.…”

“…The effects of the range of SBHC services were evaluated: 23 studies in 24 papers 49,52–56,59,69–72,74,77–79,82,85,88,89,91–93,96,97 compared SBHCs that provided primary care only (often including reproductive services); nine studies in ten papers 47,48,62,68,73,75,81,87,90,94 assessed SBHCs that also provided mental health care; and 13 studies 46,51,58,60,61,65–67,76,83,84,86,95 provided some combination of primary care and mental, dental, or social services. Most studies (28 studies in 29 papers 47,48,52–56,58,59,62,69,75–79,81–83,85–88,91–94,96,97 ) did not report hours of operation; among those that did, only two SBHCs 49,89 were open for fewer than normal school hours.…”

“…Most studies (28 studies in 29 papers 47,48,52–56,58,59,62,69,75–79,81–83,85–88,91–94,96,97 ) did not report hours of operation; among those that did, only two SBHCs 49,89 were open for fewer than normal school hours.…”

Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers

“…In another recent systematic review of SBHCs’ impact on sexual, reproductive, and mental health [27], of the 27 studies included from 1990–2012, only three were categorized as examining outcomes beyond health care utilization or behavioral health risks, and each found positive impacts of SBHCs for only a subset of the primary outcomes studied or some of the subgroups studied [[17], [20], [28]]. While this review did not include published studies before 1990 [29] or after March 2012 [[30], [31]] as well as several studies published during the period covered by their review [[19], [23], [32]], it did demonstrate the limited data available on a SBHCs’ reproductive and mental health outcomes.…”

“…To date, the best example of a large-scale national study was conducted in New Zealand [30]. The aim of the study was to examine the relationship between access to and quality of SBHCs and the reproductive health outcomes of contraceptive use and self-reported pregnancy.…”