Indian River board OKs reproductive health care at wellness centers

GEORGETOWN — With funding for its two high school wellness centers in jeopardy, Indian River School District will soon be incorporating contraceptive services and reproductive health care in its overall comprehensive health plan.

Following a presentation by Dr. Bobby Gulab, senior vice president/chief medical officer for the Beebe Medical Group, Indian River’s board of education, by a 7-2-1 vote, agreed Aug. 26 to a comprehensive health plan to maintain its 340B Plan, a federal program that offers a variety of comprehensive health services and discounts on medications and sometimes even free medications.

Wellness centers at Sussex Central and Indian River high schools are two of Beebe’s three school-based wellness centers. The other is at Cape Henlopen High School.

“Only two schools in the public school system that in-state do not offer contraceptive services to students – Indian River High School and Sussex Central High School. Every other public school system in the state of Delaware does,” said Dr. Gulab prior to the board vote. “What we’d like to do is develop a plan for the Indian River School District similar to have we have done at Cape Henlopen … comprehensive health services, that includes reproductive health.”

While reproductive health represents only 9 percent of the wellness center services, the school district is at risk of losing its other services the centers provide under the 340B Plan.

“One percent of what they do is pregnancy related. Three percent is sexually transmitted diseases related and 5 percent is family planning. The rest of it encompasses everything else that is health care related of the students, which is 91 percent; illness, immunization, sports physicals, mental-health services and anything else that comes up,” Dr. Gulab said. “You are at risk of losing your 340B Program, which would take away free medications and immunizations provided to the students. Because you’re not in 9 percent of something you will lose that for 91 percent of what you do, you do.”

“That is a push from the state … that wellness centers should offer these services to their students and community,” said Dr. Gulab. “340B Plan has been provided by the federal government for about 25 years.”

“One of the reasons why the 340B pricing is in jeopardy for the Indian River School District is not the policy of (Delaware) public health, it is the policy of the federal government,” said Dr. Gloria James, chief of the state Bureau of Adolescent & Reproductive Health through the Delaware Division of Public Health.

Dr. Bobby Gulab

IRSD board members Charles Bireley and James Fritz voted against the proposal, while board member Dr. Donald Hattier abstained.

“I see it as government coercion, to peel away a family from their kids. I feel very strong about that because that is what has been going for years anyway. I think it is another chink in the armor here,” said Dr. Hattier. “While it may be well-meaning, the government does a lot of things well meaning that don’t work out too terribly well.”

“One of the reasons my kids never got involved in the programs in any of our schools is because the parents lose their right to hear what’s going on in their own kids’ medical records,” said Dr. Hattier.

“There are certain things about this that personally that I don’t feel very comfortable with either. And that is one of them,” said Dr. Gulab. “But again, it’s not a personal decision for me. Currently, the state law … minors are allowed to have treatment for certain things without their parents being involved. Sexually transmitted diseases is one.”

The others are pregnancy and mental health, Dr. Gulab said.

“Then it’s a program I cannot support,” Dr. Hattier said. “It takes parental rights away.”

Dr. Gulab emphasized this is not mandatory as parents have the choice to opt into school-based wellness centers.

“Parents still have a choice if they want their students to use those services. If parents feel like they don’t want their children to be part of that, they can opt to not be in our school-based wellness center,” said Dr. Gulab. “They have that choice.”

The United States ranks 10th among countries worldwide in teen pregnancies and Delaware stands 10th in the nation. Sussex County has the highest rate among the three counties for teen pregnancies, Dr. Gulab said.

“Most of the pregnancies coming out of the Indian River School District are coming out of Sussex Central. These are conservative numbers,” said Dr. Gulab, noting it is difficult to be exact because some pregnancies are not reported, and some may be terminated.

Dr. Gulab said there is an overall average of 20 to 30 pregnancies reported in the district.

“What we’re seeing with the numbers of pregnancies compared to Cape (Henlopen), with your socio-economically challenged population … and how this medication benefit program benefits them and how they are the ones that are affected mainly by pregnancies, I see it as a way to combat that and really do a service to the community,” said Dr. Gulab. “It’s not just about contraception. It’s about preventing pregnancies and giving students a better future as they move forward.”

The comprehensive health plan would include contraceptive care to help educate and to help prevent teen pregnancies and sexually transmitted diseases. Dr. Gulab noted that Cape Henlopen High School went from nine pregnancies prior to plan approval and implementation to one pregnancy last year following implementation.

School-based wellness staff do much more than prescribe and treat, according to Dr. James.

“They also talk about prevention all the time. It is one of the requirements the Division of Public Health imposes,” she said.

According to data provided by Dr. Gulab, 65 percent of Delaware high school 12th-graders are sexually active. For juniors, it’s 51 percent, 46 percent for sophomores and 23 percent for ninth-graders.

“Sex isn’t going anywhere unfortunately. But I think the more educated the students are about it, the more they know about can help prevent some of the detrimental effects we’ve seen with people with poor decisions,” Dr. Gulab said.

“This is not really about contraceptive care per se, it’s really about a bigger global picture. There are schools with contraceptive care that still have pregnancies. This is about a bigger kind of picture or plan, that includes sexual education and health. Contraception is one part of that.”

“Children are having sex. They are being sexual. We can’t stop it one way or the other,” said Dr. James. “What we can do is education them, allow them and allow the parents to know the choices that they have in school-based centers.”

The comprehensive plan also incorporates drug and alcohol use. According to Dr. Gulab’s data, 22 percent of seniors reported using alcohol before their last sexual intercourse. For 11th-graders it was 20 percent and 14 percent for 10th-graders.

“I think it is clear how drugs and alcohol can alter those decisions,” said Dr. Gulab.

Dr. Gulab, a Sussex Central High School graduate and Hall of Fame member, admitted that reproductive health and contraception “isn’t always an easy topic to talk about. I know it is not always easy for a school board to address. It is not always an easy topic for me to get up here and talk about. There are people that feel very strongly about it. I am here out a sense of responsibility.”

IRSD Superintendent Mark Steele said the school district has had over 20 years of wellness partnership, with a good number of those years with Beebe. “It’s a great organization,” he said. “We’ve done great things.”

School board member W. Scott Collins said he has been impressed with the benefits of the school wellness program at Indian River High School. “It’s been a great program and I would gladly make a motion that we accept an enhanced health program,” Mr. Collins said.

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