By Tony Richards
Editor-in-Chief

Despite alarmingly- high teen pregnancy rates in Highbridge, a local health clinic is among several throughout the city that does not provide emergency contraception (EC) to patients.

According to recent statistics from the city Department of Health and Mental Hygiene (DOHMH), the birth rate among teenagers ages 15 to 19 in Highbridge and Morrisania was roughly 150 per 1000 live births in 2003-04. While this represents a local teen birth rate that has gradually and steadily declined over the past decade, this figure is still slightly higher than the overall teen pregnancy rate for the Bronx and considerably higher than the teen pregnancy rate for New York City as a whole (roughly 100 per 1000 live births).

In spite of these statistics, a study released last month by the office of Public Advocate Betsy Gotbaum revealed that the Highbridge Health Center, on 1015 Ogden Avenue, does not offer teenage patients emergency contraception—pills taken within 72 hours of sexual intercourse to prevent pregnancy. In fact, the clinic does not even offer birth control pills or female condoms, making it the only one of eight teen health clinics in the Bronx run by the city Health and Hospitals Corporation (HHC) and surveyed for the study that lacked all three of these resources.

A Citywide Problem

Both the title and the content of the report, “Unintended Consequences: Problems With Contraception Access at City Clinics,” suggest that lack of access to pregnancy- prevention resources is a multi-faceted problem that extends well beyond Highbridge. For instance, many health clinics that were found to provide emergency contraception required an appointment with a doctor rather than accepting prescriptions; this was true of 73 percent of the STD clinics run by the city health department that were surveyed.
Emergency contraception was also found to be frequently expensive and often not readily available; at 61 percent of the HHC teen clinics contacted for the study, emergency contraception was not available for pick-up the same day as the call, while 73 percent of the teen clinics that offered emergency contraception did not do so for free.
And at some of the health centers contacted for the survey, simply getting through to a sensitive staff member was a challenge: more than half of the clinics had to be called more than once, while a staff member at the Health Center at Tremont, on 1826 Arthur Avenue, was overheard by a phone surveyor to say, “Someone should keep their legs closed.”

In total, 38 HHC teen health clinics, and 11 STD clinics and District Public Health Offices run by the city health department, were contacted in July. Surveyors calling the health clinics pretended to be a 17-year-old girl with no health insurance; for the district public health offices, they impersonated an adult woman with no health insurance.

Findings Generate Concern, Dispute

Councilmember Maria del Carmen Arroyo, in whose district the center is located, was not familiar with the study when contacted about it October 19. However, after reading the report, she called its findings “very concerning” and said she had spoken to Councilmember Joel Rivera, the City Council’s majority leader and head of its Health Committee, about taking immediate action.

“I think one of the possible points that we can address is [to] organize a hearing at the city council around the report,” Arroyo said, “and bring both the Department of Health and HHC to testify about why this is a problem and what they’re gonna do about it.”
The administration of the Highbridge Health Center did not return requests for comment by press time. The Health and Hospitals Corporation, while not commenting specifically on what contact—if any—the agency had initiated with the Highbridge Health Center since the publication of the report, released a statement disputing the study’s conclusions. HHC suggested surveyors had looked for emergency contraception in the wrong places.

“Despite the Public Advocate report findings, all 11 HHC hospitals, as well as our community-based adolescent health centers provide access to emergency contraception for adult women and adolescents,” reads the statement, issued September 23. “The report fundamentally confuses HHC teen health clinics that provide basic pediatric care with our adolescent health centers where reproductive and adolescent medicine is practiced.”

But Gia Storms, a spokesperson for Gotbaum’s office, defended the report’s methodology. “We did not call anywhere that was listed as a child health center,” Storms said. “We specifically targeted only centers that had the word ‘teen’ listed on the HHC Web site.” She added that, in conducting the study, surveyors attempted to place themselves in the shoes of women needing contraception quickly. “If you’re a young woman in trouble, and you got on the web and you need to get EC right away, what is your success rate at that?” Storms said. “What are they looking for? They’re looking for somewhere that says ‘teen health clinics.’”

Fear of (Losing) Funding

Sylvia Henriquez, director of the National Latina Institute for Reproductive Health, said one obstacle community health centers faced in providing emergency contraception was a lack of funding. She also echoed the study’s conclusions that many staff members of these centers were not aware of, or knowledgeable about, emergency contraception.
In fact, Henriquez further suggested these two factors were linked by a federal law called Title X.

Title X of the Public Health Service Act, passed in the 1970s, provides federal funding for clinics providing reproductive health care services; the funding is distributed first to regional Health and Human Services offices, and then to individual clinics. According to a fact sheet from the National Latina Institute, more than 4 million women each year—most of them poor and uninsured—benefit from Title X funds.

Clinics receiving Title X funds are not allowed to use those funds for abortion. Henriquez said the misconception that emergency contraception is a form of abortion often led to clinic staff being fearful of providing the contraception. “Many times, if people think emergency contraception can be used as an abortion,” Henriquez said, ‘that can be seen as ‘Is that a violation of our federal guidelines?’”

Going forward, the Public Advocate’s report recommends that all HHC teen health clinics, District Public Health Offices, and STD clinics provide patients with birth control, emergency contraception, and female condoms. The report also suggests staff at health centers should receive sensitivity training and be more readily available to callers.

The study further says the city should play a more active role in educating New York City residents about birth control, and more widely publicize clinic locations and other sources where women can acquire birth control and contraception.