Does Access to School-Based Healthcare Reduce Teen Birth Rates and Lead to More High School Completion?

Access to affordable healthcare for low-income Americans has become a preeminent policy concern in the US. Even though the expansion of Medicaid and the State Children’s Health Insurance Program (SCHIP) has been able to provide health insurance coverage for most children from low-income families, the actual realization of health services still depends on the affordability and convenience of effective healthcare. It has been well documented that Medicaid access can lead not only to better health, but also to more stable household finances and higher educational attainment and earnings. However, inadequate access to primary care services among low-income families may preclude individuals from realizing these benefits, which would make the roughly $86 billion the US spends on Medicaid for children less effective.

Given the large and persistent disparity across the socioeconomic distribution in academic achievement, healthcare access, and health status, Michael F. Lovenheim, Randall Reback, and Leigh Wedenoja analyzed educational and health data to study how primary care healthcare services affect important life outcomes among youth from low-income families. In their research, they estimate the effects of providing primary care health services to teens through school-based health centers (SBHCs), health clinics located in schools or on school grounds.

While varying in size and scope, almost all SBHCs provide preventative health services to students, and many of them also provide reproductive health services and contraception. Since SBHCs target underserved communities by locating within schools in predominantly low-income urban and rural areas, they are a targeted method for reaching the most needy populations. Combining the National Alliance on School-Based Healthcare survey data with county-level information on births, as well as district-level information on high school dropout rates, the research focuses on two possible outcomes of primary healthcare services: the effect on teen birth rates, and the effect on the educational attainment of children from low-income families.

The findings suggest that SBHCs reduce teen fertility, with a relatively large reduction among younger teens, African American teens, and Hispanic teens. To be specific, the entry of SBHCs into a county reduces the teen birth rate by 1.3 per 1,000, a three percent reduction relative to the baseline birth rate. Despite the effectiveness of SBHCs in reducing teen pregnancies, the research finds no evidence of substantial reduction in high school dropout rates. A possible explanation is that high school years might be too late in a child’s life to substantially alter the likelihood of high school completion via improved access to primary healthcare.

There may be concerns about trying to identify the causal effect of SBHC services on teen fertility and dropout rates. First, the timing of the center openings might not be random. However, SBHCs are funded by various combinations of state and federal grants, plus private donations, and school districts typically do not provide direct financial support except for the space for the centers. This should help to control for local conditions affecting the results of the study. The authors also use various methods to control for local variations in yearly service hours and for omitted variables specific to the different localities that open these centers versus those that do not.

There are several important policy implications of this research. One central message of the findings is that SBHCs are a useful tool for reducing teen birth rates in the United States. Another important implication of the research is that the provision of low-cost and convenient primary care services through schools has at most a small effect on students’ decisions to drop out of high school. This suggests that high school health interventions may come too late to influence high school completion, and it is possible that having expanding healthcare services to these children when they were younger would have produced greater effects on high school completion rates.

Article Source: Lovenheim, Michael F., Randall Reback, and Leigh Wedenoja. “How Does Access to Health Care Affect Teen Fertility and High School Dropout Rates? Evidence from School-based Health Centers.” NBER Working Paper 22030, 2016.

Featured Photo: cc/(Cathy Yeulet, photo ID: 44018876, from iStock by Getty Images)'
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