For Medical Director Tina Raine-Bennett and the staff at the New Generation Health Center in San Francisco’s Mission District, the job is far more than the advertised reproductive health care.
There was the lonely sixteen-year-old girl recently arrived from Central America, whom the staff learned had attempted suicide two days earlier. They were able to connect her with a therapist and find her a support group.
Another young woman appeared quite sophisticated, wearing a wig and makeup when she walked through the clinic doors. Raine-Bennett guessed she was in her late teens. When it turned out she was thirteen and sexually active, the clinic staff got her counseling and became part of her life for the next decade.
Jennifer Moran’s story is less dramatic. From a stable family in the neighborhood, Moran found the clinic when she was fifteen and needed a place to turn for contraceptives and confidential care. Today, thirteen years later, she is still there: a licensed vocational nurse working to help girls much like herself when she first visited.
“The clinic’s had a big impact on my life,” says Moran. “I don’t know what I would have done if it wasn’t here. I never thought about the possibility.”
All in a Day’s Work
Stories like these are all in a day’s work at the health center, a Hewlett Foundation grantee and, for the past thirteen years, a fixture in the lives of many young people in the Mission, Ingleside, Excelsior, and Bayview-Hunters Point neighborhoods. It’s part of Hewlett’s strategy to expand and improve direct services for teen pregnancy prevention in the Bay Area and Central Valley, particularly for low-income youth.
The clinic, affiliated with the University of California, San Francisco, provides teens and people in their twenties with high-quality reproductive health care, performs regular community education in neighborhood schools, and conducts research into the factors that influence young people’s decisions regarding reproductive health and family planning.
“I’d have to say that the unique thing about us is that we are here for them despite everything that is happening in their lives,” Raine-Bennett, an OB/GYN physician, says of the 2,400 young people, aged twelve through twenty-four, who come to the clinic each year. About half of them are Latino; another quarter, African American; and the remainder, Caucasian or Asian. Most are poor.
“The fact is, there is a high rate of unintended pregnancy in these neighborhoods despite the fact that we give out birth control,” she says. “What that says is we can help our clients, but we can’t change the circumstances in their lives. So being here to deal with the consequences of their lives is important. Over time, we see them get it together and move on, but we do a lot of handholding.”
Raine-Bennett and Clinic Manager Lisa Hardy agree that one thing that sets the clinic apart is its use of peer educators, who both engage in outreach in the neighborhood schools and greet new clients when they walk through the door. The clinic has two full-time staffers who do outreach exclusively. In a typical week, they might visit two or three schools, reaching about 7,500 students a year with information about family planning and related issues, Raine-Bennett says.
Connecting with the Clients
“The first person new clients usually see is someone in their twenties who asks them why they are here today,” says Hardy. “The counselor can do an initial risk assessment and see what other services the client might need.” Often, adds Raine-Bennett, that staffer might be someone the new client has already met through visits to the schools.
Hardy says those risks might be anything from pregnancy or sexually transmitted diseases to broader issues like homelessness, domestic violence, and depression.
“Often the counselor will hear things that the clinician doesn’t,” says Raine-Bennett. “Usually it’s relationship issues. The counselor might learn the client had more sexual partners than she would admit to the clinician. Or that she is in a bad relationship. More often than not, the interview might reveal abuse. And we find an individual reveals more in general as the day goes along.”
“Counselors do something called ‘meeting clients at their level’ – not being judgmental, not making decisions for them – just trying to meet them where they are,” she says.
Toward the end of the initial interview, the counselor discusses a range of contraceptive methods with the client, who then sees a nurse practitioner or physician to make a sound choice and review how the method works.
Researching to Reduce Teen Pregnancy
Raine-Bennett, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, also conducts research at the health center.
One recent project involved telephoning teenagers aged fourteen to eighteen who were not consistent users of birth control to see whether monthly follow-up calls after they visited the clinic would increase their reliable use of their contraceptives.
The study, currently under review by a professional journal, did not find a meaningful difference in the use of birth control between those called and a control group, Raine-Bennett says. But it did find what she called “a huge jump” in contraceptive use from the start of the study to six months later, regardless of calls. “What that shows is that going to the clinic in the first place has a big impact,” she says.
Raine-Bennett is now working on a study related to emergency contraception. Currently, those under seventeen must have a prescription to obtain it, while those seventeen and older can get it over the counter. Raine-Bennett hopes her research will help determine whether those under seventeen are able to follow instructions that accompany the medication. This would inform the debate over the age restriction.
For the physician, it’s one more small piece in what she’s come to view as a complex social puzzle in the effort to reduce unintended pregnancy among teens.
“We still don’t do a good enough job of understanding unintended pregnancy,” she says. “Many girls out there are not trying to get pregnant, but they’re not trying to not get pregnant. We don’t understand that as well as we should. One thing is clear: just giving out birth control is not enough.”
Fortunately, from Raine-Bennett’s perspective, the New Generation Health Center is a close-to-ideal place to further that understanding.
“The staff is uniquely committed to serving the community,” she says. “It’s very much of family here. It’s a fun place to work.”