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Hagedorn's program in Colorado, because it is partially funded by a Catholic Health Initiatives grant, offers no reproductive services on site. That is appropriate, Hagedorn said, because the community is "fairly conservative" and "the biggest needs are primary health care and episodic acute care."

The Hope Healthy Start program, at Newport-Mesa Unified School District in Costa Mesa, Calif., gets around the issue by focusing on students aged 2 weeks to 12 years.

"Working with teenagers opens up a whole new area of sexual health that in some areas is difficult to get involved in," said Leslie Dootson, MSN, PNP, RN, who works as both a clinician and a school nurse at the clinic on the district's elementary school campus. "It's not appropriate for our community. Our focus is school readiness."

At the Berkeley High School Health Center, however, 75 percent of services used by students fall under family planning. "We're one of the few [school-based health clinics] that can give out contraceptives," said Kimi Sakashita, MPH , director of the center, which serves about 1,400 high school students annually at its clinic as well as providing outreach education for another 3,000 students.

Sakashita said that in a survey done several years ago, 88 percent of Berkeley high school students reported being sexually active and not using birth control. Since the clinic opened in 1991, the school's teen birth rate has dropped almost 60 percent. "We have the lowest teen birth rate of any jurisdiction in California," Sakashita said.

Although few school-based health centers are as progressive as Berkeley's, many programs provide some kind of reproductive health services. According to a recent survey completed by the National Assembly on School-Based Health Care, 76 percent of the clinics nationwide do not dispense contraceptives on site; however, 75 percent will do pregnancy testing and 60 percent will test on site for STDs like chlamydia.

The biggest threat to the health of school-based health programs is not politics or controversy, but funding. Although some federal money is available for the programs, most clinics must scramble to cobble together money from various public and private sources.

"All the school districts around us are pleading to have the same kind of program," Hagedorn said. "With the funding we have now, we can't get something started. Unless funding gets better, these kinds of programs are never going to expand."

Contact Janet Wells at janetawells@hotmail.com