Confidential Sexual Health Care is Key for Off-Radar NYC Teens

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Courtesy of The Door

NEW YORK (WOMENSENEWS) — One afternoon this past winter, 20 girls and five boys sat in a green waiting area in SoHo, the trendy neighborhood in lower Manhattan. They scrolled away on their phones, trying to pass the time. Some took off their puffy jackets in the warm clinic.

The TV screen displayed clips of female OB-GYNs sharing facts about pregnancy, sexually transmitted infections, or STIs, and birth control.

A receptionist dressed in colorful scrubs went around the room handing out appointment cards. Then she handed health educators and nurse assistants forms of the patients next on their schedules.

Ashley sat near her friend Tamara Drame in the corner by a gray staircase. “I go to my pediatrician for regular checkups but I come here for birth control because nobody knows,” the 17-year-old said.

Ashley, whose last name wasn’t used due to privacy concerns, has been getting health care from The Door since she started coming to the youth service center a few years ago from her home in Brooklyn, a 40 minute train ride away.

Health services are just one aspect of The Door, which opened in 1972 and offers young people a range of programs in a new, urban building that resembles a school and offers dance classes, yoga, tutoring, college advisement, LGBTQ services and support services for homeless youth and children in foster care.

The Door has 10,000 members, 60 percent of whom are girls. These young people come from all parts of the city and represent a population that health clinics often can’t get to cross their doorways. As such, it serves as a model for reaching the 78 percent of sexually active teen girls who aren’t getting screened.

“Without confidentiality policies, teens who don’t have a reliable service provider whom they trust will not seek services and care that they need,” said Andrea Brand, a representative for the health advocacy nonprofit Our Bodies, Ourselves, who spoke with Teen Voices in a recent email interview.

Carrie Mumah is a Planned Parenthood representative based in New York City. Many girls do not know they have access to confidential sexual and reproductive health, Mumah said in a recent email. “Sometimes young people even have trouble accessing simple information on sexual and reproductive health.”

If teens don’t seek and find the help they need the consequences can include higher rates of STDs and unintended pregnancies, especially in lower income neighborhoods, said Mumah.

Other Confidential Clinics

Mumah emphasized that The Door is not the only clinic that provides confidentiality. She said services for female teens are provided on a confidential and sensitive basis at all five Planned Parenthood clinics in the city, including the one that just opened in Long Island City, Queens, where signs are written in bright colors and several languages to create a welcoming environment.

Financial and cultural barriers hinder teenagers from getting the proper care they need, Mumah said. It’s hard for teens to be honest with their parents when it comes to sex but at youth-focused places where teens feel comfortable being themselves, trust is earned more easily.

This was important to Ginger Williams. The 17-year-old Harlem student didn’t go to her local clinic or her school nurse when she needed care. She said she didn’t trust those health professionals not to tell her parents.

“I don’t really like doctors. You can tell that most doctors judge their patients,” she said.  “If it wasn’t for The Door, I don’t know what I would have done.”

Williams also learned safe sex tips and effective birth control options from the health educators and nurse practitioners at The Door, information she didn’t get in school. “School only teaches us basic things about sexual health and at the clinic they fill in the gaps and make you feel more comfortable,” she said.

Other teens interviewed for this article also said they avoided traditional doctor offices because they didn’t trust that their information would be kept private. It’s why Alice McNeal got her birth control from The Door instead of from her family doctor.

“I didn’t want to tell my parents about it,” said McNeal, 17.

Cost a Concern

Price is another reason teens go to The Door. Getting birth control in New York City is free and confidential under the Affordable Care Act, but a girl would have to pay for the services of a nurse practitioner or an OB-GYN, who she can see for free at The Door.

The average cost to see an OB-GYN, without health insurance, can range from $120 to $200 out of pocket. That price is for basic exams like a pelvic exam and Pap smear. The door is a Title X clinic, meaning it is dedicated to family planning and preventing STIs and gets its funding from the federal government.

For areas such as the Bronx, one of the lowest income neighborhoods in the country, serving the needs of teens is especially important.

Less than two-thirds of Bronx high school students said they learned about healthy relationships and just 37 percent learned communication skills when it comes to sex, said Planned Parenthood’s Mumah, citing data from the Connect to Protect Bronx Coalition, a group that works to prevent HIV/AIDS among young people of color.

Keya Fraser started coming to The Door when she was 14. “I used to go to a different OB-GYN at that time, but they were so dumb,” Fraser, who is now 21 years old, said. “They won’t tell you how much they are charging you and they sent bills to my house stating what services I got done. I didn’t want my family to see what I was doing at the time.”

Even though she is a college graduate, she still gets her reproductive health checkups at The Door, which has an age limit of 21.

Teens and staff said the success of The Door’s health clinic comes from the trust that is developed between the teenagers and the larger youth organization, which began providing youth services since it opened.

“We want people to leave with knowledge about their sexual health and sexual lives rather than just to treat them,” said Silvano DiMonte, a health educator at the clinic. “We usually teach and cater to people’s preferences. All clinics give great care but clinics should also be educators.”

DiMonte added: “If someone comes in looking for birth control pills, and they voice that they are nervous about colleges we can get them counseling or into our college prep programs.”

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