School-based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado.

OBJECTIVES: We examined the changes in Black adolescent fertility rates in high-school areas with school-based health centers and compared them over time with changes in rates in high-school areas without school-based health centers. METHODS: Fertility rates were estimated for high-school areas with and without school-based health centers with geocoded birth certificate and school enrollment data. RESULTS: A high adolescent fertility rate (165 births/1000) in 1992 among Black students in Denver high-school areas with school-based health centers declined to a low rate (38/1000) in 1997 that matched the rate of school areas that did not have school-based health centers. Rates declined for both types of areas over the study period, but the rate of decline in the areas with school-based health centers was significantly greater (77% vs 56%). CONCLUSIONS: The rapid and significant decline in Black adolescent fertility in school areas with school-based health centers strongly suggests that attending to the health needs of students at risk of pregnancy resulted in a radically lowered risk of fertility. The decline is likely the result of strategies to identify, intervene, and follow-up on students engaging in behaviors that place them at risk for unintended pregnancy.