According to New Generation Health Center manager Beth Brown, learning how to manage reproductive health is no different than understanding the correct ways of “walking down the street.” Parents of young children have to hold their hand and provide guidance before they can trust the child to do it alone, she said. But when it comes to sexual health, parents are often unwilling to provide the same assistance. In such situations, teens will “run across the busy street,” endangering themselves and others.
Located in an unassuming cinderblock building on Potrero Avenue, NGHC fills the void left by parents who can’t, or won’t, provide the necessary guidance, by schools that answer only half the questions, and by a social climate in which myths and misconceptions continue to abound. The center focuses on youth aged 12 to 24 who are “high risk:” in foster care, have been incarcerated, or live in low-income households. Most of its clients reside in the Mission District or Bayview-Hunters Point, neighborhoods that have high rates of teen pregnancy and sexually-transmitted diseases.
NGHC strives to provide a space with “no sense of blame.” Clients’ needs are accommodated to the extent possible. The wait to see a clinician is short; the front desk personal is cheerful. The center never turns away a drop-in, and offers reminder calls upon request. “We do a lot of hand-holding that other clinics don’t do,” said Brown.
In an evaluation of the clinic, one patient shared her first experience receiving a pap smear, a screening test for cervical cancer that’s notoriously unpleasant. “I came in a cold sweat and I am leaving now perfectly okay with what just happened in that room with those clamps,” she said.
Another reported, “I have been a patient here for 13 years and feel blessed to be able to still come here and receive free health services.”
“Today I came and I didn’t feel judged at all,” said another.
Open most days from 9 to 5, the clinic extends its hours to 6:30 p.m. twice a week so patients don’t have to miss school or work to receive services. “That would contradict the clinic’s values,” Brown said. She noted that the center strives to help teens have as normal a trajectory as possible: graduate high school, attend college, and avoid early pregnancy.
Because the clinic’s patient no-show rate can be so high – up to 70 percent – it offers same-day insertions for intrauterine devices, and jumps patients to the “front of the line” if they’re returning for a follow-up contraceptive injection. “It’s like fast food,” said Brown. If a client is late for an appointment “we don’t send them away.”
“Teenagers are inherently disorganized. [They] are, by nature, late.” Some will be rude and demanding, wanting to be seen now, but Brown sees no point in punishing them or stopping to teach manners. She understands that her clients may be tense, and that people who have grown up around poverty may feel the need to fight to be heard, even when they have full attention. “The risk to the City is pregnancy, not another rude person,” she said.
One-quarter of the center’s patients rely on a form of long-acting reversible contraception –injections, implants, and intrauterine devices that don’t need user action – a much higher rate than other clinics.
The clinic conducts community outreach to offer “prophylactic” education. Health educator and outreach coordinator Tino Ratliff spends most of his week presenting before classrooms and community youth groups, discussing such topics as birth control, STD prevention, and healthy relationships, often using his own marriage as an example. He provides “the whole picture,” said Brown.
Ratliff engages audience members in tricky real-life scenarios. In one exercise participants navigate the nuances of consent, as a means to improve communication with their partners. The students are always brimming with questions that they may never have felt comfortable asking before. Their queries inform the agenda. A celebration of choice, after all, is the bedrock of the clinic’s policy.
“Everyone here recognizes….individual decision,” said Brown, “Just like abortion. Just like repeat pregnancy. I may not think it’s good for [a patient] to have sex with this guy. [I just have to] help her have the best outcome,” to have the necessary dialogue. “Here’s the facts. Here’s how we can help. The rest is on you.”
The center’s approach is crafted to provide youth with the compassion they need during an often difficult time while still holding them to their growing responsibility over their health and their actions. When a teenager is held to that standard, and offered an environment where no one is giggling or looking uncomfortable, they flourish. NGHC’s staff – including the five health educators, Ratliff, as well as four in-clinic educators, Americorp volunteers, and nursing and medical students who work at the clinic as part of their training – is taught to have those “awkward” but necessary conversations,