Innovative Mobile Clinic Addresses Teen Pregnancy in the Commonwealth of the Northern Mariana Islands

May 31, 2017|12:04 p.m.| Eighmey Zeeck

ASTHO’s Increasing Access to Contraception Learning Community involves 27 states and territories working to disseminate strategies and best practices and help implement policies and programs that provide access to a full range of contraception methods.

The Commonwealth of the Northern Mariana Islands (CNMI) joined this learning community in October 2016. As part of their work within the learning community, CNMI is developing an innovative mobile clinic that reaches high school students to address the high teen pregnancy rate. Esther Muna, chief executive officer for the Commonwealth Healthcare Corporation, has been instrumental in expanding family planning initiatives currently taking place in CNMI.

Muna spoke with ASTHO about CNMI’s new mobile outreach program. Additional information was provided by Heather Pangelinan and Maria Hy, MD, key members of ASTHO’s Increasing Access to Contraception Learning Community.

In 2016, the Commonwealth of the Northern Mariana Islands Youth Congress passed a resolution recommending that the CNMI public school system integrate a mandatory sex education course to help reduce the spread of STIs and teen pregnancy within the islands’ population. Did this resolution play any factor in beginning a formal campaign with the public school system to reduce teen pregnancy on the islands?

The local health department was already working to address the teen pregnancy rates prior to the resolution. However, the resolution was an important component in our overall effort to improve adolescent health and reduce teen pregnancies. It highlighted the need for programs targeting teen pregnancy prevention and signified a call to action produced by members of the teen population, who are the consumers and vital stakeholders of the adolescent health services we provide. This resolution was a vital form of stakeholder input and feedback regarding teen health.

What barriers, specific to CNMI, make outreach to adolescents about family planning and reproductive health a challenge?

As with most other preventive healthcare, our population faces the following barriers to accessing care: lack of transportation, lack of health insurance, and clinic hours limited to traditional business hours (M-F, 7:30 a.m.-4:30 p.m.). In addition, because of our small population, adolescents worry about confidentiality. Adolescents have expressed concerns about seeing a relative or another familiar adult when going to access contraception services at the women’s clinic. It is important to note that resident’s religious beliefs contribute to the perception of the acceptability of contraception and impact how parents address the topic of sexual and reproductive health with their teens.

Your public health department team has begun a mobile clinic contraceptive outreach program at local high schools, to include some of the outer islands. Why do you believe this approach will be successful in reaching adolescents populations?

The use of the mobile clinic addresses some of the more critical barriers in accessing care. The mobile clinic is provided during school hours at school campuses, eliminating the challenge of limited clinic hours and lack of transportation to get to the clinic. It also addresses confidentiality issues. The mobile clinic outreach conducted at high schools is marketed as a comprehensive public health event and not specifically for family planning and HIV and STI testing. Diabetes and hypertension screening is offered along with health counseling on topics such as healthy eating, physical activity, and interpersonal violence prevention. By offering comprehensive screenings, teens aren’t automatically identified as participating in the mobile clinic event specifically for contraception or HIV and STI testing. Teens don’t have to worry about being seen at the clinic and they can access services with the support of their friends in an environment where they are comfortable, school.

What partnerships have been established through the new mobile clinic contraception outreach project?

One of the more important partnerships that resulted from this project was with the CNMI Public School System. We have been able to produce a memorandum of understanding, identifying key teen health issues that are being addressed collaboratively. Through our mobile clinic, we will be able to address not only teen pregnancies but also non-communicable diseases, interpersonal violence prevention (bullying), and other risky teen health behavior (i.e. drug and alcohol use). We will include oral health screenings as part of our mobile clinic outreach for this upcoming school year and explore the possibility of adding HPV immunizations. Internal partnerships have also been enhanced through the mobile clinic outreach. Programs such as the Title V Maternal and Child Health, Title X Family Planning, HIV and STD Prevention, Comprehensive Cancer Control Program, and the Oral Health Program work collaboratively on addressing teen health concerns through these outreach clinics.

Health officials are often the conduit in which cross sector relationships and partnerships are developed. What was your role in supporting partnership development?

Resources are essential to our work. Ensuring that we have adequate resources, such as funding to purchase supplies and human resources to provide the needed services is critical to our success. In addition, supporting and approving policies that work to improve the health of our population and communicating with other agency heads and policy makers are critical aspects in our partnership development.

What are some successes you have already seen with the mobile contraceptive outreach to adolescents?

The biggest success is reopening the dialogue with schools that family planning is an important topic, equally as important as the curriculum. The outreach clinics were wildly successful because they demonstrated that there was a large need and we were able to provide contraception, including long acting reversible contraceptives (LARCs), on-site at school campuses. The student turnout was impressive and showed us that adolescents want more of these types of services. Hopefully this will allow future school outreach clinics to have dedicated space and time for our visits. Another success is incorporating male adolescents in the family planning conversation. We target all adolescents equally, so knowledge is shared to all students, regardless of gender. It is also important to recognize the role men play in family planning.

Is the issue of teen pregnancy an area that made the Commonwealth of the Northern Mariana Islands want to participate in the ASTHO Increasing Access to Contraception Learning Community?

Teen pregnancy is one reason for our desire to participate in this ASTHO learning community. However, there were other reasons, such as the high number of women not receiving prenatal care and the low return rates for postpartum care.

Is there anything you want other state and territorial health officials or organizations to know about the Commonwealth of the Northern Mariana Island’s Increasing Access to Contraception project?

Thanks to our participation in this learning community and support we received from ASTHO, we feel that our outreach clinics have seen great initial success. Our mobile clinic outreach project has helped to shape the relationship we have with our local public school system. We have been able to align many of our individual activities surrounding teen health issues, allowing us to leverage the limited amount of resources each of our departments has to work with. Utilizing a team approach helps to ensure our messaging is consistent and our efforts are targeted. In addition, team collaboration is more effective in comparison to addressing issues from a variety of angles or approaches.