New Generation Clinic Helps Disadvantaged Teens With Family Planning

Last winter UCSF's New Generation Health Center, which provides family planning services to teenagers and young adults with the goal of reducing unintended pregnancies and sexually transmitted diseases, did a customer satisfaction survey.

One patient wrote: “I leave today with a smile on my face and confident and comfortable with my body, health and decisions I have made in regards to sex/prevention of pregnancy.”

Another said: “I never want to stop coming to this clinic!!!” And a third wrote: “They are very nice and not judgmental.” Yet another praised the familiar focus and effectiveness of the organization, and said: “I can depend on being able to get what I need.”

These visitors were among about 2,500 youth who paid 5,500 visits last year to the health center, which targets young people ages 12 to 24. Ninety percent were female.

About 75 percent of the clinic’s clientele are black or Latino, and the majority come from rough neighborhoods, disadvantaged backgrounds and sometimes single-parent families. Most live in the Mission District and Bayview-Hunters Point, which have reported some of the highest rates in San Francisco for teen pregnancy and sexually transmitted infections.

On December 1, New Generation Health Center will hold its first fund-raiser. Besides providing much needed money, especially in light of state cuts to family planning services, the Thursday night event at the Brava Theater will emphasize the significance of New Generation’s important work.

“Can you imagine your life without being able to control your fertility?” asked center research manager Beth Brown, MA, MPA, of UCSF. “We wanted to highlight that this is still an issue. There are a lot of big problems in the world, like global warming and dirty air and civil unrest. Those things can’t be solved in a day. But a girl who’s having unprotected sex can come into the clinic on Monday and you can put her on birth control. And you have started the process of changing the world.”

She said family planning is a proven, easy and inexpensive solution that can alter the trajectory of a young woman’s life.

The New Generation Health Center began in 1974 as a weekly teen clinic at the UCSF-affiliated San Francisco General Hospital. Since 1997, it has operated out of its own space on Potrero Avenue as a clinic of UCSF’s Department of Obstetrics, Gynecology and Reproductive Sciences. It receives federal and state funding as well as private donations and grants, with core support from the California Wellness Foundation and the William and Flora Hewlett Foundation. The center is just one example of how UCSF is a pioneer in women's health.

Seeking Support for Community Outreach

The staff includes four clinicians, UCSF medical students, fellows and residents, and four health educators who do outreach in San Francisco high schools as part of their jobs. Last year, the funding for that outreach was cut drastically, which means school visits, typically by a male and female who go together, now occur only once a week.

“We really value that outreach. It’s one of the main reasons we’re doing the fund-raiser,” said the center’s medical director, Grace Shih, MD, MAS, an assistant clinical professor in the UCSF Department of Family and Community Medicine and the Department of Obstetrics, Gynecology and Reproductive Sciences.

She said clinic employees range in age from their early 20s to their 60s. “Sometimes our patients want to talk to someone who’s more like their peer and sometimes like a parent or teacher,” Shih added.

The 34-year-old Shih, whose interests include cooking, hiking and salsa dancing, said, “I’m impressed on a day-to-day basis with how they are trying to take responsibility for their choices. I’ll think, ‘Wow, I was not thinking of this when I was 16.’ They are stigmatized as not being thoughtful, but they’re trying to make hard decisions and just need a little help to get there.”

She has written articles for Bedsider, an online birth-control support network operated by the National Campaign to Prevent Teen and Unplanned Pregnancy, which are direct, conversational and down to earth. Her subject matter has ranged from male contraceptives being tested in China and India to specific sex acts that can cause – or not cause – pregnancy.

Shih received her medical degree from the University of Florida and her family medicine residency training at Brown University, and she did a fellowship in family planning at UCSF. In 1998, after graduating from college, she taught in a Boston high school for a year as a volunteer with AmeriCorps.

“I think fondly of that time,” Shih said. “Adolescents have so much energy, and they are a fun population to work with.”

Integrating Reproductive Health into Primary Care

New Generation educates young people about health risks, provides reproductive health care, leads research studies on adolescent reproductive health issues, and educates future providers.

Shih, who became New Generation’s medical director in July, said she wants to continue the health center’s primary mission, but also hopes to incorporate two of her main interests into what the center is doing: integrating reproductive health into primary care, and involving males in decisions about contraception.

“Primary care is becoming more of a centerpiece of medicine,” Shih said. “I want to make sure we’re strengthening our ties with primary care. A lot more primary care people, especially family medicine residents, are coming to train at our center. That improves teen health, as those residents graduate and have stronger skills.”

She said her other major research focus, increasing the role of men in family planning, is not looked at in general and even less so with teenagers.

“Part of our mission is to show teens how to have healthy relationships that are built on mutual trust,” Shih said. “Helping them learn how to make decisions that include males can be very rewarding. It’s amazing how disengaged we, as a society, have allowed men to become.”

Shih also would like the center to apply for more research grants that integrate technology, especially social media, into patient care. For example, she wants to investigate whether texting will improve the re-injection rate for Depo-Provera, a birth-control drug.

“There have been oodles and oodles of studies here,” Brown said. The research has looked at everything from vaginal rings and plastic condoms to whether girls under 17 can figure out how to properly take contraceptives.

Shih said getting teenagers to think long term is a perennial challenge, but that the center’s ability to form relationships with its patients helps a great deal.

“They get to know our clinic really well,” she said. “Recently, we had a mom who came in with her daughter. She herself had come here when she was in high school. She said, ‘I got care here. I trust you guys.’ The continuity and repeat visits make our patients think longer term than if they just went to get pills somewhere.”

Brown said the health center often sees girls right after their coital debut because they want a pregnancy test or emergency contraception, which offers a good opportunity to discuss birth control. Many heard about New Generation from a friend who attended a school presentation by one of the clinic’s health educators.

“At least 30 percent of our patients come here because of school presentations,” Brown said. “So I’m worried. Without those presentations, how are they going to find out about us? Adolescents are a group whose story hasn’t been written yet. We can let them write it themselves or we can invest in them and help them write it.”

Photos by Brian Auerbach

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