Reproductive Choice Not a Reality in Rural B.C.
Teens living in small towns in B.C. are more likely than their counterparts in Vancouver to be sexually active, contract sexually transmitted infections, or get pregnant. This is not because they are less responsible or savvy than their urban pals but because they don't have the same access to sexual-health information and services.
In theory, reproductive choice is a universal right throughout Canada; in reality, it varies according to postal code. Here in B.C., there is no provincial strategy for teen sexual-health programs. Because access and privacy, taken for granted in larger urban centres, depend in part on funding and partly on the very personal values of local residents, school boards, and doctors, they are privileges not necessarily enjoyed in smaller communities.
Take the town of Port Alice, little more than 800 strong, on northern Vancouver Island, a region with the highest rate of chlamydia (326.2 per 100,000 people compared to 261.9 for Vancouver, according to 2002 figures from the British Columbia Centre for Disease Control). Chlamydia is an often symptomless, sexually transmitted infection that, if left untreated, can cause pelvic inflammatory disease and infertility. In a phone interview with the Georgia Straight, George Markides, principal of Sea View elementary-junior secondary school, which serves kindergarten to Grade 10 students in the town, said he realizes there's a dearth of reproductive services.
For a sexually active teenager in Port Alice looking for contraceptives, emergency contraception, or STI testing, the challenges are prohibitive. First, there's the confidentiality issue. "You can get condoms at the grocery store," Markides said, "but everybody knows everybody here."
Then there's the problem of access. "We have three doctors that rotate in," Markides said, "but they're all men. There are doctors in Port Hardy and Port McNeill, but they're 50 minutes away, and there's no bus service there. You could take a taxi, but that would be very expensive." A pregnant teenager wanting an abortion is looking at a couple-of-hours' drive to Campbell River.
Markides acknowledged that the sex-education program in his school isn't doing all that it could, either. "In Grade 5, the public-health nurse comes in to talk to the girls and boys separately about the basics of puberty. Career and Personal Planning covers a little, then Science 9 covers some of it. But the programs are not great."
The school does make available to students the Options toll-free Facts of Life information line, but there is no reproductive clinic in town. Options, a nonprofit society with 41 clinics throughout the province offering birth control, STI testing, and pregnancy counselling, was formerly known as Planned Parenthood.
Marilyn Graham, a public-health nurse at the Port Hardy health clinic to the north, teaches basic sex ed to the fifth-graders at Sea View. "Apart from that, the kids get their information from their parents, from each other, and from TV," she said during a phone interview. "Oh, and there's a church group that tries to instill an abstinence approach."
For kids in Cranbrook in East Kootenay--which, together with the West Kootenay region has one of the highest rates of sexually active teens in the province--there isn't a whole lot of choice either. (Thirty-one percent of teens in the Kootenays are sexually active, compared to 18 percent in the Greater Vancouver Regional District, according to the 2003 Adolescent Health Survey by Burnaby's McCreary Centre Society, a nonprofit research and education organization dedicated to improving the health of B.C. youth.)
Kids in Cranbrook can go to an Options clinic in town, but their "options" are severely limited. The place is only open one night a week for a few hours. And the alternatives are restricted, clinic supervisor Linda Douglas said in a phone interview. "Some physicians won't prescribe birth control to teenage girls, and some are against emergency contraception," Douglas said. For an abortion, the journey is downright arduous: three to four hours through mountain passes into West Kootenay. "Geography is a huge issue here."
Some towns in B.C. are making concerted efforts to turn around the alarming statistics. According to Prince Rupert public-health nurse Jane Wilde, who is also an Options clinic supervisor, in the late 1980s teen-pregnancy rates on the northern coast of B.C., including Prince Rupert, were the highest in the province. From 1999 to 2001, teen pregnancies in the community of 14,000 still ranked relatively high, at 56.7 per 1,000 in the 15-to-17 age group (more than double Vancouver's rate of 21.6), but Vancouver Island North, which has about the same population, had taken over top spot, with 61 pregnancies per 1,000 in the 15-to-17-year range. Wilde attributes the decrease to the fact that nurses, teachers, and social workers have teamed up to ensure there is a full spectrum of confidential sexual-health services and a comprehensive education program in the schools.
"We have a lot of supportive family doctors here," she said in a phone interview, "but teenagers have this absolutely irrational fear that all adults will immediately get on the phone with their parents. After six years, the clinic has established trust with the kids." Up to 30 teenagers visit the clinic each week.
Education is equally important, according to Wilde. "We live in a culture where there's this strange combination of overt sexuality and repression. Kids are being exposed at a very young age to sexual practices I never knew existed before I was 35, some of it exploitive and violent. They get confused. They want to talk about it; they're desperate to talk about it. We provide a balance. And we're not saying, 'Go have sex.' What we say is, 'Here's all the information you need to make informed decisions.' "
Until the B.C. government develops a provincewide sexual-health strategy, however, Prince Rupert will likely remain an exception rather than the rule. And kids who live outside the bigger cities, the hundreds of thousands of kids who live in B.C.'s many rural and remote towns, will continue to pay the price in unwanted pregnancies and sexually transmitted infections.