To the Editor.—
In the article supporting the concept of school-based clinics,1I note that you state that "the St Paul program showed a decline in fertility rates in four participating high schools, from 59 births per 1000 female students in 1976-1977 to 26 per 1000 in 1983-1984." I should point out that, while statistically the birth rate may be used as an assessment of the fertility rate, it is not an assessment of the number of pregnancies that occurred during the period. The resulting drop in the birth rate could be solely due to an increase in the number of abortions, and indeed the fertility rate, as measured by the number of pregnancies, may have increased during the same period. Perhaps you would clarify this for your readers.
Cullen TF. School-Based Clinics' Birth, Fertility, and Abortion Rates. JAMA. 1989;262(23):3271. doi:10.1001/jama.1989.03430230043018
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