Reproductive health and education

Before making investments in this strategy, city and county leaders should ensure it addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in reproductive health and education. To measure these indicators and determine if investments in these interventions could help, examine the following:

• Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.

• Neonatal health: Share of low-weight births. These data are available from the CDC’s National Center for Health Statistics.

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in this strategy. To measure these indicators and determine if investments in this strategy could help, examine the following:

• Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.

• Access to health, mental health, and social supports: Percentage of programs offering health, mental health, and social services, or staff or consultants providing infant and early childhood mental health consultation (IECMHC) services.

• Invest in specialized staff: While sexual health education and services can be delivered by general clinic or medical staff, evidence-based models often employ highly trained specialists. These professionals are experienced in discussing sensitive topics with the groups that could most benefit from the intervention (i.e. teenage girls) and demonstrate a high degree of cultural competence. By hiring staff members committed to the subject matter, programs can increase the likelihood of cultivating strong relationships with clients, engaging in follow-up sessions, and delivering the model effectively.
• Prioritize one-on-one visits, follow-ups: For those most at risk for unintended pregnancy or contracting an STI, visits with a trusted specialist are often the most impactful in shaping behavior. While requiring significant staff time and private office space, many crucial services, such as intensive sexual health counseling and discussions of highly sensitive topics, can only be delivered in a private setting.
• Cultivate partnerships for program sites: Effective sexual health and education models are often delivered at a site offering a range of other services, such as a community health center or a school-based clinic. Identifying a strong host site for program delivery allows programs to reach a higher number of residents who could benefit from the services (i.e. high school students) and can produce significant ancillary benefits, such as increased use of other clinic services as a result of referrals. School-based clinics have demonstrated particularly promising results, given their high visibility among students. 
• Address stigma through education: A major barrier to accessing sexual health and well-being services is stigmatization. Programs can address this through community-wide programming that includes a robust educational component on the benefits of such services. Staff at delivery sites (such as teachers) should receive training on how to discuss sensitive topics and when to refer individuals for one-on-one services.