She’s 15. She lives with her boyfriend. He wants kids — he won’t use protection. She loves him, she says. But she doesn’t want to get pregnant. She knows how much harder it would be for her to finish high school.

At many schools, she would have gotten little more than some advice from a school nurse. But here at Anacostia High School in Washington, D.C., she gets a dose of midwife Loral Patchen.

Patchen asks her bluntly what she’s going to do about it. Because one of these days, the test is going to show a positive.

Patchen talks her through a range of birth control methods. There’s a shot you take every few months, an IUD, or a small implant that goes into your arm, which can prevent pregnancy for years. And, of course there are birth control pills. The student opts for pills, and leaves Patchen’s office with a one-month supply with a standing order for refills through the school clinic.

The hope is that this interaction will mean one fewer teen pregnancy in the city. In the Washington, D.C., neighborhood where this student lives, her chance of getting pregnant is nearly three times the national average.

While U.S. teen pregnancy rates overall have trended steadily downward in the past decade, they remain high in some communities. The rates for black and Latina teens is around twice that of whites, and kids from low-income families tend to have higher rates.

Patchen has been a midwife for 20 years and is the founder of the Teen Alliance for Prepared Parenting, or TAPP, at MedStar Washington Hospital Center. (Meredith Rizzo/NPR)

Anacostia High School’s midwife program is a novel approach that’s showing promise in tackling the problem.

Patchen had been trying to combat the city’s teen pregnancy rates for 20 years as the founder of the Teen Alliance for Prepared Parenting, or TAPP, at MedStar Washington Hospital Center. She was happy with what they accomplished, but she wanted more access to the young people who needed her. Her organization received a 2015 grant from the CareFirst BlueCross BlueShield health insurer to start working in two schools. Now she’s one of a handful of school midwives in the country, she said.

“It’s much better to go where the need is rather than to sit back and wait for the need to come to you,” she said.

And her role goes beyond providing prenatal care for the five to eight pregnant students who get care in the school clinic each year. Being at the school gives her a chance to help prevent pregnancies in the first place. “I wouldn’t have seen these youth in any other setting — not easily, anyway,” she said.

As the school midwife, Patchen can be an informal — and reliable — resource for students’ questions about sex and contraception and relationships.

“I love it when I’m walking in or in the hall during lunch because I see people and they recognize me,” Patchen said. “And they come in to ask me a question and they’ve got their two girlfriends with them. And we’ll talk about condom use or a side effect of a particular method or they’ll say ‘I heard …’”

If she were in a hospital, seeing young people only after they’re pregnant, she would never get this kind of interaction, Patchen said. Plus, the information she gives them spreads through their circle of friends.

At the school, Patchen keeps her schedule flexible to leave room for informal interactions and walk-in appointments, alongside her regular appointments with students.

When a student comes in, Patchen can offer counseling and immediate options. If a student decides she wants an IUD, Patchen can insert it on the spot. She can prescribe birth control pills and then hand the student a packet.

                                     Patchen consults with a student about available pregnancy prevention options. (Meredith Rizzo/NPR)