Emergency Contraception for Teens: The New Politics of Plan B

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The post-election political landscape for emergency contraception might help teens prevent pregnancies. The American Academy of Pediatrics (AAP) published a new policy statement on November 26, drawing attention to America’s teen birth rates, which are consistently higher than those of other industrialized countries.

The major pediatrics group is recommending that teens be prescribed Plan B “preemptively,” improving the ease-of-access to the emergency contraceptive. “Adolescents are more likely to use emergency contraception if it is prescribed in advance of need,” they state in their revised policy, drafted by their Committee on Adolescence.

Plan B (levonorgestrel) does not terminate an existing pregnancy, but can reduce the risk of pregnancy if used within approximately 5 days after unprotected sex. All versions of the emergency contraceptive pill work by preventing ovulation and not by stopping the implantation of an already fertilized egg. Plan B is not to be confused with the abortion pill, RU-486.

Mired in Politics

Controversy has flourished in the past decade regarding the regulation of contraceptives for teens.

In 2005, the FDA refused to approve the sale of emergency contraceptives over-the-counter for all ages in a bizarre decision that overruled its own scientists and advisory panels. In December of 2011, the FDA finally changed its stance, allowing over-the-counter sales of Plan B without any age restrictions.

The new AAP policy bolsters the current FDA position on the matter. The FDA’s stance supports emergency contraceptives being available to women of any age, but they were overruled in 2011 by the Health and Human Services (HHS) who imposed restrictions on the use of Plan B for women under 17. The HHS decision would require women under 17 to show proof of ID to obtain the contraceptives.

Because the current federal law requires women under 17 to obtain a prescription for Plan B prior to using it, young women face a hurdle in actually using it as an “emergency” contraceptive. Not only must the teens first obtain a prescription for Plan B, but also must go to a pharmacist and show ID to obtain it over the counter.

This is not the most efficient situation for a pill that works best within the first 24 hours after unprotected sex. The new AAP policy statement supports the idea that pediatricians should be providing “just-in-case” prescriptions for all sexually active teens.

In 2011 when the HHS overrode the FDA and began to require prescriptions for teens to obtain emergency contraception, the AAP President responded with a scathing admonition. “The decision to continue restricting access to this safe and effective product is medically inexplicable,” said Robert Block.

If goal is to prevent unwanted pregnancies, the chances of doing just that are impeded by the current policies.

Obstacles for Teens

Research has shown that teens face several obstacles if they wish to obtain emergency contraceptives. Aside from the difficulty many underinsured or uninsured teens face in seeing a physician, other situations can prevent them from obtaining emergency contraceptives within the effective time period.

One example can be seen in the results of a 2012 study in which 17-year women were asked to call pharmacies and ask questions about Plan B. The results showed that only 57 percent of the pharmacists correctly informed the teens that they could, in fact, obtain Plan B without a prescription.

Additionally, physicians can vastly differ in their stance on providing Plan B to teens. The new AAP policy conjectures that this might be due to “the physician’s beliefs about teen sex in general.”

The Road Ahead for Emergency Contraception

The AAP’s new policy is potentially a step closer towards making all oral contraceptives available with greater ease. Easier availability of birth control options is a victory for women’s reproductive choices. Recognizing the barriers to teens’ access of contraceptives is progress.

“Having Plan B on the shelves between the condoms and pregnancy test kits is where it belongs,” said Kristin Moore, President of the Reproductive Health Technologies Project.

More also said that the reelection of President Obama is proof that a majority of American women “think prevention is a good thing, contraception is a good thing and reducing barriers to cost is a good thing. . . and they (the voters) supported a candidate who clearly made that a part of his message.”

Also in the past year, the American Council on Obstetrics and Gynecology has recommended that all birth control pills be available over the counter. They join the Society for Adolescent Health and Medicine in denouncing the current age restrictions on obtaining Plan B without a prescription.

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