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Girls need just-in-case birth control prescriptions, pediatrics group says

Pediatricians treating teenaged girls should consider writing just-in-case prescriptions for the morning-after pill,  the American Academy of Pediatrics (AAP) said on Monday.

It’s the second recommendation in a week from a major doctor’s group that would make contraception more widely available to women. Last week, the American College of Obstetricians and Gynecologists recommended making all birth control pills available over the counter.

The Food and Drug Administration says emergency contraception – the so-called morning after pill – should be available to any woman who needs it without a prescription. But Health and Human Services Secretary Kathleen Sebelius overruled the FDA a year ago. Now, federal policy says girls under 17 need a prescription to get it.

AAP says many teenaged girls need emergency contraception, and their pediatricians should help make it easy for them to get it. “Studies have shown that adolescents are more likely to use emergency contraception if it has been prescribed in advance of need,” the group said in a policy statement.

“Despite significant declines over the past two decades, the United States continues to have teen birth rates that are significantly higher than other industrialized nations,” it added.

Morning-after pills can prevent pregnancy -- they don’t cause abortions -- if they are used within five days of intercourse.

Dr. Susan Wood, who resigned her job as assistant commissioner for women's health at the FDA in 2005 in a dispute over the then-Bush administration’s handling of the birth control issue, called the decision a significant one. “It's not often you see physician organizations saying that their patients are better off without the physician involvement,” Wood told Reuters.

"We do hope that pediatricians read the policy statement and follow the recommendations," said Dr. Cora Breuner, a pediatrician at Seattle Children's Hospital who led the AAP panel that produced the recommendations. "The Academy prides itself on a devoted membership."

Emergency contraception for adolescents has been one of the most politically fraught areas in health care for almost a decade.

In 2005 the FDA declined to approve any over-the-counter sales of the Plan B morning-after pill, overruling its own advisory panel, as well as its own scientists. Last December the FDA reversed  its stance when it approved over-the-counter sales with no age limits. When Sebelius overruled the decision, it meant many women must present proof of age to get the pills.

Virtually every medical organization with expertise in the area supports making emergency contraception available for sale to girls and women of all ages who might need it. The American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the Society for Adolescent Health and Medicine joined forces to denounce Sebelius’s action last year.

“The decision to continue restricting access to this safe and effective product is medically inexplicable,” AAP president Dr. Robert Block said in a statement at the time. One of the reasons Sebelius gave for her decision was the worry that girls as young as 11 might get the pills and might not understand the consequences. But the pediatricians have said they do not share that worry.

Arthur Caplan, head of the division of medical ethics at NYU Langone Medical Center and an NBC News contributor, calls it a "remarkable and innovative idea."

"Having emergency contraception readily available will surely lead to fewer young women getting pregnant and fewer abortions.   The battle over abortion should not hinder making this sort of safe and reliable emergency pill easily available especially to those who may be coerced into sex, forget to take their birth control or have a partner whose birth control method fails," Caplan said. "Improvements in medicine are shifting the arena for discussing reproductive ethics from abortion clinics and surgical procedures to choices made by individual women talking to their doctor, nurse, pharmacist and others whom they trust.  Those on all sides of contraceptive availability need to come to terms with this new moral reality."

The most common form of emergency contraception is a high dose of a regular birth control pill such as Plan B and Plan B One-Step from Teva Pharmaceutical Industries Ltd or Next Choice from Watson Pharmaceuticals Inc. They generally sell for $10 to $80 and are most effective in the first 24 hours.

All work by preventing ovulation, not by stopping the implantation of a fertilized egg. "These are not abortifacients," said Breuner.

A 2006-08 survey found that 14 percent of sexually experienced girls had used emergency contraception, up from 8 percent in a 2002 survey. The most common reason given was condom failure, but 13 percent of the girls said it was because of rape.

A 2010 analysis of seven randomized studies of emergency contraception found that teens who had a morning-after prescription in were not more likely to have sex or less likely to use contraceptives.

"It's just common sense that requiring a prescription is a barrier," said Bill Alpert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy. "If an august and respected medical group like AAP is suggesting providing emergency contraception to minors is OK, that is a big deal."

That is especially so when teens face other obstacles to getting emergency contraception. For instance, a 2012 study that had 17-year-olds telephone pharmacies asking about morning-after pills found only 57 percent of them correctly told the caller that she could get the drugs without a prescription.

Also, some physicians refuse to provide the prescriptions to teenagers, while others do so only in cases of rape, AAP's research shows, suggesting that the refusal "may be related to the physician's beliefs about whether it is OK for teenagers to have sex."

There are no good data on how many physicians write prescriptions ahead of time for emergency contraception. "But we do know that pediatricians don't even talk about it, let alone offer advance prescriptions," said Breuner. "We tend not to like bringing up stuff that's controversial."

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