Some see easy access to emergency contraception as a way to drastically reduce teen pregnancy, already on the decline since the early 1990s. Others worry that its long-term effects on young women are unknown or argue that the drug, also known as the “morning after pill,” encourages teens to have sex.
Ultimately, it will be up to Food and Drug Administration officials to decide: Should older teens be able to buy emergency contraception over the counter?
Earlier this year, the FDA denied one drug company’s request to sell its brand of emergency contraception to anyone. Now that company, Barr Pharmaceuticals, has submitted a second proposal — to sell its Plan B brand to people 16 and older, but to require anyone younger than that to consult a physician. The company expects a decision next year.
Over-the-counter sales have received support from both the American College of Obstetricians and Gynecologists and American Medical Association.
Such access, some argue, would make it easier to get emergency contraception on evenings and weekends, allowing more women to take it in the recommended 72-hour window after unprotected sex.
Others, including some young women, see it as a way for teens who don’t want their parents to know they’re having sex to help prevent unwanted pregnancy.
“Kids are going to end up having kids because they’re hiding from their parents; they’re too scared to tell them,” says a 17-year-old in Brooklyn, N.Y., who thinks over-the-counter access would “definitely” help teens like her. She asked that her name not be used because her parents don’t know she used the morning-after pill in April after her boyfriend’s condom broke.
Skipping doctor visits?
The young woman is a patient of Dr. Bernadith Russell, the attending physician at Long Island Hospital’s obstetrics and gynecology department who also works in private practice at teen clinics in Brooklyn. She says the topic of unplanned pregnancy and emergency contraception comes up with her patients nearly every day. But few want to discuss it with their parents — or use insurance to buy emergency contraception out of fear their parents will find out.
“I can’t begin to say how much of a barrier that is,” Russell says.
However, a physician who opposes over-the-counter sale of emergency contraception fears that young women would skip regular visits to the gynecologist if they didn’t need to see a doctor to get it.
“They’re not going to get their pap smears; they’re not going to get screened for sexually transmitted disease,” says Dr. Gene Rudd, a gynecologist who serves as associate executive director of the Tennessee-based Christian Medical Association.
He also says some young women might not want to use emergency contraception if they knew how it worked.
A stronger dose of regular hormonal contraception, the morning-after pill can prevent pregnancy by delaying a woman’s ovulation or keeping sperm from fertilizing an egg.
It also can thin the uterus lining, making it difficult for a fertilized egg to implant. That’s a major reason anti-abortion groups — from the American Life League to the Pro-Life Action League — are among emergency contraception’s main opponents.
While many in the medical field do not share their view, they see interfering with a fertilized egg as abortion.
“Emergency contraception is not true contraception,” says Sierra Correa, the 22-year-old vice president of Collegians For Life, a student group that opposes the morning-after pill. “Drug companies have been getting away with calling it contraception by redefining pregnancy to mean implantation” of a fertilized egg.
Cutting unwanted pregnancies
Some opponents also have argued that easier access to the morning-after pill would make teens more likely to engage in risky sexual behavior — though some doctors say that research done at the University of Pittsburgh School of Medicine casts doubt on that argument.
The study, published in the April issue of the Journal of Pediatric and Adolescent Gynecology, found that teens who had emergency contraception on hand were not more likely to have unprotected sex. It also concluded that those teens were more likely to use emergency contraception correctly and sooner after sex, when it is most effective.
Such findings have motivated some nonprofits that serve youth to launch information campaigns to let teens know emergency contraception exists.
Officials at one of those nonprofits, Washington, D.C.-based Advocates For Youth, also point to the research of James Trussell, director of Princeton University’s Office of Population Research. Trussell has concluded that easy access to emergency contraception could cut by half the number of unintended pregnancies and abortions among U.S. women, ages 15 to 44.
Each year, there are about 3 million unintended pregnancies — and in about 800,000 of those cases the parents are teenagers, according to the federal Centers for Disease Control.
Those statistics were cited last year when the FDA’s scientific advisers voted, 23-4, in favor of Barr Pharmaceuticals initial proposal to sell Plan B with no age restriction.
Ultimately, however, FDA acting drug chief Dr. Steven Galson overruled the vote due to concern about young teenagers’ use of emergency contraception without a doctor’s guidance and the long-term effects of its use.
A young woman who has taken the morning-after pill — and has testified before the FDA to ask for over-the-counter access — hopes the agency will reconsider.
“The sad thing is,” says Vera Brown, a junior at the University of Florida, “teenagers need it the most.”