Emergency contraception: emotion, evidence and bubble gum
Earlier this year, the FDA recommended that emergency contraception, or Plan B, should be available without prescription to girls under 17 as it is currently available by prescription only to this age group. In an unprecedented move, the US Health and Human Services secretary Kathleen Sebelius vetoed the FDA's recommendation to make Plan B available without prescription to all women of childbearing age in the US. Mr. Obama said the secretary felt a 10- or 11-year-old should not be able to buy emergency contraception “alongside bubble gum or batteries."
What is Plan B or emergency contraception? Plan B is a pill that consists of the hormone progestin that works by preventing an egg from being fertilised. It must be used within 120 hours after unprotected sex, is safe and effective with few side effects and none dangerous.
Unlike some misconceptions, the availability of emergency contraception dose not change rates of sexual activity or increase the frequency of unprotected sex among adolescents.
Unintended pregnancies are an emotional and controversial issue, invoking deep-rooted religious, political and ideological beliefs. The US has one of the highest rates of unintended pregnancies with nearly half of all pregnancies unintended. In particular, adolescent birth rates in the US are much higher than rates in other developed countries.
Side stepping the issue of induced abortion, what is the effect of unintended pregnancy on women? A recent Lancet editorial discussed the results of a comprehensive review into the mental health outcomes of women after having an induced abortion. The key study finding was that having an unwanted pregnancy leads to an increased risk of mental health problems, not having an induced abortion.
The US should be leading the battle to reduce unintended pregnancies. Indeed the American Academy of Pediatrics (AAP) “encourages abstinence plus comprehensive sexuality education as the best way to help prevent unintended pregnancy and sexually transmitted diseases.” Further, they support the availability of emergency contraception, or Plan B, for adolescents.
Given that only 20-25% of health care providers discuss emergency contraception with adolescents, the restriction of Plan B to prescription only to adolescents under 17 seems a major barrier to access.
What is the likelihood that a 15-year-old who had unprotected sex is going to get a prescription for Plan B? She will be able to purchase acetominophen (i.e. Tylenol or Paracetamol) without a prescription, a medication that can potentially cause fatal liver damage and lead to liver failure if used inappropriately, yet she cannot purchase Plan B to prevent an unintended pregnancy.
Rather than rely on evidence, emotion wins. But the real loser are adolescents under 17 who may face life-long mental health problems. When emotion wins, we all lose.