Pediatricians: Sending Teenage Girls Home with Morning-After Pills

 

 

This interesting and provocative move by the Amarican Academy of Pediatrics is discussed in this trrrific piece by Roni Caryn Rabin in Tuesday's NYT. I would love to hear your sense of the issues.

--  JW

 

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Teenagers and the Morning-After Pill

When a teenager goes in for a checkup, the pediatrician often asks the parent to step outside so the doctor can talk to the youngster one-on-one about sensitive topics, like whether she is using drugs or is sexually active.

Now the nation's leading pediatrics organization is encouraging doctors to also talk to teenagers about the morning-after pill - and to send girls home with prescriptions for emergency contraception, just in case.

The recommendation, announced last week by the American Academy of Pediatrics, is the latest salvo in the contentious debate over access to emergency contraception. Ever since the Food and Drug Administration approved levonorgestrel (now sold under the brand name Plan B One Step, and generically as Next Choice), advocates have pushed to make it more easily accessible.

Several medical societies, including those representing gynecologists and pediatricians, favor making emergency contraceptives available over the counter, since the drugs are supposed to be taken within five days of unprotected sex in order to be effective. In 2006, levonorgestrel was made available over-the-counter for women age 18 and older. In 2009, after a legal fight, the age was lowered to 17.

The academy's policy revision was prompted in part by new research showing that young women provided with advance prescriptions for the morning-after pill were more likely to use the drug after unprotected sex than those without a prescription, and were more likely to use it in a timely manner.

"If you've got a teen in the clinic, you ought to be talking to them about sexual activity, even if that's not necessarily why they're coming in," said Dr. Cora Breuner, a pediatrician and a member of the academy's committee on adolescence. "Not enough people know about emergency contraception, not even 30- and 40-year-old women."

A recent study of college students, for example, found that only 16 percent knew that emergency contraception was available at college health centers.

Compared to years past, American teenagers have actually been postponing sexual activity. The average age of initiation is 17; by age 19, about 70 percent of teenagers are sexually active. Still, though teenage childbearing rates have dropped sharply in the last 50 years, the teenage birthrate in America is one of the highest in the developed world, according to the Centers for Disease Control and Prevention.

Many teenagers use condoms for birth control, but while they also protect against sexually transmitted diseases, they may break or slip. Teenagers may forget a birth control pill on occasion, and a significant number of young girls are sexually assaulted.

Just last month, the American College of Obstetricians and Gynecologists also called for making oral contraceptives available without a prescription; it recently endorsed teenage use of long-acting reversible birth control methods, like intrauterine devices and implants. In some states, a parent's permission may be needed for a doctor to prescribe emergency contraceptives to a minor.

Emergency contraceptives prevent fertilization of an egg by delaying or inhibiting ovulation and thickening cervical mucus, obstructing the progress of sperm. Though some critics have suggested these are abortion pills, in fact they are distinct drugs with different modes of action.

Curiously, however, no studies have found significantly lower pregnancy rates among young women who received advance emergency contraceptive prescriptions.

Some of the studies may have been too small to detect a statistically significant reduction, said Catherine L. Haggerty, an associate professor of reproductive epidemiology at the University of Pittsburgh and one of the authors of a recent review of the literature.

One 2006 study found that even when young women have emergency contraceptives on hand, many didn't use them.

Emergency contraception may also be less effective than believed, according to an updated review of studies published last year. Researchers often depend on study subjects to estimate their pregnancy risk at the time of unprotected sex themselves, but many do not accurately date their menstrual cycles, skewing the results, the review noted.

Plan B One Step and Next Choice are effective in at least half of the instances they are used, according to the review. But some studies have found that the drugs are just as effective two to four days after unprotected sex as they are when taken the morning after.

Objections to increasing availability come from many quarters. Advocates of abstinence education say doctors should encourage teenagers to delay sexual activity.

"Why not write a policy that encourages physicians to use their influence to guide teens to avoid all the risks related to sex?" said Valerie Huber, president of the National Abstinence Education Association.

John B. Jemmott III, a professor at the University of Pennsylvania who developed an abstinence-only sex education program, said, "The problem is that this doesn't do anything about sexually transmitted diseases and H.I.V." If teenagers have sex, "we want them using condoms."

Researchers have found that having a prescription for emergency contraception does not lead to more risky sexual behavior among young women. But many of those studies included few girls younger than 18.

Two studies that did include younger girls - a 2000 report that included many high-risk adolescent girls in San Francisco and a 2005 study of teenage mothers - found that those given advance prescriptions said they had been more careless about birth control and more likely to have had unprotected sex.

Dr. Elizabeth Miller, at Children's Hospital of Pittsburgh of UPMC, said she routinely provides teenagers with an advance prescription for emergency contraceptives, but she takes her cues from the patient and does not force a prescription on anyone.

She said she recently saw a 16-year-old girl who told her that she planned to wait until marriage to have sex, but was confused about her nascent sexual feelings. "We had a wonderful conversation about emerging sexual drive and about masturbation and orgasm, and I absolutely supported her wanting to wait to be intimate with someone until after marriage," Dr. Miller recalled.

At the same time, she emphasized that the morning-after pill could also be used after contraception failure, or after sexual assault.

To those who worry that talking about sex and contraception with youngsters is tantamount to condoning sexual activity, advocates say research shows the opposite.

"Good information, in fact, has a protective effect," said Sarah Brown, of the nonprofit National Campaign to Prevent Teen and Unplanned Pregnancy. "What we've learned from good research is that talking about these issues helps young people have a plan, understand it, and know what they would do."

 

 

 

 

Views: 184

Comment by Catnlion on December 5, 2012 at 6:26am

JW,

Not going to be a big fan of this except in a very small number of cases.  As a general rule I'm sorry but no.

First I'm a parent.  I need/want to know what is going on with my kids.  What happens if, even though it's small, they take it and have a reaction?  What happens if she is assaulted and tries to cover it up by taking the MAP so she doesn't get pregnant?  While that may solve so of her problems it won't take care of all of them.

Next your piece states: "Two studies that did include younger girls - a 2000 report that included many ...found that those given advance prescriptions said they had been more careless about birth control and more likely to have had unprotected sex." and "One 2006 study found that even when young women have emergency contraceptives on hand, many didn't use them."

To put a girl in a position where she is more likely to be careless about sex and then not use the protection she is provided after sex doesn't seem to make since.  I have no problem with a doctor talking to girls about things.  You know how it is, they are not the parent so maybe the same message will be better received.

Finally, there is going to be a girl who the doctor thinks is going to get "in trouble" and that the parents are not going to be a "go to" option for the girl.  In a case like this then sure I wouldn't have a problem, but, this is the exception not the rule.

** Sorry but I can't figure out how to make all the type match.**

 

Comment by Jonathan Wolfman on December 5, 2012 at 6:29am

Cat   Thanks. Of course, as I say, above, this isn't my piece. I brought it here to get interesting responses and yours is. Thanks!

Comment by JMac1949 Memories on December 5, 2012 at 7:35am

My grandson is the result of a failed condom... he's a sweet little bugger and my wife, my stepson and his wife are all working to provide him with a good life.  When she discovered she was pregnant, L and Kelton made their choices.   L. carried him to term, and they were married in the hospital on the day of his birth.  Neither of them were teenagers, but these things can happen to everyone.  Life's funny that way:

Comment by Safe Bet's Amy on December 5, 2012 at 8:47am

I think it's a damn shame that the AAP has to resort to recommending subterfuge to protect young women from unwanted pregnancies.

JMac can show all the cute baby pictures he wants...  the fact of the matter is in, his case, having the baby was a CHOICE.  MANY time this choice is taken away from a pregnant teen because of the less than concerned parent's religious or political beliefs.  

Additionally, it ain't a cute little baby when the the morning after pill is used.  it is a simple mass of cells that are much less complex than a fingernail clipping.  (and yes, I DO expect the fundy right to start protesting the evils of murdering your fingernails any day now)

Comment by Catnlion on December 5, 2012 at 9:27am

JMac1949

I have a woops also.  Great aren't they.

Comment by Catnlion on December 5, 2012 at 9:32am

So Amy, when does cells become life, in your opinion?  Would that be brain form, heart beat, comes all the way out?

Comment by Catnlion on December 5, 2012 at 9:34am

JW,

Given that the youngest of my daughters will be 10 next month, this is great info to have.  It looks like they are doing it behind the parents back.

Comment by Jonathan Wolfman on December 5, 2012 at 9:37am

To all:  Thanks. I do think, that this is a complex issue, that the safety of teen girls must be protected even tho this is fraught w complexity.

Comment by froggy on December 5, 2012 at 9:57am

If I could post a link to it, I would. I did a post on the old OS site a few weeks back about an excellent book, "Not Under My Roof" by Amy T. Schalet. It's a sociological study, looking at about 150 families split between the USA and the Netherlands. As a generality, the US families said "no, no, no" to teen sex. The Dutch families, by contrast, talked openly about teen sex, and the parents took the role of saying sex was OK, within very definite boundaries. No sex with the whole football team, no sex with random strangers in parks, but sex with a committed long-term teenage partner (a boyfriend or girlfriend that the parents knew, who was already integrated somewhat into the family), and sex with preparation like birth control, feeling ready, and trusting their partner, was OK. With permission from both teens' parents, they have boy-girl sleepovers, at home. (Wow. Mind blown). And breakfast after, with the family and all the little brothers and sisters. (Again, mind blown). The Dutch parents said they'd rather have their teens having sex at home, with someone they know, than having it out somewhere else without permission. The Dutch parents are essentially teaching that sex belongs in a committed relationship, with a loved and trusted partner. And they do believe that teens are capable of love, that it isn't just hormones (common language from American parents).

It seems mindblowing to me, an ex-Catholic. But the result is that Dutch teens have much less sex than their American counterparts. They start later, they have fewer partners, they have vastly fewer STDs and unplanned pregnancies. An interesting fact, too, is that Dutch teens also reported a higher sense of pleasure in the sex that they'd had. Most didn't feel pressured by a partner, or by a great situation that might not come again. Instead, they felt happy and ready. 

My takeaway from the book is that a chorus of "no, no, no" doesn't stop teen sex. It just drives it underground and makes it more dangerous. The Dutch teens have a steady chorus both from home and school sex ed classes of responsibility, commitment, preparation, and control--essentially sex within distinct boundaries. Not "no sex until you're married" which for the average teen is like saying "no sex until forever."

So... long-winded answer... I think this is a great idea from the AAP, but I think it's only a small part of the discussion that needs to take place.

Comment by Jonathan Wolfman on December 5, 2012 at 9:59am

Froggy   thanks so much!   

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