NEW YORK (Reuters) - Wading into the incendiary subject of birth control for young teenagers, the American Academy of Pediatrics (AAP) on Monday called on the nation's pediatricians to counsel all of their adolescent patients about emergency contraception and make advance prescriptions for it available to girls under 17.
Because current federal policy bans over-the-counter sales of the pills to girls under 17, having a prescription on hand could help younger teens obtain emergency contraception more quickly than if they have to contact a physician only after they need it.
Calling the AAP decision "significant," Susan Wood, former assistant commissioner for women's health at the Food and Drug Administration (FDA), said, "it's not often you see physician organizations saying that their patients are better off without the physician involvement."
It is anyone's guess whether pediatricians will heed their organization's recommendation, but AAP leaders are optimistic.
"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 healthcare for almost a decade.
In 2005 the FDA declined to approve any over-the-counter sales of Plan B, a "morning-after pill," overruling its panel of outside experts as well as its own scientists. Last December the FDA reversed that stance and moved to approve over-the-counter sales with no age limits. But Health and Human Services Secretary Kathleen Sebelius overruled it, ordering that for girls under 17 the pills remain available only by prescription.
The policy means that women in their 20s, 30s, or beyond must also present proof of age, and that teenagers "face a significant barrier if they suddenly need emergency contraception at midnight on a Saturday," said Wood, who resigned from the FDA in 2005 over its Plan B decision and is now director of the Jacobs Institute of Women's Health at George Washington University in Washington, D.C.
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, although they can work as long as 120 hours after unprotected sex, 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.
GREATER USE OF EMERGENCY CONTRACEPTION
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 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 having a morning-after prescription in hand did not increase teens' sexual activity or decrease use of standard contraceptives but did increase use of the pill and shorten the time before a teenager used it after sex.
"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, in a 2012 study that had 17-year-olds telephone pharmacies asking about morning-after pills, only 57 percent of them correctly told the caller that she could get the drugs without a prescription.
Another barrier is that 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."
But pediatricians, said AAP in its policy statement, "have a duty to inform their patients about relevant, legally available treatment options," even those "to which they object."
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."
One factor in the AAP's recommendation, which is being published in the journal "Pediatrics," is that although teen pregnancies in the United States have declined since 1991, the rate is higher than in most other developed countries. The percent of 15- to 18-year-olds who report ever having intercourse - just over 40 percent, according to the U.S. Centers for Disease Control and Prevention - is, however, lower than in many developed countries. In other words, fewer of America's teens are having sex but more are getting pregnant.
"We think this is a big deal," Breuner said of the new recommendation. "The mothership of pediatricians has come out in favor of encouraging routine counseling and advance emergency-contraception prescriptions as one part of a public health strategy to reduce teen pregnancy."
(Reporting by Sharon Begley; editing by Prudence Crowther)
I still cannot fathom why anyone should listen to what doctors who are "in bed" with farmaceutical companies say when it comes to issues which should be strictly parental decisions and a matter of proper upbringing and correct moral values. In addition, the morning after pill, as some studies have shown, can cause cervical cancer down the road, just like the HPV vaccine that is being pushed on adolescent girls (and now even boys). Why would any parent in his/her right mind give this garbage to their own child? I have only one thing to say to these awful bedfellows: poison your own kids, not ours! And this applies to both drugs and moral decadence that you are trying to propagate.
I agree with FireSign and disagree with the AAP. Underage minors often times are unable to make intelligent and rational decisions on their own (and decisions affecting their health raise the stakes higher. For example if a minor waited 2 weeks after having unprotected sex to use Plan B and the embryo has already implanted in her uterus, then there could be harmful consequences to mother and baby), which is why 18 is generally the voting age, marriage age, etc.
Exactly! Scientists have proven that the brain is not entirely developed even in teenagers, and many are not capable of fully understanding the consequences of their choices. "The doctor said I could have it" is just the kind of thinking a teenaged girl "in love" would have if offered birth control. The doctor offering it makes it okay, which also means the consequences are not what Mom and Dad said they might be. Since the doctor isn't the one suffering the consequences - unwanted birth, or even worse an abortion that may affect her ability to have children in the future when she's ready - then the doctor should shut up. I think it would be a very good idea if the pediatrician talked to the parents first. If the parents are okay with it - and some are - then fine. Otherwise, physicians should stop not only playing God, but also stop playing parents to children that are not theirs.
To all Pediatricians who would counsel my daughter about sex:
Thanks for encouraging her to have sex, which is against my wishes. This is not your job. If she gets sick, that is your job. Raising her and instilling values in her is not your job. She is a dependent. If she does get pregnant after taking your advice, or using your pills, I'll send you the baby to raise. There is no use destroying her life due to your ill advice.