WEST PALM BEACH, FL, December 10, 2011 – The issue of legislating morality is again hitting the headlines. This time, the question is whether pharmacies should make the Plan B One Step pill available to all customers, or whether they should limit its sale to customers over 17.
Currently, Plan B One Step pill prevents pregnancy by restricting ovulation or blocking the implantation of a fertilized egg when taken within 72 hours of having unprotected sex. The so-called “morning after” pill is available without a prescription to customers over 17 years old.
Controversy ignited this week when the FDA decided to allow stores to sell the pill to all customers, even those under 17. Things then inflamed when Health and Human Services Secretary Kathleen Sebelius overturned that decision.
The FDA decided to provide full access to the drug after agency studies found adequate science-based evidence that “Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of childbearing potential.”
Opponents of making the pill widely available pulled out all the stops arguing everything from science to religion to parental rights. They say the package instructions are confusing to minors and that minors did not participate in the trials. They say greater accessibility undermines parental rights.
They say the pill is equivalent to abortion, which is morally wrong.
The real argument is not about safety or efficacy, but a woefully misinformed attempt to change behavior. Opponents believe that making the pill available to everyone means that young girls are more likely to engage in high risk sexual activities. The corollary argument to that is that if the Plan B drug is not available, girls will not engage in high risk, unprotected sexual activities.
That is just plain wrong.
The fact is that teenagers are sexually active, and recent studies show that most sexually active teens take precautions. According to the Kaiser Family Foundation, 46% of high school students in 2006 were sexually active. Approximately 20% of high school students have had more than one sexual partner. Nearly 80% of those who are sexually active said they used a condom in their last sexual encounter.
Young girls – girls under 17 – who are sexually active are highly unlikely to take Plan B into account when they are deciding whether or not to have sex. If they are planning ahead, they are far more likely to use condoms or oral contraceptives, which are readily and easily available through Planned Parenthood or other outlets.
20% of sexually active teens use oral contraceptives. Condoms and oral contraceptives are also socially acceptable.
If they are making a calculated decision, they are unlikely to consider the option of Plan B rather than more traditional contraceptive options.
But not all teenagers use contraception, and even if they do, accidents occasionally happen. The pregnancy rate in the United States for 15 – 19 year olds was 71.5 per 1,000, one of the highest rates in the world. Less than 11% of high school students say they have used the Plan B pill.
The abortion rate in the United States during the same time was 19.3 out of 1,000.
Introducing parental rights into the equation is tricky. In an ideal world, parents and children discuss healthy sexual activity, problems with risky sexual activity, and how to make good decisions. Unfortunately, the real world does not necessarily reflect that ideal.
Many teenagers do not have positive relationships with parents that enable them to discuss difficult issues openly.
If a teenager makes a decision to engage in high risk sexual activity, it is highly likely she does not have the access to talk to a parent about Plan B after that sexual activity. A positive parent-child relationship generally means discussion before the teenager engages in unprotected sex. For a minor who chooses to engage in unprotected sex, the idea of confessing to a parent may be more traumatizing that visiting an abortion center – 15 states still do not require parental notification or consent — or simply ignoring the possibility of pregnancy until it is too late.
In extreme cases, girls are so afraid of talking to their parents about sexual activity that they hide their condition even when they are pregnant, and then kill or attempt to kill the baby, sometimes after an undisclosed birth. Accurate statistics on the number of neonatacides, killing of infants less than 24 hours old, each year are difficult to access, because of the number of undetected deaths. The Department of Justice reports 250 cases a year, but other groups such as A Safe Haven for Newborns estimate that the number is much higher.
90% of neonatacides by a mother are by women under 25 years old.
Requiring a minor to receive parental approval for contraceptives does not make her less likely to engage in sexual activity. Planned Parenthood polled minor patients in Wisconsin about what they would do if they had to notify their parents that they were using contraceptives.
According to Planned Parenthood, “Nearly half said they would stop going to the clinic. Many others said they would stop using any sexual health care service. But only one percent said they would stop having sexual intercourse.”
The best scenario is where minors, and adults, avoid risky sexual activity. Ideally, minors and parents have strong relationships that help minors make good decisions and guide them toward healthy lives. Ideally, no one ever needs Plan B.
However, in the real world, women – even minors – sometimes need a Plan B. Failing to make options readily available does not change behavior. It just gives fewer options.