By Michael Yudell
In a move sure to rankle anti-birth control activists, the American Academy of Pediatrics, one of the nation’s foremost expert groups on child and adolescent health, recommended Monday that its members provide emergency contraception to “teenagers in immediate need” and also write prescriptions, in advance, for emergency contraception “for teenagers to have on hand in case of future need.” The move seeks to skirt a federal ban on over-the-counter sales of emergency contraception to girls under 17 and to educate physicians on the use, safety and efficacy of these pills.
This is good public health.
Why? Because it depends on science, mixed with compassion and understanding, to address two persistent and interrelated public health challenges: how to empower young women to prevent unwanted pregnancies and how to lower abortion rates that remain way too high in the United States.
Emergency contraceptive pills, generally sold in the U.S as Plan B One-Step or Next Choice, are not abortifacients (they should not be confused the abortion pill RU-486) and thus do not abort the fertilized egg. Instead, the pills, which contain a synthetic hormone similar to birth control pills, prevent ovulation – and, therefore, pregnancy – about 85 percent of the time when taken within 72 hours of unprotected sex. The pills won’t work if you are already pregnant, and they should not be used for regular birth control. Side effects are similar to standard birth control pills.
The pediatrics academy's announcement comes in the wake of a Food and Drug Administration recommendation, just under a year ago, that called for emergency contraception to be available for all girls of reproductive age but was overruled by Kathleen Sebelius, secretary of the Department of Health and Human Services. Her decision kept in place the existing policy, which allows women 17 and over non-prescription access to the pills.
You may remember the controversy surrounding the ruling. Sebelius' boss, President Obama, the father of two adolescent girls, weighed in the next day, using unusually personal language, in support of the HHS secretary. FDA Commissioner Margaret Hamburg, whose agency is part of HHS, had no choice but to agree with Sebelius' ruling on emergency contraception. But she nevertheless issued a written statement that stood behind the science that led to the FDA recommendation, saying, that her agency’s scientists had “determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted disease.”
A key scientific issue here, and the flashpoint in the debate, is the science of behavior. And these positions – the FDA's recommendation last December and now the pediatric academy's – are indeed strongly supported by the science. A review of relevant literature on the use of emergency contraception by adolescent and young adult women by scientists from the University of Pittsburgh School of Public Health found that providing the pills before sex rather than after it had no effect “in ongoing contraceptive use or risky sexual behavior.”
Speaking to NBC news, Arthur Caplan, head of the division of medical ethics at NYU Langone Medical Center, formerly of Penn, said Monday that he believes that "having emergency contraception readily available will surely lead to fewer young women getting pregnant and fewer abortions.” Caplan points out that "improvements in medicine are shifting the arena for discussing reproductive ethics from abortion clinics and surgical procedures to choices made by individual women talking to their doctor, nurse, pharmacist and others whom they trust. Those on all sides of contraceptive availability need to come to terms with this new moral reality.
Whether this new reality will spur pediatricians to talk more openly with young women about this and other birth control options is another story. Will these recommendations take hold among pediatricians? Will the use of emergency contraception lower unwanted pregnancy and/or abortion rates? Time, and more studies, will tell.
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