The FDA announced today that it is approving Plan B for all girls age 15 and up without a prescription.
This is good news for girls in the US of A. The easier the access to contraception, the less likely girls will have an unintended pregnancy.
As many as 80% of pregnancies in teen girls in the United States are unintended. Most pregnancies are a result of non-use of contraception or mishaps with protection (condoms breaking, pills being missed and/or forgotten or used inconsistently). The birth rate for 15 to 19 year-olds is 34 out of 1000 and although only 13% of 15 year-olds say they have had sex, by the time children head out the door to adulthood, the majority (70%) say they have had sex.
Allowing the majority of teens access to Plan B seems a great step in the right direction in avoiding unintended pregnancies. I was thrilled to see the news tonight about the FDA shifting the age from 17 years down to 15 years. Some 10% of teens report being a victim of sexual assault, putting them at risk for unintended pregnancy.
The Academy of Pediatrics’ policy on emergency contraception has provided comprehensive insight on understanding, prescribing, and using emergency contraception.
What is “Emergency Contraception?”
Emergency contraception (EC) is the use of hormone pills after sexual assault, unprotected intercourse, or contraceptive failures.Teens and women can take EC after unprotected intercourse, failures in contraception, or after they have been forced to have sex. The pills work similarly to how they work when taken routinely to prevent pregnancy (“the pill”)–they prevent ovulation (eggs being released), disrupt the follicles in the ovary from working properly and ultimately prevent pregnancy from occurring.
Teens can take emergency contraception up to 5 days after sexual activity to reduce the likelihood of getting pregnant. It works best when taken early or even within 24 hours of sexual activity. This is precisely why we want teens to have EC on-hand.
Unfortunately, sexually active teens don’t use contraception like we’d like: only 60% state they used a condom the last time they had sex while 13% of teens state they didn’t use any contraception at all.
Emergency Contraception For Teens:
- Partnering with a doctor still helps, when teens get prescriptions for emergency contraception ahead of time they are more likely to use it to prevent a pregnancy.
- Studies find that teens who have access to emergency contraception are not more promiscuous and are NOT less likely to use routine birth control.
- Emergency contraception (Plan B) is now available over-the-counter for women & men over 15 years of age.
- Emergency contraception is often sold under the name Plan B, Plan B One Step, or Next Choice. These medications contain progestin (a hormone) and are generally very well tolerated. Side effects from these methods tend to be minimal–most often teens report a heavier menstrual cycle but reports of nausea and rarely vomiting should be mentioned as well.
- Teens and women can also be advised how to use combinations of their own birth control pills as emergency contraception (the Yuzpe method). These combination birth control pills may cause more side effects (nausea/vomiting). You can find out dosing info and read more about emergency contraception here at The Emergency Contraception Website.
- Emergency Contraception does not prevent or protect against any sexually transmitted diseases. Teens must use condoms as a barrier method to protect against sexually transmitted diseases.
- We want teens to know about emergency contraception. If a pharmacist or pediatrician is opposed to EC, they are obligated to inform teens and women about their use and direct them to a provider that can assist them.
Great news! I grew up in France and this is a step in the right direction for the USA!
Kathleen Berchelmann, MD says
Dear Dr. Swanson,
Your passion for speaking out for America’s youth is commendable, and I thank you for all your continued efforts, including this summary of today’s FDA announcement.
The mechanism of action (MOA) of Plan B is becoming an increasingly important issue. The AAP policy statement to which you link above also states that physicians should counsel patients on the mechanism of action of emergency contraception.
Most medical professionals and ethicists have come to believe that Plan B given in the fertile window works by primarily by preventing or blocking ovulation (and secondarily by prefertilization effects only or predominantly). This is not true.
Plan B’s own website states that Plan B One-Step works primarily by, ‘Altering the endometrium, which may inhibit implantation’ – the implantation of a human embryo. Because the American College of Obstetrics and Gynecology has defined pregnancy as implantation into the uterus, many health care professionals now feel supported in stating that Plan B does not cause termination of pregnancy, aka abortion.
Many patients would not want to take a drug that may prevent a human embryo from implanting in the uterus. Many Americans consider this a form of murder. Few patients understand the caveat that Plan B “doesn’t cause an abortion” only because pregnancy as been define as “implantation into the endometrium.” Out of respect for those who hold this view, a full explanation of the mechanism of action of Plan B should include its postovulatory effects.
Thank you for allowing me to contribute to this conversation.
Kathleen Berchelmann, MD
Mike Kruse says
This does not substitute for the need for parents to provide virtues to our children. I’ve been on dates with women who are unhappy with their previous experiences. I say “women”…. much less children. While we promote this as a “win”, a real win would be parents revisiting our virtues and values to promote saving ourselves for marriage. Sex is pleasure, but sex in marriage is a Vocation toward a deeper relationship and commitment.
Kate G says
I’ve had the pleasure of hearing you speak before (at the HIMSS conference in 2012), and I’m a regular reader of your blog.
I applaud you for speaking out on a very controversial topic. It’s one that many public figures tend to avoid it, which is unfortunate. I’m a parent, and although my daughter is an infant, I’ve already thought about how I will eventually approach these topics with her. As much as I’d love for her to wait as long as possible to become sexually active (it pains me to even write that), I don’t think that’s a realistic approach. Plan B can help prevent unwanted pregnancy, something that can absolutely derail a young woman’s future. While it would be ideal to avoid even having to take this step (through abstinence or preventative birth control methods), we need our daughters to have this option.
Zannah Merrill says
It’s important to teach our kids responsibility and having access to Plan B enables them to be responsible. These ages are a delicate balance as they learn to be adults, but limiting their ability to control their bodies and protect themselves from unintended consequences is simply throwing stumbling blocks in their way as they try to build lives for themselves. We want to support our children, teach our children, and build up our children- not tear them down.
As for Plan B causing abortion, most authorities do agree that implantation is the beginning of pregnancy, partly because many or most zygotes fail to implant naturally. If the mechanism is explained, as it well might be, than this piece of information is also pertinent.
Kathleen Berchelmann, MD says
Here’s an article by a St. Louis University OB/GYN that explains the science behind Plan B’s mechanism of action. Plan B, when taken in the fertile window, works not only by delaying or preventing ovulation but also by preventing implantation in the uterus. Here’s the “State of the Science”: https://www.truthandcharityforum.org/a-scientific-argument-against-the-use-of-plan-b-in-catholic-hospitals/
I’m just curious – are there any longitudinal studies showing if Plan B affects the reproductive system in the long run? I would imagine that using Plan B once wouldn’t have much of an effect, but what if it is used multiple times?
Bob Young says
I find the history of birth control within the recent lifespan of history [70 years or so] interesting.
In the early part of this period only the “rhythm method” was available and once not used for whatever reason [including unwanted sex and lack of rhythm] only natural or unnatural abortions which were both rarities ended pregnancies.
Attending these unwanted pregnancies then were rampant transmissions of sexual diseases throughout our population providing full time work for our then PHS [Public Health Service] which also tracked other life threatening diseases, which caused many latex condom manufacturers, who claimed then as now to be almost totally effective “if properly used as directed”. Use of these products taught in school either weren’t effective or the “rubbers” weren’t, or they weren’t used as is the case found to exist Globally where they are not used by choice, and in cases of rape as is said to be true in the U.S. One or the other must be true for 60% to claim they used condoms and had unwanted pregnancies.
The acceptance by the FDA of birth control pills was to be the defining moment, many decades ago and they have been available as they are now by prescription only, but with age limitations, while condoms have “come out from behind the counter” decades ago. Required to be clearly stated on each container of birth control pills must be the clear statement that they do nothing to prevent sexually transmitted diseases, which continue to be a National and international scourge to women and men.
Birth control pills were and are used in rape kits at police departments and hospitals for decades to prevent unwanted pregnancies in those cases where women reported rape in what you alone to my knowledge pointed out as the Yuzpe method, which was known by physicians and nurses for decades as a method to avoid unwanted pregnancies. This use for birth control pills costs much less than a “day after pill” offering choices to women, if they know the specifics, that would serve two purposes and be much less costly. If used only as a day after pill the cost would be about $10 per use compared to $60 per use for an over the counter day after pill. So why are hormones to provide unwanted pregnancies, many of which are in cases where finances are limited OTC, while birth control pills which can be used for a less expensive way to accomplish the same purposes still require a physicians visit, attending disclosure and a prescription that must be renewed annually?
It just makes no sense, except to “the day after” pill manufacturers!