In Jan. 2011, New York City quietly launched a pilot program to dispense free prescription contraceptives, including birth control pills and the morning-after pill, Plan B, to students at more than a dozen public high schools in the city.
The program, known as CATCH, for Connecting Adolescents to Comprehensive Healthcare, is an expansion of an existing, privately administered program that has run health centers in about 40 city schools over the past several years, offering students primary health care services as well as contraception, including oral birth control pills and Plan B.
In early 2011, CATCH launched in five New York City schools; this year, the program is in 13 schools. All schools were chosen because they are in neighborhoods that lack nearby clinics or health services or because they have high teen pregnancy rates. While public high schools around the country have offered condoms for students for years, CATCH is thought to be the first to provide contraceptive pills. The program works with city health department doctors and trained school nurses to give students a fuller range of contraceptive services, including pregnancy tests.
So far, city officials said, parents have not resisted the program. Parents were notified of the program by letter, and were given the opportunity to opt out by signing a form. Children of parents who don’t opt out can then visit the school nurse and receive contraception, or get a pregnancy test and Plan B after having unprotected sex, without explicitly notifying their parents. About 1% to 2% of parents have opted out, according to the health department.
“We’ve had no negative reaction to the CATCH program,” Deborah Kaplan, assistant commissioner of the health department’s Bureau of Maternal, Infant and Reproductive Health, told NBC News. “We haven’t had one objection. We’ve just had the opt-outs.”
During the 2011-12 school year, 567 students received emergency contraception and 580 received the birth control pill Reclipsen through the program.
Plan B is currently available without a prescription for teens aged 17 and older. Younger users must have a prescription. Last year, the Food and Drug Administration (FDA) was prepared to remove the age restriction, which would have brought Plan B from behind the pharmacist’s counter to store shelves and made it available for all teens. But the move was blocked by Health and Human Services Secretary Kathleen Sebelius, who said she thought there was insufficient evidence that the youngest girls fully understood how to use the drug appropriately.
The FDA’s advice was based on a review of data: one study involving 335 girls aged 12 to 17 showed that 72% to 96% of them understood the package label well enough to use emergency contraception safely and effectively one their own; another study of about 300 girls aged 11 to 16 also found that they could use the drug properly without the help of a doctor. But Sebelius said a significant proportion of American girls start menstruating earlier and could be in need of emergency contraception, yet may not be able to use it safely without consulting a doctor. Critics of Sebelius’s ruling say her decision was based in politics, not science.
Plan B contains a high dose of the progestin hormone levonorgestrel, the same hormone as in birth control pills. It is most effective when taken within 24 hours of unprotected sex, but can prevent pregnancy within 72 hours. Removing barriers to access — like having to get a prescription from a doctor — makes it more likely that girls will take the drug in time, or at all. As Healthland reported last December:
Making access easier is likely to increase use: in the two-year period after the FDA approved emergency contraception for over-the-counter sales, the rate of use more than doubled, compared with the four-to-six year period before that when it was available by prescription only, according to data reported by the Guttmacher Institute in April. Tellingly, the percentage of women who had discussed emergency contraception with a doctor did not change between the two periods, but the overall rate of use remained low, the study found.
As for the question of whether emergency contraception leads to more unsafe sex, at least one study of 15-to-20-year-old women who were provided with emergency contraception shows that preemptive access didn’t reduce pill or condom use — or increase the likelihood of unprotected sex. Abortion and teen birth rates are down as well, although it’s impossible to know how much of this can be attributed to the use of emergency contraception; given how few women use it, the impact is unlikely to be significant.
Overall, the data suggest that making Plan B as easy to get as aspirin will serve to benefit women’s health, without increasing harm. … Indeed, one could argue that it’s safer than aspirin: overdoses of over-the-counter painkillers like aspirin and ibuprofen can lead to serious liver, kidney or gastrointestinal problems, or even death. In contrast, it is impossible to overdose on Plan B. The drug is not used in the manufacture of illegal substances nor is it possible to abuse it like cough medicine. And although combination birth control pills containing both estrogen and progesterone are associated with a very slight elevation in stroke and blood clot risk, the progestin-only emergency contraception is not.
Critics of CATCH cited data suggesting that increased availability of emergency contraception could actually increase risky sex, and faulted schools for not doing enough to promote abstinence education. But many adolescent medicine experts lauded the program for proactively attacking the problem of teen pregnancy. “In New York City, over 7,000 young women become pregnant by age 17 — 90 percent of which are unplanned,” Alexandra Waldhorn, a health department spokeswoman, told reporters. “We are committed to trying new approaches, like this pilot program in place since January 2011, to improve a situation that can have lifelong consequences.”