Will discussing and prescribing emergency contraception help lower teen pregnancy in the U.S.?
Despite declines over the past few decades, the rate of unintended teen pregnancy in the U.S. remains the highest in the developed world. So the American Academy of Pediatrics (AAP) is recommending that pediatricians discuss emergency contraception with teens and make it more available — perhaps even by advance prescription — to those teens who are becoming sexually active.
The AAP’s policy statement addresses concerns that many pediatricians have, including the promiscuity effect: If they discuss emergency contraceptive use with their teen patients, will that lead them to become more sexually active?
“We have no data showing that,” says Dr. Cora Collette Breuner, a professor of pediatric and adolescent medicine at the University of Washington and one of the statement’s lead authors. “Because of the adolescent mind and brain, teens don’t think in the abstract. They don’t think, ‘I need to be careful because I might have sex tonight.’ They can make impulsive decisions.”
Teens are at high risk of having unprotected or underprotected sex, which includes instances of sexual assault. They’re also prone to experience contraceptive failure, making emergency contraception an important backup method. Drugs including Plan B One-Step and Next Choice are considered effective up to 120 hours after unprotected sex, but they work best when used as soon as possible. That’s why the AAP suggests doctors consider giving teens prescriptions or a supply of contraceptive medication, just in case.
Access to emergency contraception (EC) varies. Plan B, which prevents fertilization, is available over the counter to anyone 17 or older. Teens younger than 17 need a prescription. Some forms of prescription EC require women to take a pregnancy test first.
Those choices may contribute to the confusion over EC, particularly among teens. Recent research shows that just about half of U.S. teens are aware of emergency contraception as an option. And pediatricians aren’t as educated about the various methods available as they could be either. “A lot of people still do not know about it — even my colleagues!” says Breuner. “The education piece is still sorely lacking.”
The availability of EC should be discussed proactively with teens at pediatric visits starting at age 12, says Breuner, who dismisses the suggestion that the subject is a controversial one.
But in a concession to the fact that not all pediatricians may be comfortable discussing sex and contraception with their young patients, the policy statement notes that doctors may share information about EC based on their personal beliefs about teen sex.
A study published in 2009 demonstrated that the decision to provide emergency contraception at a time of need but not in advance of need may be related to the physician’s beliefs about whether it is O.K. for teenagers to have sex. Often, physicians hold conflicting values when approaching reproductive-health issues with teenagers. Physicians may object to unprotected intercourse or intercourse outside of marriage, but they may also feel the need to prevent teen pregnancy.
Discussing EC is no different than doctors discussing drug-and-alcohol use and smoking or inquiring about depression or suicidal feelings or urging their teen patients to wear helmets while biking, says Breuner. “This is not about saying a 12-year-old should be given a prescription for emergency contraception,” she says. “We are recommending that pediatricians start talking about some of the things that promote happy and healthy living for teenagers. This is about prevention.” And hopefully continuing the trend in declining teen pregnancy.