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American Academy of Pediatrics Recommends Children and Teens Have Easy Access to Plan B

--by Nina Lincoff

Late last month, the American Academy of Pediatrics (AAP) released a statement that came as a surprise to many, but to pediatric physicians and teens, the announcement was most likely met with, “it’s about time.” Unequivocally, the AAP recommends that the emergency contraceptive Plan B be made readily available to children and teens, with the possibility of prescribing the drug in advance to ensure that patients have quick access if the need arises.

Using Plan B is relatively simple: take the oral contraceptive within five days of unprotected intercourse or intercourse during which the primary contraception failed, and the chance of pregnancy falls dramatically. The United States has the highest rate of teen pregnancy in the developed world, but greater access to Plan B could change that.

Critics say the AAP statement is a potential incentive for teens to start engaging in unprotected sex, but the fact is that many minors are already sexually active. The AAP reports that 43 percent of 15- to 19-year-old females have had intercourse, along with 42 percent of males in the same age group. And during those four years, the rate of intercourse drastically increases, from just 13 percent of 15-year-olds to 70 percent of 19-year-olds.

But there is a big difference in access for a 15-year-old and a 19-year-old when it comes anti-pregnancy medications. The legal age in the United States to purchase Plan B over the counter (OTC) is 17, but those younger than 17 must obtain a prescription.

The AAP aren’t the only ones backing greater access to Plan B.

“It’s about time,” says Sydney Spiesel, Ph.D., M.D., a professor of clinical pediatrics at the Yale University School of Medicine. “Kids and adults do things impulsively and sometimes thoughtlessly. Kids in particularly are not well developed in thinking of long-term consequences,” he says, “and then they have that sort of ‘oh my god' moment.” It’s unnecessary to make it harder to get Plan B for those who've made a mistake, says Spiesel.

“I believe in empowering people, and there is no doubt in my mind that this should be over the counter [for all],” he says.

The controversy over access to Plan B echos debates about contraception that have being ongoing for decades, but the drug itself is relatively new.

Plan B, or the morning after pill, was the first progestin-only contraceptive. Progestin is a hormone used to treat both men and women for a variety of conditions, but in the emergency contraceptive pill, it takes the form of levonorgestrel. The pill largely works by stopping the release of an egg from the ovaries, though it can also block sperm from fertilizing an egg or keep a fertilized egg from implanting itself in the walls of the uterus.

Since 1999, there has been a Food and Drug Administration-approved oral emergency contraceptive. Originally, the drug, named—without apparent irony— Plan B, consisted of two pills to be taken within 72 hours of intercourse. It was manufactured by Barr Pharmaceuticals, before the manufacturer's 2008 acquisition by Teva Pharmaceuticals.

At first, Plan B was prescription-only. In 2003, Barr applied to make the drug available OTC, and late that year an FDA committee voted 24-3 to move Plan B to OTC. But in May of the following year, the FDA switched positions, citing inadequate data on the effects of the drug on girls 16 and younger.

Five years later, a federal judge said that Plan B must be OTC to those 17 years and older, and urged that all age restrictions be removed. However, since the 2009 ruling, the push to make Plan B universally available without a prescription has stalled. When the FDA again reversed course and recommended the pill be available OTC for everyone in 2011, the agency was overruled by Health and Human Services Secretary Kathleen Sebelius. It has since been mired in a larger national debate about contraception, abortion, and the right to choose.

Whether or not the AAP statement on Plan B tips the scales in favor of universal availability, Spiesel hopes that doctors "are completely respectful of children’s needs and desires on this topic and would understand that unwanted pregnancy is a disaster for everyone in sight.” Ideally, he says, a sensitive doctor will “explore with a young person what’s going on with their relationship with their parents, keeping a line open between parent and child. [But] the bottom line is that it’s up to the kid.”

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Tags: Awareness , Drugs , Public Health & Policy

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