The age group that needs it most.

by Emily Willingham  

In December of 2011, Kathleen Sebelius, the Obama Administration’s Health and Human Services secretary, shocked the reproductive health community by blocking a bid to make Plan B, or “morning after” contraception, available over the counter (OTC) to teens under age 17. The much-anticipated OTC availability of this intervention to this age group had already received FDA approval. Sebelius’s countermove against the FDA’s OK-and against the expert advice of a large number of medical professionals, including the American Academy of Pediatrics (AAP)-did not go over well. One member of the AAP called her decision “medically inexplicable.”

Today, a federal judge has overturned that decision, saying that in making it, Sebelius appears to have bowed to “political pressure.” According to a report at Medpage Today, the judge wrote in his opinion that

“Secretary Sebelius’s directive to the FDA … forced the agency to ride roughshod over the policies and practices that it has consistently applied in considering applications for switches in drug status to over-the-counter availability.”

At issue was an order from Sebelius denying an application allowing sales of Plan B to girls under age 17. Her decision countermanded a previous ruling by the same federal judge, Edward Korman, that the FDA had to make Plan B available over the counter without an age 17 lower limit.

Sebelius’s 2011 decision left many observers baffled. According to a report from ABC, Sebelius said that she was “worried about confusing 11-year-olds.” With that logic, a girl who’s too young to understand how to purchase and take a pill would somehow still have the wherewithal to be a parent?

We’re in an era when girls are becoming able to conceive at earlier and earlier ages. Having an intervention available that prevent a pregnancy in a young girl is a logical and reasonable option, and the AAP agrees, urging that teens have access to emergency contraception. Issues of responsibility or morality or gnashing of teeth over their youth do not efface the cold hard facts: Some girls are having sex at this age. Some girls are getting pregnant at this age. Their hormones are actively readying them for sexual activitiy and pregnancy, even as their minds and the society in which they live have not. They deserve, just as much as any 17-year-old or grown woman, access to interventions that can keep them from conceiving. It’s easy to say from an airmchair that they shouldn’t be having sex. Of course they shouldn’t. But some are, and that is a simple, stark reality.

And they have been for a long time. If Kathleen Sebelius had attended the middle schools I did, she’d have seen it for herself. She’ve seen girls, ages 12, 13, 14, who were pregnant, in exactly the age range most likely to have unplanned and unprotected sex. She’d’ve seen girls who’d just crossed the threshold into their teen years talking, simultaneously knowing and naive, about having sex with boys, even with grown men, all unprotected. She’d’ve seen a cheerleader on her first day of class in 9th grade, clearly pregnant in her cheerleading uniform. She’d know that these girls who got pregnant disappeared from school, never to be seen again. Their pregnancies meant a life-a very young, uninformed life-derailed. Given their ages, I suspect that their pregnancies derailed more than the one life.

That one night that a high-school freshman drinks too much, depresses her judgment, and has unprotected sex? That night leads her (but usually not him) to a crossroads. The young teenager who’s pressured by an older boy or man to have sex, which is most likely among the youngest teens? That leads her (but usually not him) to a crossroads. As many as 10% of teens are victims of sexual assault. They all deserve access to safe, effective emergency contraception. With this judge’s decision, the crossroad now offers a path to Plan B. It’s far preferable to another crossroad of decisionmaking between an invasive procedure like abortion or having a child, which is particularly dangerous for teens. According to data from the Guttmacher Institute, in 2006, the teenage abortion rate was 19.3 abortions for every 1000 women.

Plan B, which the AAP describes as having few side effects, none of them dangerous, is far safer than the other options. Teenage pregnancy carries more than a risk to socioeconomic stability and education for both mother and child. It also carries a large number of health risks for both, as well. These include a higher risk of developmental disorders, prematurity, and low birthweight for the child and a higher risk of sometimes-fatal pregnancy complications for the girl. According to a recent report, girls under age 15 are five times more likely to die in pregnancy than adult women in their 20s, and pregnancy kills an estimated 1 million teenage girls each year worldwide.

Some moralists may claim that a girl (but not boy or man) who has unprotected sex must deal with the consequences of it, or that the availability of emergency contraception will make teens more likely to have sex. The AAP states that studies have found no evidence of increased teen sexual activity with the availability of emergency contraception. More important, a child is not a consequence, death is not a “consequence,” and the girl in question is herself not yet an adult. Biology ran its course and led to the sex act, and the female of our species is the one who gestates. In our society, that translates into her also being the one who is “punished” for what was (often but not always) a mutual behavior. That misguided interpretation of biological reality doesn’t mean that the girl shouldn’t have a fundamental right to a safe way of determining the outcome and course of her life and health.

Some people seem to be unaware of these outcomes for a teen pregnancy for both the mother and child. When Sebelius made her 2011 announcement, Chuck Grassley, the Republican US senator from Iowa, was quoted in an AP story as saying, “This is the right decision based on a lack of scientific evidence that it’s safe to allow minors access to this drug, much less over-the-counter.” Clearly, the gentleman from Iowa needs a few instructions in how reproduction and contraception work. The “drug” is hormones, tiny amounts of mimics of the hormones these teens make in their bodies already. These hormones have several effects on reproductive tissues that can prevent conception. Plan B does not cause an abortion and does not prevent implantation. It works by preventing conception itself. There’s no mystery about it and no question of available evidence. Here is a nice video for the gentleman from Iowa and anyone else who is confused:

What the gentleman from Iowa-and his fellow moralists-fail to understand is that becoming pregnant, carrying a child to term, and having a baby all are far, far more damaging to the health of a teenager than any Plan B pill ever would be. Making Plan B available to teens under age 17 is a data-driven, evidence-based decision, given that this group remains the most likely to engage in unplanned, unprotected sex. In addition, its OTC availability for this age group gives access to a demographic that through fear or discovery (or worse) or embarrassment might find it difficult to access it through a prescription.

[A different version of this post appeared at The Biology Files in 2011,when Sebelius’s decision was announced.]

Image credits: Thumbnail and large homepage image and image of Kathleen Sebelius, Wikimedia Commons.

Addendum: Post updated with italicized text at 11 pm EST: “shocked the reproductive health community by blocking a bid to make Plan B, or “morning after” contraception, available over the counter (OTC) to teens under age 17. The much-anticipated OTC availability of this intervention to this age group” and the addition if the final sentence of the post.