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Archive for Monday, December 10, 2012

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Double Take: Parents should consider Plan B guidance

December 10, 2012

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Dr. Wes: Longtime readers of Double Take know my position on birth control, honed over 20 years of dealing with unplanned pregnancies, some with kids as young as 13.

Regardless of your position on abortion, the fact remains that one-fourth of teen pregnancies end this way, and very few young people emerge unaffected by that experience. Most elect to keep their babies and to struggle with all the problems that young parenthood entails for them, their families and society.

Thus, one of the most epic events for teens in the last ten years has been the advent of emergency contraception, most notably Plan B. While the under-17 crowd requires a prescription in all 50 states to use it, I personally know of parents who keep Plan B in their home with a no-questions-asked policy. Liberal hipsters? Not hardly. Some are pro-life conservatives who want to avoid the prospect of an abortion at all costs. But most are just pragmatic.

To be clear, emergency contraception is exactly that. It’s not a substitute for a sensible, sustained approach to birth control. Nor should it take the place of the lifelong conversation about sex we always recommend parents have with their kids. It won’t prevent STDs.

Still, Plan B has its place. Common sense is not at full flourish among teens, and learning from mistakes is the rule, not the exception. There is also a substantial connection between alcohol use and sex among teens. Pregnancy should not be a consequence for foolishness.

On Nov. 26, the American Academy of Pediatrics placed itself firmly in this camp. In the journal Pediatrics, the Academy officially recommends that doctors begin prescribing emergency contraception in advance for all teens so they can access it within 120 hours of sexual contact.

This will, no doubt, stir controversy. Some will argue that such a policy condones or even encourages sexual expression among kids who are not yet ready to handle it. Yet teens have been having sex forever and suffered the consequences, and all that good logic hasn’t really made an impact. Contraception has.

AAP’s position is not the optimal solution. But it is the smart one.

Katie: I can see the scene playing out in the pediatrician’s office: The doctor is telling a not yet sexually active patient about her options regarding sexual safety, offering a prescription for emergency contraception, “just in case,” the young patient’s face turning redder and redder. At last her mother intervenes, “I don’t think she’ll be needing a morning-after pill anytime soon.”

Maybe the mom is right — her daughter may be one of the many teenagers who don’t become sexually active until after they turn 17, when women can buy emergency contraception over-the-counter without a prescription. However, there’s also a good chance she’s wrong. The AAP is merely suggesting that given the risk of unintended pregnancy from unprotected sex, a broken condom or rape, it’s best not to take chances.

Doctors are obligated to present patients with the information and advice they need to make educated decisions about their health. That includes educating young women about emergency contraception — which, by the way, does not induce abortion, but rather prevents fertilization. If it’s possible to improve access to contraception in case of emergency, teens and their families have a right to know.

Without a pre-written prescription for emergency contraception, girls have to visit their doctors during the short window of time between having sex and taking the pill, which is more effective the sooner it’s started. That includes the lag time before the teen tells her parents or schedules an appointment on her own. If the sexual contact occurred on a Saturday night, it could be Monday before the girl can get a prescription.

Knowing she can easily obtain Plan B isn’t likely to increase or accelerate a teen’s sexual activity. Emergency contraception is like a fire extinguisher, not something the average teen expects (or wants) to use on a regular basis.

But if that panicked “morning after” does come for a young woman before she turns 17, at least she can be prepared.

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