* In U.S., girls must be 17 to buy them over-the-counter
* Having script on hand doesn't increase teen sex, studies
By Sharon Begley
NEW YORK, Nov 26 Wading into the incendiary
subject of birth control for young teenagers, the American
Academy of Pediatrics (AAP) on Monday called on the nation's
pediatricians to counsel all of their adolescent patients about
emergency contraception and make advance prescriptions for it
available to girls under 17.
Because current federal policy bans over-the-counter sales
of the pills to girls under 17, having a prescription on hand
could help younger teens obtain emergency contraception more
quickly than if they have to contact a physician only after they
Calling the AAP decision "significant," Susan Wood, former
assistant commissioner for women's health at the Food and Drug
Administration (FDA), said, "it's not often you see physician
organizations saying that their patients are better off without
the physician involvement."
The announcement was controversial with some religious
"Since when should the physicians take over the
responsibility of what parents should be doing?," said Michael
O'Dea, founder and executive director of Christus Medicus
The non-profit foundation provides consulting services to
health plans which wish to avoid payments to physicians and
hospitals for providing abortions, sterilization, contraception
and other services it considers inconsistent with biblical
"Parents are the primary educators of children, not
physicians or the government," O'Dea said. "This is a violation
of parents rights to be the primary educator of their children."
The United States Conference of Catholic Bishops, which
represents the country's Catholic church leadership, called the
"It is a very sad day when physicians think that "good
medicine" is to attack an adolescent girl's healthy fertility
with potent drugs just to prevent a possible pregnancy," said
Theresa Notare, assistant director for the Conference's Natural
Family Planning Program.
"This recommendation becomes tragic when we consider that
the recommendation is built upon overriding a parent's rights
over their own children," she said.
Whether pediatricians heed the recommendation remains to be
"Some pediatricians are already doing this," said Dr.
Melissa Kottke, director of The Jane Fonda Center for Adolescent
Reproductive Health at Emory University and medical director for
the teen services program at Grady Memorial Hospital in Atlanta
where it is common practice to provide Plan B, "a morning after
pill", in an advanced fashion.
"Pediatricians who primarily take care of adolescents may
already be comfortable with it but what this recommendation does
is provide encouragement and support for pediatricians who take
care of the full spectrum of pediatrics."
Dr. Cora Breuner, a pediatrician at Seattle Children's
Hospital who led the AAP panel that produced the recommendations
said pediatricians in general have preferred not to talk about
emergency contraception, let alone offer advance prescriptions.
"We tend not to like bringing up stuff that's
controversial," she said.
Emergency contraception for adolescents has been one of the
most politically fraught areas in healthcare for almost a
In 2005 the U.S. Food and Drug Administration declined to
approve any over-the-counter sales of Plan B, overruling its
panel of outside experts as well as its own scientists. Last
December the FDA reversed that stance and moved to approve
over-the-counter sales with no age limits. But Health and Human
Services (HHS) Secretary Kathleen Sebelius overruled it,
ordering that for girls under 17 the pills remain available only
The FDA subsequently denied a Citizen's Petition that would
have allowed over-the-counter access to emergency contraception
for women of all ages.
As a result, teenagers "face a significant barrier if they
suddenly need emergency contraception at midnight on a
Saturday," said Susan Wood, former assistant commissioner for
women's health at the FDA. She resigned from the agency in 2005
over its Plan B decision and is now director of the Jacobs
Institute of Women's Health at George Washington University in
The Center for Reproductive Rights, a global legal advocacy
organization devoted to reproductive rights, has filed a lawsuit
seeking to overturn Sebelius' decision and welcomed the AAP
"We are very pleased to see this recommendation because it
represents progress towards our ultimate goal which is that
women of all ages should have unrestricted access to emergency
contraception, said Janet Crepps, senior counsel in the U.S.
legal program at the Center.
Women's advocates also hailed the recommendation, saying it
offers a workaround current health policy which places
unnecessary hurdles in the way of young teenagers obtaining
"This shames the department of Health and Human Services and
its nakedly political attempt to override science and medicine,"
said Terry O'Neill, president of the National Organization for
Women, a non-profit advocacy organization. "HHS's policy means
doctors have to use this workaround, and good for them, but they
shouldn't have to do it," she said.
A spokeswoman for HHS, Erin Shields Britt, declined on
behalf of the department to comment.
The most common form of emergency contraception is a high
dose of a regular birth-control pill such as Plan B and Plan B
One-Step from Teva Pharmaceutical Industries Ltd
or Next Choice from Watson Pharmaceuticals Inc
. They generally sell for $10 to $80 and, although they
can work as long as 120 hours after unprotected sex, are most
effective in the first 24 hours.
All work by preventing ovulation, not by stopping the
implantation of a fertilized egg. "These are not
abortifacients," said Seattle Children's Breuner. Abortifacients
are drugs or devices used to cause abortion.
GREATER USE OF EMERGENCY CONTRACEPTION
A 2006-08 survey found that 14 percent of sexually
experienced girls had used emergency contraception, up from 8
percent in a 2002 survey. The most common reason was condom
failure, but 13 percent of the girls said it was because of
A 2010 analysis of seven randomized studies of emergency
contraception found that having a morning-after prescription in
hand did not increase teens' sexual activity or decrease use of
standard contraceptives but did increase use of the pill and
shorten the time before a teenager used it after sex.
"It's just common sense that requiring a prescription is a
barrier," said Bill Alpert, chief program officer of the
National Campaign to Prevent Teen and Unplanned Pregnancy. "If
an august and respected medical group like AAP is suggesting
providing emergency contraception to minors is OK, that is a big
That is especially so when teens face other obstacles to
getting emergency contraception. For instance, in a 2012 study
that had 17-year-olds telephone pharmacies asking about
morning-after pills, only 57 percent of them correctly told the
caller that she could get the drugs without a prescription.
Another barrier is that some physicians refuse to provide
the prescriptions to teenagers, while others do so only in cases
of rape, AAP's research shows, suggesting that the refusal "may
be related to the physician's beliefs about whether it is OK for
teenagers to have sex."
But pediatricians, said AAP in its policy statement, "have a
duty to inform their patients about relevant, legally available
treatment options," even those "to which they object."
One factor in the AAP's recommendation, which is being
published in the journal "Pediatrics," is that although teen
pregnancies in the United States have declined since 1991, the
rate is higher than in most other developed countries.
The percent of 15- to 18-year-olds who report ever having
intercourse - just over 40 percent, according to the U.S.
Centers for Disease Control and Prevention - is, however, lower
than in many developed countries. In other words, fewer of
America's teens are having sex but more are getting pregnant.
"We think this is a big deal," Breuner said of the new
recommendation. "The mothership of pediatricians has come out in
favor of encouraging routine counseling and advance
emergency-contraception prescriptions as one part of a public
health strategy to reduce teen pregnancy."