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Updated Tuesday, November 27, 2012 at 11:38 AM

Doctors: Teens should have access to emergency contraception

By Anna Edney
Bloomberg News

WASHINGTON — U.S. teenagers should be given prescriptions for emergency contraception to keep on hand in case they ever need it, the American Academy of Pediatrics said.

Emergency contraception, sold under the brand names Plan B and Next Choice, should be given to teens directly ahead of time, or they should get prescriptions that will allow them to have access to the drugs as needed, the doctors group said in a policy statement online Monday.

The pills are available now without a prescription to females 17 and older and males 18 and older. A move by the Food and Drug Administration (FDA) to allow emergency contraception to be sold over the counter to girls younger than 17 was rejected by Secretary of Health and Human Services Kathleen Sebelius in December 2011.

The American Congress of Obstetricians and Gynecologists said last week that oral contraceptives should be available without a prescription.

The Center for Reproductive Rights is awaiting a federal judge's ruling in Brooklyn, N.Y., on its lawsuit against Sebelius and the FDA to allow over-the-counter access to emergency contraception regardless of age.

"The point of this whole piece would be to reduce unintended pregnancy," said Cora Breuner, a member of the academy's committee on adolescence who was a lead author of the statement and a physician at Seattle Children's Hospital.

It's a pressing issue, Breuner added, because babies born to teens have been shown to fare poorly compared with their peers. Among other problems, they are more likely to do worse in school and suffer behavior problems such as truancy and early sexual activity.

Emergency contraceptives such as levonorgestrel, if taken within three to five days, can prevent pregnancy by stopping the ovary from releasing an egg or by stopping sperm from fertilizing an egg. The drugs are also thought to change the uterine lining, thwarting a pregnancy that might otherwise take hold, according to the National Library of Medicine.

But emergency contraception pills are most effective when they're used within the first 24 hours after unprotected sex, Breuner said, and teens are more likely to use them if they're readily available. That's why it's imperative to give teens prescriptions ahead of time so that, when condoms break or they forget to take their birth-control pills for more than two days, they can get the medication as soon as possible. Almost 80 percent of pregnancies in teens are unintended, resulting from contraceptive failure or nonuse, according to the statement to be published next month in the journal Pediatrics.

"That's tragic, really," said Breuner, a member of the academy's Committee on Adolescence. "We really can do better. By providing more education and improving access to contraception and more education about family planning, we can do better."

Teen pregnancies in the United States have declined over the past 20 years, according to data released this year by the Centers for Disease Control and Prevention (CDC). The birthrate among Americans ages 15 to 19 dropped 44 percent between 1991 and 2010, to 34.3 births per 1,000 women, the CDC reported.

But that's still about five times the teen birthrate in France and 2 ½ times the rate in Canada, according to United Nations data. It also is higher than the rates in China and Russia.


PATRICIA WALL / THE NEW YORK TIMES
Plan B One-Step emergency contraceptive.




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