Teen girls should get advance prescription for morning-after pill, pediatricians recommend

By Deborah Kotz, Globe Staff

On the heels of a gynecologist group’s recommendation to make birth control pills available over-the-counter and potentially available to teens without a prescription, another group of doctors has called for teenage girls to get a morning-after-pill prescription during their annual physical -- just in case they might need it when a condom breaks.

As the mother of a 17-year-old girl, this latest recommendation by the American Academy of Pediatrics sets off some pretty strong warning bells. Should parents and doctors send teenage girls the message that it’s okay to skip effective contraception if you have a Plan B?

(That’s, of course, assuming that parents have already faced the squeamish reality that their teen is having sex and needs birth control.)

But the new recommendation does make sense if you consider the public health goal of reducing the number of unplanned pregnancies and abortions. The morning-after pill is already available to girls 17 years of age and older without a prescription as long as they show proof of their age to a pharmacist. Government efforts to move Plan B over the counter without any age prescription -- which was endorsed last year by FDA head Margaret Hamburg -- never came to fruition.

Emergency contraception like Next Choice or Plan B doesn’t cause a termination in a pregnancy that’s already established, so it’s not akin to green-lighting a form of abortion. The product most recommended for teens contains a high dose of a form of estrogen called levonorgestrel, causes milder nausea than older versions that contain a combination of hormones, and doesn’t require a pregnancy test before taking.

Doctors should also serve to educate teens about how to use the product, the pediatrics group recommended, which will increase the chances that girls will use it when needed. Teens should be told, for example, that the pills are most effective at preventing pregnancy if taken within 72 hours of unprotected sex but can be taken up to five days after intercourse.

This education can help those who are most in need of emergency contraception: Teens are at greater risk of contraceptive failure and unplanned pregnancies than women in their 20s and 30s, according to the latest research; studies have also demonstrated that girls who have easy access to emergency contraception have a lower likelihood of having an accidental pregnancy.

The product can also help prevent pregnancies in teens who are sexually assaulted -- often by someone they know. One study found that 13 percent of adolescent girls who used emergency contraception did so because they were forced to have sex.

I would hope that those teens also get counseling and help from loved ones and doctors, but many teens don’t tell anyone if they’ve experienced date rape or incest at the hands of a relative or family friend.

Unfortunately, the biggest hurdle to implementing this new recommendation may not be the objections of parents -- but the objections of pediatricians who don’t feel comfortable writing a Plan B prescription for a 15-year-old just as they may not feel comfortable prescribing oral contraceptives.

“Some physicians refuse to provide emergency contraception to teenagers, regardless of the circumstance, and others may provide emergency contraception only if nonconsensual penetration has occurred,” wrote the guideline authors.

Often, this relates to a physician’s own values about premarital or teenage sex., but the authors stressed that doctors have a duty to set their own ethical beliefs aside when it comes to educating their patients about emergency contraception.

That’s a pretty strong message to send, and I’m curious if you agree.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.