November 26, 2012
Pediatric Group Recommends Advance Prescriptions For Emergency Contraception For All Teenage Girls
Lawrence LeBlond for redOrbit.com - Your Universe Online
The United States has the highest rate of teenage pregnancies in the world, yet efforts to curb these types of unplanned pregnancies have been largely avoided. Current federal policy bans the sale of over-the-counter birth control pills to girls under 17, and often young girls do not have immediate access to emergency contraceptives when they need them.
Nearly 80 percent of teenage pregnancies in the US are unplanned, usually a result of contraception failure or nonuse, according to AAP data.
"The discussion of emergency contraceptions methods [sic] with patients must also include the fact that none of these methods will protect from sexually-transmitted infections," wrote Krishna Upadhya, MD, Cora Breuner, MD, and colleagues of the AAP Committee on Adolescence in a statement.
The authors of the report noted that despite significant declines in teen birth rates over the past 20 years, teen birth rates in the US are still “significantly higher than other industrialized nations.” They further wrote that emergency contraception use can reduce the risk of pregnancy up to 120 hours after sexual intercourse, though they are most effective when used within 24 hours afterwards.
The authors said that teens are also “more likely to use emergency contraception if it has been prescribed in advance of need.”
Emergency contraception, contraceptives that are taken after intercourse to avoid unwanted pregnancy, have been around since the 1970s, when doctors first advised patients to use them along with their regular birth control pills in a method called “Yuzpe.” Since then many products have been approved for use either by prescription or over-the-counter.
Breuner said despite its broad availability, there are still many people who do not know about emergency contraception (EC) or have unfounded fears about using it.
EC works by inhibiting ovulation and disrupting the production of key cells needed in a woman´s body to conceive. While it can be effective up to 120 hours after sex, it will not work once a woman becomes pregnant. EC is available with a prescription for all patients and without for women over 17 years of age. The pill costs up to $80.
Susan Wood, former assistant commissioner for women's health at the Food and Drug Administration (FDA), called the AAP decision “significant.” She said, “it's not often you see physician organizations saying that their patients are better off without the physician involvement.”
While AAP leaders remain optimistic, they say it´s anyone´s guess whether pediatricians will follow the group´s recommendations.
“We do hope that pediatricians read the policy statement and follow the recommendations,” said Breuner, a pediatrician at Seattle Children's Hospital. "The Academy prides itself on a devoted membership."
EC for adolescents has been one of the most politically tense issues in healthcare for nearly a decade.
The FDA in 2005 declined approval of any over-the-counter sales of Plan B, the “morning-after pill,” overruling its own panel of experts and scientists. The FDA then reversed that stance and approved over-the-counter sales with no age limits. But the measure was then overruled by Health and Human Services Secretary Kathleen Sebelius in December 2011 ordering that girls under 17 could only get the pill with a prescription.
The new policy presents a “significant barrier” said Wood in an interview with Sharon Begley at Reuters Health. Women in their 20s and 30s must present proof of age to receive over-the-counter EC, and teenagers could be out of luck “if they suddenly need emergency contraception at midnight on a Saturday.”
According to the AAP´s new statement, nearly 45 percent of teen girls between the ages of 15 and 19 have had sex, and adolescent girls are among the largest portion of sexually active females that are at high risk of skipping birth control pills or failing to use contraceptives.
"Cognitively, teens tend to be very concrete -- they make decisions based on 'right now'," Breuner said. "They can be impulsive."
Thus, the main focus of the new recommendations is the importance of offering prescriptions ahead of time. In a 2010 review in the Journal of Pediatrics and Adolescent Gynecology, researchers concluded that advance prescriptions of EC decreased the time before usage, making it more effective, and did not increase sexual activity among teens.
"From a strictly scientific point of view, there's not much controversy -- the medicine is pretty safe and pretty effective," Dr. John Santelli, a pediatrician and chair of the department of population and family health at Columbia University's Mailman School of Public Health, told Catherine Pearson at HuffPost. "To say that emergency contraceptive is controversial goes back to the fundamental issue that many adults in this country are uncomfortable with adolescent sexuality and sexual behavior."
Breuner stressed that scientific literature has typically not shown that greater use of EC would affect rates of unplanned teen pregnancies. In the US, teen pregnancy rates have fallen to an all-time low in 2011, with 333,000 unintended births from 15- to 19-year-old women. Still, that is significantly higher than other in other similarly-developed nations.
A 2006-08 survey found that 14 percent of sexually active girls had used EC, up from 8 percent in a 2002 survey. The most common reason for EC use was condom failure, but a small percentage was also due to rape.
"As pediatricians, our job is to help make sure adolescents have healthy, productive lives with families that they plan," she said. "Our job is to [explain] that there are options out there. Knowledge is power."
Bill Alpert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy, said it is “common sense that requiring a prescription is a barrier“¦If an august and respected medical group like AAP is suggesting providing emergency contraception to minors is OK, that is a big deal.”
The AAP report authors, said pediatricians “have a duty to inform their patients about relevant, legally available treatment options,” and one of the most important options would be to offer ahead-of-time prescriptions for EC.
There are no good data on how many physicians currently write prescriptions ahead of time. “But we do know that pediatricians don't even talk about it, let alone offer advance prescriptions,” said Breuner. “We tend not to like bringing up stuff that's controversial.”
In addition to informing patients about EC, pediatricians should also encourage both male and female patients to get tested for sexually transmitted diseases (STDs) and discuss ongoing contraception methods following use of EC.
The authors also noted that, at the policy level, "pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers."