Pediatrician Group Urges Doctors to Offer Teens Emergency Birth Control in Advance

Updated policy statement takes stronger stand for access.
An updated policy statement from the American Academy of Pediatrics recommends pediatricians offer teen patients access to emergency contraception and discuss the need for routine birth control for sexually active teens.
Nov 26, 2012· 2 MIN READ

The couple was young—17 and 18—but driven, both intent on becoming doctors.

They were mutually monogamous, and routinely used birth control, but one night had an emergency.

"The condom broke, and she got very upset," says Dr. Jill Maura Rabin, chief of the division of ambulatory care and head of urogynecology at Long Island Jewish Medical Center of the North Shore—LIJ Health System, who cared for her.

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"They couldn’t find the condom," Rabin tells TakePart. "They came in, and we found the condom."

The good news? The woman had taken the emergency contraception, which she had gotten at a previous visit, as instructed, says Rabin, who is also professor of obstetrics and gynecology at Hofstra North Shore—LIJ School of Medicine.

"She started to cry, and she was very relieved she had the emergency contraception," Rabin says.

This scenario is familiar to gynecologists and pediatricians alike, as Rabin knows. And it supports the wisdom of an updated policy statement on emergency contraception, issued today (Nov. 26) by the American Academy of Pediatrics.

In the update, the Academy makes a stronger case for counseling teen patients about emergency birth control, says Cora Collette Breuner, MD, MPH, professor of pediatrics and adolescent medicine at Seattle Childrens Hospital and the University of Washington.

She is a member of the AAP Committee on Adolescence which oversaw the new statement, two years in the making. The updated policy replaces the previous one, issued in 2005, she says.

The update goes beyond simply suggesting that pediatricians talk about emergency birth control with their patients, Breuner says. It recommends that they do so with all patients, boys and girls, and with the families of disabled teens.

"This one comes out with more emphasis on education," Breuner tells TakePart. Doctors are encouraged to counsel patients who are sexually active or may become so to rely on dual methods routinely, such as condoms and IUDs, but to also learn about emergency contraception.

The policy also advises pediatricians to prescribe emergency contraception so teens will have it in place should they need it.

The new policy statement suggests that doctors provide teens with levonorgestrel 1.5 mg.—sold as Plan B, Plan B One Step, or Next Choice—as no pregnancy test is required before use as it is for some other forms.

Teens 18 and over can get levonorgestrel 1.5 mg. over the counter, but those 17 and younger must have a prescription.

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Emergency contraception can reduce the risk of unintended pregnancy if taken up to 120 hours after unprotected sex or contraceptive failure. It's most effective, however, within 24 hours.

Plan B works by preventing the release of an egg from the ovary, preventing fertilization or implantation of a fertilized egg.

The cost of emergency contraception is about $80, Breuner says. Some clinics charge on a sliding scale based on ability to pay.

Pediatrics should also advocate for increased access for teens, regardless of age, and for insurance coverage of emergency birth control, the policy advises.

''The timing is good, because I think we need a reminder on the topic," Rabin says. "We still have pharmacies uncomfortable filling the prescription [for teens]."

Doctors are urged to emphasize that emergency means just that, Breuner says. "You would not want them to use it frequently.''

While critics have said supplying teens with emergency contraceptive sends the wrong message, Breuner says research suggests having it doesn't change activity patterns. "The data is pretty clear that providing advance contraception does not promote promiscuity," she says.

Research also shows that teens will fill the prescription in advance.

The hope, of course, is to stem the rate of accidental pregnancies. While teen pregnancies have been declining since the 1990s, there is a ways to go, Breuner says.

"Sadly the U.S. still wins the prize of having the most unintended pregnancies in developed countries," she says.

Among 15- to 19-year-old, the birth rate is about 34 per 1,000, according to the policy statement.

While some teens practice abstinence, about 43 percent of those 15 to 19 are or have been sexually active, according to research.

About 80 percent of pregnancies occurring in teens are accidental and are result of not using birth control or birth control failure.

As for critics who say teens have no business using contraception or being sexually active? Dr. Rabin responds this way: "We think abstinence would be marvelous, but we know teenagers….So we have to be realistic." Contraception, emergency and routine, can help them stay healthy, not pregnant, and on their career track, she says.