Teen pregnancy is a hot topic in the media and pop culture these days, as attested to by movies including "Juno" to "Teen Mom 2" to "16 and Pregnant." Events of recent weeks may indicate this concern is finally cracking the shell around our public health leaders as well better late than never.
It's an inconvenient and sad fact that our nation has the developed world s highest rate of teenage pregnancy and its handmaiden, abortion. It's a problem that Republicans, Democrats, health care workers and public health officials all agree needs to be more effectively addressed and physicians' groups have just come out with a series of proposals to do just that.
A few days before Thanksgiving, the major society of obstetricians and gynecologists in the U.S. issued an advisory recommending that oral contraceptives be made available over the counter, meaning no prescription necessary. They did not specify any age limit or cutoff for this suggestion. The rationale for this advice is simple: The fewer obstacles in the path of girls and women vulnerable to unintended pregnancy (meaning any sexually active female) to getting effective protection, the better.
Some might object that young teenage girls should not be allowed to just go to the local drugstore and buy birth control pills, while some point out correctly that pills do not protect against sexually transmitted diseases as well as condoms do. Others argue that "the pill" may have side-effects warranting discussion with a trained healthcare professional.
However, pregnancy especially unintended pregnancy in a youngster has far higher health risks than the minuscule risk of oral contraceptives in most girls. As for requiring the intervention of a responsible adult, preferably a parent, in this transaction, the unfortunate fact is that teenshave sex (and get pregnant) without parental supervision. Requiring parental acquiescence would likely have the unintended consequence for sexually active teens of keeping their activities hidden and the benefits of birth control pills so close, but so far away.
That recommendation would ordinarily be enough of a birth-control breakthrough for a year or two. But lo and behold, only a week later, right after Thanksgiving, another erudite medical group had an even more remarkable announcement. The American Academy of Pediatrics the nation's leading pediatric group advised doctors caring for girls of childbearing age to give them a prescription for emergency contraception the morning-after pill at the time of their annual check-up.
Yes, you heard me right: Without delving into their young patients sexual proclivities, they are advised to just routinely give them the prescription to carry with them, just in case. The "just -in-case" scenario would be after unprotected sex, or if a condom should break, or in the less-common instance of sexual assault.
The morning-after pill reduces the risk of pregnancy by a substantial amount, if taken up to three to four days after sex. In fact, the sooner the medication is taken after unprotected sex, the less likely that pregnancy will result. Right now, women aged 17 years and older can purchase OTC emergency contraceptives, while girls younger than 17 must obtain a prescription. The reasoning of the pediatric society was simply that reducing the time between sex and taking the contraceptive pill would prevent pregnancy more effectively, so why not just give the girl the script in advance?
Studies have shown that adolescents are more likely to use emergency contraception if it s prescribed in advance, and since many teens engage in unprotected sexual intercourse, that seems like a wise plan. Other indications for use include contraceptive failures (defective or slipped condoms, or missed or late doses of other contraceptives). Again, some concern about foregoing barrier (condom) protection if the morning after pill is at hand is warranted, given the exposure to STDs. On the other hand, the fear that any form of contraception promotes earlier or promiscuous sex has been shown to be unfounded, and studies have shown the contrary: Good sex education actually leads to less sexual adventurism.
While the science behind this is strong, it seems a bit hard to swallow for many, parents and clinicians alike. Whether this policy catches on remains to be seen.
We are not yet done with reproductive health news. That same group of ob-gyns at the American Congress of Obstetricians and Gynecologists published a study in their journal, Obstetrics and Gynecology, analyzing the effects of giving out long-acting reversible contraceptives at no cost to poorer urban girls. These products IUDs and hormonal implants significantly reduced the rate of teen birth and abortions among almost 10,000 teens and young women in inner city St. Louis. They found that abortion rates plummeted by over half among the women getting the intervention, and teen birth rates were reduced by 80 percent!
How should we put all this together? The American public health approach to teen sexuality and its predictable consequences has mostly involved pretending it doesn t exist, and that the perverse effects of such a blithely ignorant policy teen pregnancy, abortion, and disruption of young lives must be tolerated. These sad and expensive outcomes are more pervasive in those areas where sex education is lacking by custom or law. New efforts to reduce teenage pregnancy such as those described in this article should be welcomed as medical and social progress.
By ACSH's Gilbert Ross, M.D. Originally posted Dec. 4, 2012 on Examiner.com
