In the United States, recent news about teenage sexuality is promising. Fewer teens are having sex, and less than half of girls have sex before they graduate high school according to data from the Florida Youth Risk Behavior Survey. Teen pregnancy rates are also falling, probably due to a combination of fewer teens having sex, better long-acting birth control options such as Depo-Provera, and condom use by teens. In spite of this great news, the U.S still has one of the highest rates of teen pregnancy among developed countries. Nearly 80% of teen pregnancies are unplanned, a result of birth control failure or nonuse, according to the American Academy of Pediatrics (AAP).
We know teen pregnancy is a tremendous burden for the teens, their families and the children, as teens are less likely to stay in school, continue to college and get good-paying jobs. In an effort to prevent more unplanned pregnancy, the AAP urges pediatricians to counsel all adolescent patients on the use of emergency birth control as a part of routine practice, and also suggests providing advanced prescriptions so teens can have quick access in the event they need it, along with having it available in their office. The AAP policy, to be published in the December 2012 issue of their journal, Pediatrics, states, “Advanced provision increases the likelihood that teenagers will use emergency contraception when needed, reduces the time they have to use it, and does not decrease condom or other contraceptive use.”
So what is the morning-after pill?
The morning-after pill is a type of emergency birth control. The one most commonly used is Plan B One-Step, or its generic equivalent. It is levonorgestrel, a synthetic form of progesterone, the hormone normally made by the ovary after ovulation (release of the egg). By taking levonorgestrel, a woman stops the brain from sending the signal for ovulation. By not ovulating, there is no egg for a sperm to fertilize and pregnancy is prevented. The important point is that if a woman has ovulated, emergency birth control doesn’t work. It should be taken as soon as possible after unprotected intercourse. Although it can be used up to five days after unprotected intercourse, the longer a woman waits to take it, the less likely it is to work.
This is the heart of the reason the AAP believes in prescribing emergency birth control to teens in advance. It is currently available with a prescription for all patients and available over-the-counter for women over the age of 17. The cost is anywhere from $40 to $80. But teens under 17 years of age need a prescription. In my experience caring for teens and adult women, condoms don’t break during office hours! If a teen has a prescription, and better yet, the prescription is filled and the pills are available, she is more likely to take Plan B if needed.
What do I tell my own patients and their parents?
Obviously abstinence works best to prevent pregnancy and sexually transmitted diseases (STDs). It also reduces stress and drama in a girl’s life! I also advise that if sexually active, use of condoms to reduce risk of STDs, PLUS another form of contraception such as Depo-Provera or Mirena or Implanon is best. The reality is that teens, like us, make mistakes, and some choose to be sexually active at times without contraception. Having a “Plan B” available can help avoid an otherwise disastrous situation. I believe parental involvement is important. At a cost of $40-$80, most teens can’t afford emergency birth control, and might delay taking it, even if they have a prescription, and even if that would be much cheaper than diapers!
A few notes about what the morning-after pill doesn’t do. Levonorgestrel does not cause abortions, prevent implantation, or hurt a baby if a woman is already pregnant. In fact the baby’s placenta makes progesterone to maintain the uterine lining to keep a woman pregnant. If a woman has already ovulated or is pregnant, Plan B just won’t work. Plan B does not contain estrogen, so there are NO contraindications for teenagers. It does not cause blood clots, cancer, or problems with later fertility.
What does emergency birth control do? It gives parents and teens a second chance. A chance to seek better birth control. A chance for a teen to rethink her choices and make better ones.