When the Food and Drug Administration refused to approve over-the-counter sale of emergency contraception last Thursday, it rejected the findings of two independent advisory panels, the opinions of more than 70 of the nation’s leading medical and public-health organizations, and the advice of its own staff. Why? According to Steven Galson, acting director of the FDA’s Center for Drug Evaluation and Research, the government denied easy access to Plan B, a double dose of ordinary birth-control pills that can prevent pregnancy up to 72 hours after sex, out of concern for young girls. Galson said he was especially worried about “the younger age group, between 11 and 14, where we know there is a substantial amount of sexual activity.”
To wit, the agency is keeping Plan B out of reach because some of the people most likely to need it—kids—might actually get it. The decision is so nonsensical it can only be political. But who exactly the Bush administration might be appeasing with this declaration of war on teenage girls is unclear. For opponents of abortion, the choice to block access to a drug that could drastically lower the abortion rate is bizarre. And while some conservatives have expressed fear that the drug might somehow cause kids to have sex, as Galson himself points out, teens are already having sex—even without easy recourse to Plan B.
Indeed, nearly one in five teenage girls has had sex by her 15th birthday, according to the National Campaign to Prevent Teen Pregnancy. Given that reality, the FDA’s decision to deprive these kids of nonprescription emergency contraception—which is already available in 33 countries—condemns the less fortunate of them to early pregnancy. Since it’s undoubtedly been a long time since President Bush or Steven Galson or any of the other men setting the administration’s reproductive policy have had unplanned pregnancies themselves, perhaps it’s time for a review of what happens next.
These girls give birth or have abortions—the latter an outcome the administration supposedly abhors. According to the Alan Guttmacher Institute, a nonprofit that researches reproductive issues, 8,519 girls 14 and under gave birth, and another 8,560 had abortions in 2000, the most recent year for which there are statistics. Those between 15 and 17 had another 157,209 births and 84,770 abortions.
So what’s a girl who’s just had unprotected sex, or had a condom fail, to do? Theoretically, since Plan B is available with a prescription, she can immediately explain her dilemma to her parents, who will talk it over with her in soothing voices, make an appointment with her doctor, cart her over to the office (her parents have the day off and a car, you see), get the prescription, and then take her to the neighborhood pharmacy, which will happily dispense the drug. All of this must happen quickly, of course, since the sooner after sex she takes it, the better the chances it’ll work.
In reality, many girls don’t have insurance providers, doctors, or understanding parents. And some who do are simply afraid to ask them for a prescription, as Jennifer, a high school senior from New York City, well knows. She was 16 and attending boarding school when the condom she and her boyfriend were using broke. “I freaked out,” says Jennifer. “I thought about going to the doctor, but if I had visited a doctor, the school would have told my parents—and I was scared of that.” If emergency contraception had been available at the time, Jennifer says she would have taken it. Instead, she says she ended up getting pregnant and having an abortion, an experience she describes as “really tough.”
The girls who give birth have it worse. Pregnancy can be dangerous for young teens. For starters, they’re at increased risk of having labor obstructed by their narrow hips, which can result in their disability or death. Their babies don’t do very well either, with infants born to women age 15 or younger having more than twice the average infant death rate. And we all know teens aren’t as ready as adults for the demands of parenting.
Still, the FDA says it’s concerned about what might happen if these girls could pluck Plan B off a pharmacy shelf, where we already present a selection of potentially deadly medicines, from sleeping pills to cough syrups. If we trust teens with those, why not let them buy the far safer contraceptive? Daniel Summers, an adolescent specialist who has dispensed the two-pill regimen to hundreds of girls between 14 and 20 through Mount Sinai’s Adolescent Health Center, says he has never had a patient who couldn’t understand how to take it. “It’s very straightforward,” says Summers. “And, of course, it’s vastly, vastly more benign than either outcome of a teen pregnancy.”