Back Up Your Birth Control

One would believe that bulging bellies and tenacious toddlers are rarely seen in a suburban, predominately middle class high school setting. However, from my first year of high school through the summer following my graduation, I saw countless childbearing contemporaries and had many pregnancy troubled friends. Some of my fretful peers exemplified the racy, risk-taking stereotype of sexually active teens. Others were relatively careful, and still others were the reason for the “it only takes once” cliché. A friend of mine, Tiffany, came dangerously close to illustrating the cliché. Though she and her partner used a condom, it broke during intercourse. This left her with the two awful options of waiting two to four weeks to learn if she was pregnant or using emergency contraception to significantly reduce the odds of pregnancy. However, at only sixteen years of age she was not legally eligible to make this decision on her own. Access to emergency contraception would have required a prescription and a doctor’s appointment that her parents were likely to become aware of. The need to involve her parents and a physician deterred Tiffany from obtaining the emergency contraception she needed. Though she did not become pregnant, the difficulty involved in obtaining emergency contraception caused Tiffany to jeopardize her future.

Although adolescents regularly make independent decisions regarding sexual activity, they are not always on the forefront of making their own sexual healthcare decisions. It is widely known that teenagers are making the decision to have sex, so how can they be denied the right to protect themselves as they see fit? Teenage pregnancy was an issue for many of my high school classmates and is for many American teenagers. Though some of my peers, and countless other adolescents, would not consider any options beyond raising the baby or allowing the child to be adopted, others, given the opportunity, would opt for last minute precautionary measures. However, this choice is not readily available due to age restrictions on emergency contraception. Adolescents must not continue to be stuck between a rock and a hard place when coping with the possibility of teen pregnancy. Government regulations are constantly created and revised to adapt to evolutionary civic and medical societies; so, the needs of the sexually active teenage population must not be ignored. In order to accomplish this, emergency contraception must be made readily available to adolescents as an over-the-counter medication.

It is not as if emergency contraception is a novel medication. Physicians have been advising women on how to properly increase regular birth control dosages to serve as emergency contraception since 1991. It was not until Barr Pharmaceuticals, the manufacturer of the commercial emergency contraception pill, PlanB, petitioned the FDA to make PlanB an over-the-counter medication for adolescents that endemic debate ensued. National campaigns have even been sparked to increase knowledge, awareness, and availability of emergency contraception. Most notable is the Back up Your Birth Control campaign which involves more than one hundred medical organizations and women’s advocacy groups. These voices of change know that Tiffany was not the first and certainly will not be the last adolescent to experience such hardship if the unjust prohibition of adolescent over-the-counter access to emergency contraception remains in effect. It is time that government regulators, especially those with the Food and Drug Administration, listen to the voices of impassioned social leaders and take notice of this need among female adolescents.

One unifying characteristic of emergency contraception supporters is the understanding that adolescents are having sex. It is irrefutable that abstinence is the preeminent way to prevent teen pregnancy, but frankly, it is clear teens are going to have sex regardless. Many states throughout the nation spend millions of dollars of federal funding on abstinence-only programs. However, these states which include Mississippi, New Mexico, Texas, and Arkansas, also have the highest teen birthrates. Meanwhile, states that spend little-to-no money on such programs have the lowest rates (Friedman 16). Simply telling teens not to have sex does not impede their actions. Adolescents are curious, inexperienced young adults who grasp for the adulthood that is constantly looming before them. This instinctive curiosity combined with the rampant hormones characteristic of adolescence makes sex an inevitable temptation. Teaching only about abstinence also serves to create a generation that is ignorant to contraception. This too is likely a driving force behind the high teen pregnancy rates in states with abstinence-only programs. Since teens have shown that they are going to have intercourse, they must be properly equipped with the knowledge and tools to handle this decision. Restricting emergency contraception to people above the age of 17 or with a prescription limits the ability of adolescents to access a necessary means of pregnancy prevention.

The lack of regard for abstinence-only programs and the inability to resist the urge to have sex are prevalent among teenagers. In 2009, 46% of high school students engaged in sexual intercourse at some point and 34% did not always use a condom (CDC). With nearly half of adolescents engaging in intercourse and with a large portion of those doing so without the proper contraception techniques, unexpected pregnancies are inevitable. In fact, in 2002, 12% of all pregnancies were among adolescents between the ages of 15 and 19 (CDC). But, it is estimated that this number could be reduced by half by emergency contraception (AAP 1026). How can legislators and government agencies such as the Food and Drug Administration ignore the high rate of teen pregnancy when it is clearly a widely prevalent, avoidable issue? There are not a few teenagers dealing with this life altering predicament, but hundreds of thousands that stand to benefit from having the option of preventing pregnancy through the use of emergency contraception. However, in order for teens to reap these benefits they must be able to obtain emergency contraception. The availability of emergency contraception as an over-the-counter drug would make this necessary goal accomplishable.

This perspective on teen sex simply acknowledges the sexual activity of adolescents and seeks to support not the decision, but adolescents.  However, oppositional conservatives insist that unrestricted access to emergency contraception would advocate a message of acceptable promiscuity. Teens for Life, an affiliate of the National Right to Life Committee which seeks to educate teens about abortion, infanticide, and euthanasia, argues that giving adolescents a pill which prevents pregnancy causes them to believe that “any consequences of sexual activity” will be removed (Friedman 38). Conservatives insist that adolescents will not consider the other risks, such as contracting sexually transmitted diseases (STD). If factual, this expectation would be especially alarming considering half of all sexually active teenagers and adults will contract an STD by age twenty-five and that “half of all new HIV infections occur among adolescents” (Fantasia 81). However, this incorrect belief has been disproven.

In order to address this reasonable concern of critics, multiple studies have been preformed to deduce the effect of availability of emergency contraception on women’s decisions regarding sexual activity. It has been found that the “incidence of unprotected sex does not increase” when emergency contraception is more available (Ellertson and Turner 704). The actions of women confirm what speculation about adolescents’ attitudes regarding the consequences of sex cannot. Clearly, if the availability of emergency contraception is not correlated with a rise in unprotected sex, adolescents have not formed the general consensus that emergency contraception is a means of eradicating all complications from intercourse. Furthermore, while the number of adolescents contracting HIV is disconcerting, since women continue to use protection even when they have access to emergency contraception; emergency contraception cannot be considered a variable that affects STD rates. Therefore, emergency contraception does not influence sexual risk taking and should be available to sexually active adolescents who seek to add a supplementary layer of assurance.

It is quite ironic that those who oppose emergency contraception do so believing that it would cause a devastating effect on public health when in fact emergency contraception is better for women’s’ health than its alternatives. The American Academy of Pediatrics “support[s] improved availability…including over the counter access” of emergency contraception to adolescents. Healthcare providers, the people writing prescriptions for emergency contraception, clearly support increasing its availability. When those responsible for providing prescriptions feel that emergency contraception should be available to all women over the counter, it is not logical to force teens to obtain prescriptions. Furthermore, studies show nausea, fatigue, breast tenderness, headache, abdominal pain, dizziness, and vomiting are the only adverse effects of emergency contraception use (AAP 1027). These side effects are far less severe than death and blood clots which are often associated with traditional birth control, abortion, and giving birth. Though emergency contraception is not approved for chronic use, it is the safer choice for adolescents who regularly use other forms of contraception but find themselves in an unforeseen situation. It is wrong to deny adolescents equal access to a safe product which is advocated by physicians. 

Although the short-term implications of emergency contraception are obviously safer than the effects of alternatives, the conservative opposition asserts that it causes devastating long-term consequences. This claim is based on the ideas expressed by news sources, such as those cited by the World Health Organization, which denounce the safety of emergency contraception because it causes “infertility and…increase[s] the risk of cancer” (Mawathe 1) and comes with “increase[ed] risk for blood clots” (Piccoli 2). Infertility and death are not sacrifices young women would be willing to make to prevent pregnancy. From this evidence one could logically conclude that emergency contraception is too dangerous for OTC distribution. However, the World Health Organization cited these articles to dispel the myth that emergency contraception causes these health effects and label such claims as “negative and…inflammatory media coverage” that is “factually incorrect” (Westley 243). Emergency contraception does not cause these side effects and is therefore not the unsafe medication opponents would have society believe. It is in fact safe and as previously shown, a less harmful alternative. Adolescents must be able to obtain this safer option through OTC access.

With emergency contraception having safety approval from the World Health Organization and physicians and the presence of the undeniable need of adolescents, there is no reason to prevent emergency contraceptives from being widely available to adolescents. This is especially true because in most states, traditional contraceptive services, prenatal care, and sexually transmitted disease (STD) testing and treatment are readily available to minors (Hickey 103). If adolescents are given access to these health care methods, then why do they not have access to emergency contraception? Furthermore, these tools are provided because young people have shown that they are going to have sex even though they are aware of the disapproval of adults. If teenagers can make adult decisions regarding sexual activity, contraception, and prenatal and STD care, it is only logical that they also control the fate of possible pregnancies with emergency contraception.

Although sexually-active adolescents make the adult decision to have sex, it is irrefutable that all do not possess astute perspectives. Adolescents are often rash and irresponsible. At this point in life it is common to have a “propensity for risk taking” (Johnson and Malow-Iroff 1). As a result, unexpected tragedies are often outcomes of the risks taken by adolescents. Such a tragedy was experienced by Rachel Ely, a young high school student who had complications resulting from an abortion. Because her parents were unaware of this abortion, her parents could not provide Rachel with the help she needed when she became ill. She is now “a permanently wheelchair-bound hemiplegic” because she did not receive proper healthcare before her complications became severe (Silverstein 3). Had it been mandatory for Rachel, a seventeen- year-old minor, to have the consent of her parents before having an abortion, she would have had assistance during the procedure. Removing parents from the decision-making process before adulthood allows irresponsible minors to expose themselves to health hazards.

Abortion, however, is a more serious medical procedure than taking emergency contraception. At no age should a woman experience an abortion without familial support because it poses dangerous health risks and emotional complications. Emergency contraception is far less hazardous. It does require a level of responsibility, but this is accountability that sexually-active adolescents must possess. After all, if adolescents are not capable of making the decision to lower pregnancy risk with emergency contraception, how can they be considered capable of handling even more challenging situations?

Adolescents who are unable to access emergency contraception may in fact find themselves with a much more serious predicament. Young people who are considered inadequate decision makers face the possibility of becoming pregnant because they cannot obtain emergency contraception. How can it logically be deduced that teenagers are not capable of deciding to utilize emergency contraception when they can handle the forced alternatives? In addition to the question of teenage responsibility is feasibility. Adolescents are not equipped to handle the “difficult and consequence ridden choice” of raising a child (Friedman 7). Poverty, a lack of education and a career, and not getting married are more prevalent in those that raise children as teenagers (Friedman 7). Educational and occupational success and valuable personal relationships are often unavailable to teen parents; therefore, teen pregnancy can diminish the futures of American adolescents. This also creates an unstable environment for the child of the adolescent. The qualities of two human lives are diminished by teen pregnancy, but adolescents who have access to emergency contraception can prevent pregnancy. This gives them the opportunity to create an economically stable, two-parent environment before having children. In order to maintain a good quality of life, adolescents’ possession of the responsibility to utilize emergency contraception must be acknowledged by making emergency contraception available over-the-counter.

Ultimately, the decision to make emergency contraception available to adolescents should be made based on the Food and Drug Administration’s preset, scientifically-based drug evaluation criteria. If it meets these standards, emergency contraception must be approved for sale to adolescents below the age of seventeen. To be answered are “three crucial questions: Can patients diagnose the problem themselves; can they be trusted to treat the problem effectively; and can they understand the drug’s label—all without a physician’s intervention” (Harris 1). Clearly, emergency contraception successfully meets all three of these criteria because a panel of experts assembled by the FDA “voted 23 to 4” to recommend OTC status for emergency contraception (Harris 1). It is undeniable that there is a consensus in the medical community that emergency contraception should be available over-the-counter; furthermore, the FDA “normally follows the recommendation of its advisory panels” (Harris 1). Why now has the FDA chosen to ignore its own judgment standards and the advice of its officials?

The FDA claims that the decision to prohibit adolescents below seventeen from accessing emergency contraception was made to protect them. It is insisted that Barr Pharmaceuticals has not proven that females sixteen and younger can understand the drug’s label (Harris 1). However, James Trussell, a member of the FDA’s advisory board on emergency contraception noted that the agency has never before “raised the issue of label comprehension among young teenagers” (Harris 1). Furthermore, Susan F. Wood, former assistant commissioner of women’s health at the FDA, has suggested that the FDA has become another federal health agency that is “increasingly unable to operate independently” of the Federal Government (Wood 1). Wood’s claim is supported by the outcome of the case Tummino v. Torti in which it was found that the FDA put political pressure from the White House above women’s health when it decided to limit OTC access to emergency contraception (Tummino 51). Is emergency contraception truly unsafe for adolescents or is the FDA putting politics before science?

There is no sound justification for prohibiting adolescents from accessing emergency contraception without a prescription. There is, however, evidence suggesting that the FDA has decided to deny adolescents access to emergency contraception for unethical reasons. When the FDA goes against its own policies and is found guilty of acting based on unlawful orders from White House officials, it must be concluded that the decision to deny adolescents OTC access to emergency contraception was without due cause. In order to protect its own credibility and grant adolescents a right they need and deserve, the FDA must approve emergency contraception for over-the-counter distribution.

Increasing the availability of emergency contraception would alleviate the stress teen pregnancy puts on American Society. There are far too many forecasted, unintended adolescent pregnancies each year that could be avoided by emergency contraception. Adolescents who are going to continue to make adult choices without the knowledge of the adults around them cannot be forced back into childhood when they desire control of their own bodies and futures. My friend, Tiffany, is one of many teenagers who have been forced into an unthinkable predicament simply because of her age. How can teenagers not be given equal rights to medication equally important to them as to adults? Furthermore, because the FDA and those that oppose OTC emergency contraception have not provided scientific data to support their position, the public has no choice but to consider the evidence that suggests political corruption within the FDA.  In order to right this injustice and show that the FDA is still a reliable source for medical regulations, emergency contraception must be made available to all adolescents as an over-the-counter medication.