Stating that unintended pregnancy is a major public health problem, The American College of Obstetricians and Gynecologists (ACOG) recommended that birth control pills be available over the counter this month. And this past week the American Academy of Pediatrics (AAP) outlined emergency contraception use in teens girls while urging pediatricians to provide information and access to emergency contraception for sexually active teens.
All this may seem exceedingly “progressive” until you examine some of the realities. As many as 80% of pregnancies in teen girls in the United States are unintended. The birth rate for 15 to 19 year-olds is 34 out of 1000. Most pregnancies are a result of non-use of contraception or mishaps with protection (condoms breaking, pills being missed and/or forgotten or used inconsistently). We know teens don’t take their birth control as well as adults and lapses in pills or misuse can put them at risk. This is where emergency contraception can come in. I was taught how to prescribe emergency contraception to teens as a back up for contraception failure when I was in residency. I’ve been educating teens, discussing their options, and prescribing emergency contraception ever since.
What is “Emergency Contraception?”
Emergency contraception (EC) is the use of hormone pills after sexual assault, unprotected intercourse, or contraceptive failures. Teens and women can take EC after unprotected intercourse, failures in contraception, or after they have been forced to have sex. The pills work similarly to how they work when taken routinely to prevent pregnancy (“the pill”)–they prevent ovulation (eggs being released), disrupt the follicles in the ovary from working properly and ultimately prevent pregnancy from occurring.
Teens can take emergency contraception up to 5 days after sexual activity to reduce the likelihood of getting pregnant. It works best when taken early or even within 24 hours of sexual activity. This is precisely why we want teens to have EC on-hand.
Unfortunately, sexually active teens don’t use contraception like we’d like: only 60% state they used a condom the last time they had sex. And 13% of teens state they didn’t use any contraception at all.
The years in high school are a dramatic time. Although only 13% of 15 year-olds say they have had sex, by the time children leave home and head out the door to adulthood the majority (70%) say they have had sex. Further, 10% of teens report being a victim of sexual assault, putting them at risk for unintended pregnancy. This rapid shift in sexual activity usually comes during high school, a dramatic and somewhat precarious time for nearly all of us. During this time we want teens to have access to education, contraception, and family planning. The Academy of Pediatrics’ policy provided some insights on understanding, prescribing, and using emergency contraception.
Emergency Contraception For Teens:
- When teens are given prescriptions for emergency contraception ahead of time they are more likely to use it to prevent a pregnancy.
- Studies find that teens who have access to emergency contraception are not more promiscuous and are NOT less likely to use routine birth control.
- Emergency contraception (Plan B) is available over-the-counter for women & men over 17 years of age (have to show an ID). For those under 17, they will need a prescription from their doctor. Here’s my blog post about the FDA’s decision to block Plan B as an over-the-counter medication for all sexually active teens.
- Emergency contraception is often sold under the name Plan B, Plan B One Step, or Next Choice. These medications contain progestin (a hormone) and are generally very well tolerated. Side effects from these methods tend to be minimal–most often teens report a heavier menstrual cycle but reports of nausea and rarely vomiting should be mentioned as well.
- Teens and women can also be advised how to use combinations of their own birth control pills as emergency contraception (the Yuzpe method). These combination birth control pills may cause more side effects (nausea/vomiting). You can find out dosing info and read more about emergency contraception here at The Emergency Contraception Website.
- Emergency Contraception does not prevent or protect against any sexually transmitted diseases. Teens must use condoms as a barrier method to protect against sexually transmitted diseases.
- We want teens to know about emergency contraception. If a pharmacist or pediatrician is opposed to EC, they are obligated to inform teens and women about their use and direct them to a provider that can assist them.
What questions do you have about the policy or how teens learn about preventing pregnancy?
Here’s my KING5 interview on the same topic: