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Emergency birth control for teens

Is providing Plan B an acknowledgement or approval of sexual behaviour?

For a host of reasons, most parents would probably prefer their teenager wait until they are older before becoming sexually active. They might rue the loss of their child's innocence, they might think sex at a particular age is simply wrong. But chances are, parents are also worried about the very real risks that are a part of sex.

Yet, despite the strategies parents might use to try to discourage or delay a teenager's sexual activity, many teens have other plans.

For this reason, doctors and social workers who work in adolescent health recommend teens be given comprehensive sex education and access to birth control. Moreover, it is recommended that females of reproductive age have a supply of Plan B, the so-called morning after pill, even if they are not yet sexually active.

"You shouldn't be buying it the morning after, you should be taking it the morning after, that's what it's for," says Nicolette Caccia, staff obstetrician and gynecologist at The Hospital for Sick Children (SickKids). "It's labeled as effective for up to 72 hours after sex but the reality is the morning after pill is much more effective in the first 24 hours," she says. "The chance that Plan B will prevent pregnancy diminishes with every hour. It should be in your medicine cabinet like the aspirin is for a headache."  

The morning after pill is an emergency contraceptive taken as a last resort when other birth control methods have failed. Although there are several types, it is a pill, or sometimes two pills, containing hormones similar or identical to those found in birth control pills though in different doses. Exactly how they prevent pregnancy is not fully understood, and it is believed the hormones' actions are different depending on how long after sex the pills are taken.

According to the Society of Obstetricians and Gynecologists of Canada (SOGC), the morning after pill prevents 95% of pregnancies when taken in the first 24 hours, 85% when taken 25 to 48 hours after sex, and only 58% when taken between the 49th and 72nd hour.

The pills are safe, have no contraindications, and are meant to be used in only one way: "It's a back up method for people who forget their pills or who look down after the fact and see the condom doesn't look right," says Dr. Caccia. "This is not something you take every day. It's for dealing with equipment failure," an event that is neither age nor experience dependent.   

It should be noted that because it works before implantation of an egg, Plan B does not induce an abortion. It is also not the same things as RU-486, a synthetic steroid used to induce abortion up to two months after conception.

Availability issues

Although the morning after pill is available in Canada without a prescription and without any age restrictions, barriers to getting it exist. According to the SOGC, these barriers include lack of knowledge, fear, negative or judgmental attitudes from the provider, and the unnecessary demand for a pelvic exam before getting it, among others.

In the United States, Plan B was recently made available to teenagers seventeen-year-old and over without a prescription. Previously, it was only available to adults despite recommendations to lower the age of access by the Food and Drug Administration, the government's own health agency. Although never acknowledged, this was widely believed to be due to moral objections and concerns about a loss of parental control.

These types of conflicts are not new, nor are they restricted to the United States. People have opinions about whether sex education and access to birth control encourages sexual activity or protects teenagers. Moreover, the limits of what a teenager can do without parental consent or notification are also strongly debated.

"Unless I have reason to think either the patient or someone else is in physical danger, I'm obliged to keep any information confidential. Parents don't usually like this," says Sharon Lorber, a social worker at the Teen Clinic at SickKids. Lorber counsels teens, steers them in the right direction for medical issues, and may refer them to a doctor or nurse for medications, including birth control. "They might leave the clinic with Plan B but there is always an assessment, counseling, and education with the visits," she says, noting that these are the guidelines for providing birth control to teens, and for good reason: "they need to know about sexually transmitted infections (STIs) -- they may not even understand basic anatomy or how pregnancy occurs."

Does Plan B encourage promiscuity?

While Lorber's main focus is on safety and reducing risks, she understands some people, including some parents and health care professionals, have issues with providing Plan B for young people. "A lot of people think having emergency contraception available will stop teens from using condoms or encourage them to be more promiscuous. It doesn't," she says. The statistics are similar to those gathered in studies about the value of abstinence-only sex education versus comprehensive sex education that includes abstinence. "Both groups of teens start having sex at about the same time and in about the same numbers, but the comprehensively taught kids are doing it more safely."

Dr. Caccia likens it to having airbags in the car: "They don't make people drive recklessly. If anything, having a course of the morning after pill in advance of need is a responsible thing for a young person to do."

While both Dr. Caccia and Lorber believe Plan B has its uses, they also agree that it is most effective when used in conjunction with what might be called "Plan A": a mix of sex education and counseling to address social, emotional and physical issues beyond pregnancy. "Birth control is one thing, STIs are another," says Lorber, citing just one risk. "The morning after pill does nothing to stop that."

And although condoms can play a large role in diminishing risks, Lorber believes education is where parents can have their biggest impact, especially before a child becomes sexually active.

"It's good to be speaking about sex when they are younger. You don't have to talk about yourself or her. Speak in more abstract terms, for example, discuss the characters on a TV show such as 90210," says Lorber, who says an ongoing discussion about sex and sexuality starting at a young age is smart advice for any parent. "Let them know what your values are long before they need to exercise their own."

When parents do this, the chance the child will grow into a teen who will be sexually responsible increases, and the more likely the lines of communication will remain open as they strike out on their own. "If your daughter is coming to you asking to go on the pill, it's a very good sign she trusts you," says Lorber. "But it almost never happens. Mostly they talk to their friends and go get it themselves without the parent knowing."

The best way to continue having an influence with your teen is to "try to not have really harsh judgmental reactions and let them know what the options are," she says. Including when an accident happens.

Jonathan Link
Medical Writer/Editor, AboutKidsHealth

6/11/2010

SOGC Clinical Practice Guidelines. Emergency Contraception. No 131 August 2003

Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health. 2008 Apr;42(4):344-51. Epub 2008 Jan 31

Harper CC, Cheong M, Rocca CH, Darney PD, Raine TR. The effect of increased access to emergency contraception among young adolescents. Obstetrics and Gynecology. 2005 Sep;106(3):483-91





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