Emergency contraception: what every parent of a teenager should know
In the United States, recent news about teenage sexuality is promising. Fewer teens are having sex, down 3% since 2001. Approximately 44% of girls have sex before they graduate high school according to the 2011 data from the Florida Youth Risk Behavior Survey of high school students. Teen pregnancy rates are also falling; there has been a 48% decline in teen pregnancy rates since 1988, probably due to a combination of fewer teens having sex, better long-acting contraception options such as DepoProvera, and condom use by teens. In spite of this great news, the United States still has one of the highest rates of teen pregnancy among developed countries. Nearly 80% of teen pregnancies are unplanned, a result of contraception 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 contraception (EC) as a part of routine practice, and also suggests providing advanced prescriptions for EC 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 emergency contraception?The most commonly used emergency contraception 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 contraception does not 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 EC to teens in advance. Emergency contraception 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 DMPA 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 mitigate an otherwise disastrous situation. I believe parental involvement is important. At a cost of $40-$80, most teens can’t afford EC, 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 EC 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 contraception do? It gives parents and teens a second chance. A chance to seek better contraception. A chance for a teen to rethink her choices and make better ones.