The what-if prescription

Leave it to some thoughtful physicians to put good medicine ahead of good politics. Last year, the Obama administration wrongly chose to limit access of teens to the emergency contraceptive pill known as Plan B. This week, pediatricians are urging their fellow doctors to do something that should help correct that error.

In a position paper released Monday, the American Academy of Pediatrics has recommended that doctors prescribe Plan B to girls under the age of 17 regardless of whether they are sexually active — or have some "Plan A" contraceptive in place such as birth control pills. The recommendation is both a nod to the safety and effectiveness of Plan B but more important, a recognition that the U.S. needs to do more to prevent unwanted teen pregnancy.


While the nation's teen birthrate has fallen considerably over the last decade (including 8 percent last year alone), according to the federal Centers for Disease Control and Prevention, the rate of U.S. teen pregnancy remains the highest among Western industrialized nations. That, in turn, leads to any number of health and social ills, including higher rates of abortion in this country.

That's why we still believe Health and Human Services Secretary Kathleen Sebelius erred badly last year when she overruled the Food and Drug Administration and refused to authorize over-the-counter access to Plan B for girls under age 17. At the time, she claimed that the health effects of the medication on young girls were not well documented, but that's not true. Plan B uses the same hormones found in ordinary birth-control pills.


The real problem with Plan B has always been that it has a very limited purpose. It's not the best way to prevent pregnancy — abstinence or traditional birth control methods that protect against sexually-transmitted disease are the better option. But when those methods fail, Plan B is the emergency back-up. If taken within 120 hours of intercourse, it can prevent fertilization of an egg.

That method should not be confused with the so-called abortion drugs like RU-486 that can actually terminate pregnancy and are administered in clinics or doctors' offices. Plan B has been available in the U.S. since 1999, and its growing availability is likely part of the reason why teen pregnancy rates have been in decline.

Social conservatives and some religious groups have long fought against access to Plan B, much as they've opposed access to contraceptives in general. Some believe that having a contraceptive is an open invitation to become sexually active. But that narrow point of view fails to consider the reality of teen behavior, the possibility of the unexpected and the broader public interest in reducing teen pregnancy rates.

If we lived in a world where every teen sexual encounter could be planned (or prevented), then Plan B would be irrelevant. But teen behavior is not so predictable. Nor does that world view consider the very real possibility that a young girl could be a victim of sexual assault or incest.

Now put yourself in the shoes of a young girl. The clock is ticking. Is she going to make an appointment with her doctor and then (assuming the doctor was available so quickly) fill a prescription drug order in time, or will she be unable or perhaps too embarrassed to take these steps before it's too late?

If the goal is to prevent pregnancy, better to have the medication available in advance — much as families keep an emetic on hand such as syrup of ipecac in cases of accidental poisoning. Rarely is the drug needed, but better to be safe than sorry should the unexpected actually happen.

The academy's recommendation probably won't cause all pediatricians to prescribe Plan B in advance of a young patient's need, but it should. President Barack Obama could also help the situation even more by directing Ms. Sebelius to reverse course and follow the original FDA recommendation for Plan B over-the-counter access. But in either event, the goal should be for young women to have the best and safest chance to prevent an unwanted pregnancy even if they have unwisely chosen to have unprotected sex.