Recent moves by the Obama administration to require age and point-of-sale restrictions for emergency contraception (EC) continue to erect barriers to young and marginalized women’s timely access to this safe and effective contraceptive method. The administration’s actions represent a rejection of evidence-based policy-making that will only make it harder for teens and other women to prevent unintended pregnancies.
In an April 30 announcement, the federal Food and Drug Administration (FDA) approved over-the-counter access for the emergency contraceptive Plan B One-Step for women 15 and older with an ID. The medication would be available on store shelves instead of behind the counter with a pharmacist, but only in stores with an on-site pharmacy. Teens younger than 15 would still need a prescription. While this decision theoretically represents a small step in the right direction for improved EC access, in practical terms, many unnecessary roadblocks to access remain—well beyond the targeted group of teens aged 14 and younger.
For instance, to comply with the age restriction, stores have to require proof of age via a valid picture ID from any woman who looks young enough to potentially be barred from purchasing Plan B without a prescription. Not only will this requirement ensnare older teens and even women in their 20s, it also ignores the reality that even many older adolescents, let alone 15-year-olds, do not have driver’s licenses or other government-issued forms of photo ID and would be unable to meet this requirement. Additionally, having pharmacy employees ask women to show proof of age—which in most settings would be done in front of other customers—carries the very real risk that fear of stigma or public embarrassment will deter young women from obtaining emergency contraception in the first place. Finally, undocumented immigrant women may not have ID or be wary of having their ID checked.
On a separate but related track, the day after the FDA made its announcement, the Justice Department appealed a U.S. District Court order from April 5 requiring the FDA to make Plan B (and its generic equivalent) available without any prescription or age restrictions. The district court’s ruling came in response to the December 2011 decision by Health and Human Services Secretary Kathleen Sebelius to override the FDA’s decision to approve Plan B for all women without restrictions. In his opinion, the district court judge noted that the Secretary’s actions were politically motivated, scientifically unjustified and against agency precedent.
In choosing to overrule the FDA’s scientific advisors in 2011, the Secretary’s stated reason for seeking an age restriction focused on concerns that adolescents as young as 11 would use Plan B without guidance from a health care provider. This rationale is entirely specious: Guttmacher research shows that very few young adolescent girls have sex—only 0.3% of 10-year-olds, 0.6% of 11-year-olds, 1.3% of 12-year-olds and 3.4% of 13-year-olds. Yet adolescence is a time of rapid change, and sexual activity becomes more common as teens become older. Some 8.6% of young women have had sex by age 14, and there were 10,200 pregnancies among 14-year-olds in 2008, the vast majority of them unintended. Excluding this group from timely access to emergency contraception is counterproductive.
At the same time, there is no evidence to suggest that making contraceptives—EC or any other method—available to adolescents encourages them to engage in sexual activity. Moreover, available evidence indicates that even young adolescents are just as likely as adults to understand medical labeling instructions on the correct use of emergency contraception.
In sum, a large body of research has shown that the long-term decline in teen pregnancy, birth and abortion rates between 1988 and 2008 was driven primarily by improved use of contraceptives among teens. Rather than inhibiting access to an effective backup birth control method, the science and common sense dictate that removing barriers to teens’ access to emergency contraception should be a U.S. priority.
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