In a rare example of overruling her own experts and the US Federal Drug Administration -- while apparently ignoring the highest teen pregnancy rate of any industrialised country -- Health and Human Services Secretary Kathleen Sebelius is prohibiting teenagers younger than 17 from buying the morning-after pill over the counter.
Right now, teenagers who are 17 or older with proof of age can buy the pill -- also known as Plan B -- over the counter. Teva Pharmaceuticals, which makes the drug, asked the FDA to lift the age limit, and the FDA planned to do so. FDA scientists found allowing young girls access to the drug would bring more benefit than harm. But in what looks like a politically motivated decision, Sebelius won't take the FDA's advice.
"I think the decision to overrule the FDA is a bad one," Art Caplan, director of the centre for Bioethics at the University of Pennsylvania, told me. "I don't think its consistent with the science and I suspect it's motivated by politics."
If taken within 72 hours after unprotected sex, Plan B can prevent a fertilised egg from implanting in the uterus. An old argument that refuses to die says the pill will encourage promiscuity in young girls. But there's no convincing evidence that contraception, whether it's the life-saving HPV vaccine or Plan B, leads to more sex. European teenagers use much more contraception than teens in the United States. But both have sex about the same amount. The real difference? Americans have a pregnancy rate six times higher and an abortion rate three times higher.
After decreasing over the previous decade, teen pregnancies in the United States increased again in 2005. Though they decreased in 2009, the United States has long had the highest teen pregnancy rate of all industrialised nations. In 2009, 39 out of 1000 teen girls got pregnant, while in the Netherlands the number was 4, in Japan and Italy it was 5, and in France it was 7. The only countries that came close to the US were Bulgaria and Turkey.
Young girls who find themselves pregnant have often been manipulated by an older boyfriend, uncle, neighbour, etc, into having sex. They're ashamed, scared and need help, Caplan says.
A lot of girls are going to feel uncomfortable talking with their parents. What we should do is rather than say you can't have the pill over the counter is require an insert that first gives information on how to prevent unwanted pregnancies, and second helps young women find resources on how to bring this up with their parents or where to find a religious counselor or principle to talk to. Give them some help, don't take away the pill. The manufacturer should do that anyway.
Caplan also points out that the abortion argument still lies at the heart of protests against Plan B. The pill prevents a fertilised egg from implanting in the uterine wall so it never becomes a foetus, scientifically making it not abortion. Nevertheless, during the Bush administration, some pharmacists refused to sell the drug and some hospitals still refuse to stock it. Never mind the fact that Plan B has repeatedly been proven safe and surgical abortion can be, in comparison, much more dangerous.
Reuters reported that Teva didn't convince Sebelius that younger girls would understand how to use the pill without the help of a doctor. Does Sebelius seriously believe young girls wouldn't be able to comprehend simple written instructions describing how to take a single pill? We're not talking about a series of precisely timed doses here. It's one pill.