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Teen contraception decision: Doctors say science trumps politics

April 06, 2013|By Geoffrey Mohan
  • A packet of Plan B, a morning-after emergency contraception drug.
A packet of Plan B, a morning-after emergency contraception drug. ( Scott Olson/Getty Images )

Science trumped politics, but politics may still present problems for teens trying to purchase emergency contraception.

“A lot of stuff is going to happen over the next 30 days,” said Dr. Cora Breuner, a pediatric medicine specialist at the University of Washington.

Breuner was reacting to a judge's decision Friday to overturn age restrictions on access to emergency contraception.

U.S. District Judge Edward Korman called those restrictions by the Food and Drug Administration “politically motivated and scientifically unjustified.” He ruled that levonorgestrel-based contraceptives such as Plan B One-Step and Next Choice should be available over the counter to all customers within 30 days.

“There is no serious health risk associated with use of Plan B as prescribed and intended, much less one that would make restrictions on distribution necessary for its safe use,” Korman wrote.

But the price of the levonorgestrel-based pills may remain a hurdle, along with potential changes in the way insurance companies and Medicaid reimburse for a pill that now is dispensed over the counter, Breuner said.

“The biggest issue and concern is that Medicaid continues to cover this,” she said. “That would be on a state-by-state basis.”

Many insurance plans, including Medicaid, may not reimburse as much, or at all, for such over-the-counter medication.

And while pharmacies may no longer ask for a prescription and identification, they may lock the pills up.

“It’s expensive,” Breuner said. “It probably will be locked up, not because of the type of medication but because it’s an expensive item that could be shoplifted.”

Age restrictions were among the barriers noted in a 2008 study that looked at access to emergency contraception for poor and minority teens in Philadelphia. Concerns about confidentiality also ranked high, according to the academy’s journal, Pediatrics.

Breuner, who co-authored the American Academy of Pediatrics’ position paper on emergency contraception, was among several medical professionals who praised the ruling Friday.

“I’m grateful the science has prevailed and that women will be able to access reproductive health regardless of age,” said Breuner. “We won the battle, but we have to continue the war, which is: We need to reduce our unintended pregnancy rate.”

Diana Ramos, California state officer for the American Congress of Obstetricians and Gynecologists, said: “The focus is on trying to prevent unintended pregnancies.… Whether it’s politics or science, the bottom line is preventing unintended pregnancies.”

Some 80% of teen pregnancies are unintended, according to studies cited by the pediatric academy.

Only half of teenage mothers ever graduate from high school, and their children are more likely to drop out as well, according to the Centers for Disease Control and Prevention. Those children also are more likely to have health problems, be incarcerated or become teenage parents themselves, the CDC reported. The net effect of all that on taxpayers is about $11 billion a year, according to the National Campaign to Prevent Teen and Unplanned Pregnancy.

Teens who sought emergency contraception generally resorted to it because of a failure of condoms, the pediatric academy reported.

The academy joined with the American Congress of Obstetricians and Gynecologists and the Society of Adolescent Health and Medicine in a  statement supporting the decision, which they said “reflects overwhelming evidence that emergency contraception is safe and effective for all women of reproductive age.”

“Removing the age restriction is a positive step forward, but providers must continue efforts to educate adolescents about the proper use of emergency contraception,” said Debra Katzman, president of the Society of Adolescent Health and Medicine. “We must also work to ensure that emergency contraception is affordable for adolescents of limited means.”

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