Recently, Obama's top health official, Health and Human Services Secretary Kathleen Sebelius, overruled the Food and Drug commissioner in order to block the Plan B emergency contraceptive pill from becoming available to teenagers under 17 without a prescription. Plan B, aka, 'the morning-after-pill,' can prevent conception up to three days after intercourse. Plan B is not an abortion pill. The FDA deemed Plan B as "safe and effective in adolescent females." Further, their study of the drug found that 90% of young teens used the pill effectively without adult intervention.
In a letter to the FDA, Ms. Sebelius expressed her discomfort with making this means of birth control available to young teens. She writes, "It is commonly understood that there are significant behavioral and cognitive differences between older and adolescent girls and the youngest girls of reproductive age which I believe are relevant to making this determination".
Ms. Sebelius is correct in her statement that there are "behavioral and cognitive differences" between adolescent girls and adults. However, these differences are exactly the reason why emergency over-the-counter contraception should be made available to young teens. The alternative measure currently available, namely quickly scheduling an emergency doctor's appointment, takes a great deal of maturity and highly developed cognitive resources, especially if the girl does not already have a trusted physician. In the span of three days, a girl has to locate, schedule and travel to a physician's office, feats that become nearly impossible if intercourse occurs on a Friday. Dealing with the logistics of scheduling a doctor's appointment can be frustrating for an adult, much less someone with no experience contacting insurance companies and doctors' offices.
Furthermore, there is a great stigma that is placed on women who are sexually active, which is amplified when it comes to teenage girls. Despite the fact that the average age of first intercourse has held fairly stable throughout the decades (at around 17 years of age), most people do not view teen sex as developmentally appropriate. Teenagers who are known to engage in intercourse are often labeled as juvenile delinquents or are viewed as acting out for attention and approval. Some teens come from families were premarital sex is viewed as a mortal sin; in others it is perceived as a great dishonor to the family name. Such stigmas prevent many teen girls from reaching out to their parents for help or from talking frankly with a physician.
If and when teens do reach out to an adult for help, many feel shamed by their healthcare providers. It is a highly vulnerable position to be laying on a table with ones legs open and feet strapped into stirrups. One 16 y/o told me (through tears) that while laying in the above manner for an exam, her doctor asked her just how many boys has she had sex with and then proceeded to lecture her about her high BMI and the importance of losing weight She felt judged and shamed by these comments and vowed never to return.
Finally, it's important to keep in mind that 12% of teen girls have been sexually assaulted and many more have been coerced into sexual relationships. Rape is highly traumatizing; its victims six times more likely to suffer from post-traumatic stress disorder than the general population. If a girl is raped, the physical and emotional toll may make scheduling a doctor appointment an afterthought.
Navigating the psychological barriers in order to obtain a prescription for Plan B require, as Ms. Sebelius alluded to, great cognitive and behavioral capabilities, however these cognitive and behavioral capabilities are not present in many teens. As such, the teens who have yet to develop them are at a severe disadvantage and, because of this block on Plan B, will potentially have a bigger hurdle to jump over in the future, that of an unwanted pregnancy.