Pediatrician group advises doctors pre-write prescriptions for emergency contraception

The American Academy of Pediatrics on Tuesday recommended doctors write just-in-case prescriptions for Plan B, the morning after pill, for teenage girls, regardless of their plans for sexual behavior. 

FDA regulations require girls under 17 to have a prescription from a doctor to receive emergency contraceptives, while women 17 and over can get the medicine over the counter. The academy says having pre-written prescriptions will help prevent unwanted pregnancies — a statistic that has persistently remained higher in the United States than other developed countries.

The academy says teens are more likely to use emergency contraception if they received a prescription in advance. They also said studies show it doesn’t lead teenagers to engage in sexual activities they would otherwise abstain from.

The recommendation comes on the heels of a recommendation last week from the American College of Obstetricians and Gynecologists, to make all birth control pills available over the counter, without a prescription. Under current regulations, birth control is only available with a prescription.

Dr. Arthur Caplan, director of the Division of Medical Ethics at New York University’s Langone Medical Center, said there are health risks associated with any medication, including contraceptives, that people need to be aware of, as well as how to take the medication. That’s reflected in the complicated policy landscape for the dispensing of contraceptives.

To be sure, the academy of pediatrics recommends that doctors pre-counsel patients on how to safely and effectively use the drugs they’re being prescribed — not just hand them a prescription and let them walk away. The academy recommends that pediatricians talk generally about sex and contraceptives with all teens, boys and girls, as well.

With emergency contraceptives, time is of the essence. Efficacy of the drug declines as time passes from the sexual encounter — and it’s generally considered ineffective between three and five days after intercourse, depending on which pill is taken. Caplan said that can put young teens in a troubling situation.

“In some instances, it’s going to be different for that young girl to talk to her parents. And, sadly, there are situation in which sex is coerced, sometimes by a family member, someone who’s known, and they don’t want to get into all that,” Caplan said. “Having something available easily makes sense, given the difficulty in communication.”

That said, Caplan says its critical that doctors talk with and counsel their patients, and don’t just hand them a script.

“Every doctor should be doing that,” he said. “And I have to add, there’s nothing to prevent parents from (having their own conversations) anyway.”

Unfortunately, Caplan said, parents typically aren’t doing that.

Virtually all medical organizations in the country support making emergency contraception available without prescription, in part because of persistently high teenage pregnancy rates in the U.S. — higher than in other countries.

“Other countries do a better job on sex ed than we do, and do a better job on making contraception available than we do,” Caplan said. “I think it’s also important to undertand the risk factors with the day after pill are small.”

Emergency contraception is not an abortion, it prevents a pregnancy, along the same lines as conventional birth control. There’s an abortion pill that is different, only available by prescription and not covered by the academy recommendation.

Caplan said that preventing a pregnancy from beginning is morally preferable to terminating a pregnancy.

“There are those who will say you can’t use this, it’s somehow causing abortions, or it’s high risk,” he said. “I don’t think it fits this particular medication. I do think ready availability is important.”