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This fact sheet was developed in January 2004 in response to inflated and speculative claims – being made primarily by anti-choice Republican members of Congress and advocacy groups – about the potential risks to teens of wider availability of emergency contraception. It draws upon testimony given during the December 2003 FDA Advisory Committee hearing on the Plan B over-the-counter application.
Frequently Asked Questions about Adolescents and Emergency Contraception
Would making emergency contraception available over-the-counter cause teens to engage in risky sexual behavior?
Would making Plan B emergency contraception available over-the-counter would increase young women's risk to sexually transmitted infections (STIs)?
Will making emergency contraception available over-the-counter eliminate the opportunity for healthcare providers to educate their young patients about abstinence and contraception?
Does making emergency contraception more easily available to teens send a mixed message on abstinence?
Will parents be less likely to learn about the decisions their kids make about sex if emergency contraception is available over-the-counter?
Would making emergency contraception available over-the-counter cause teens to engage in risky sexual behavior?
No. EC use is not associated with increased risk taking behaviors among adolescent women. Expanding access to emergency contraception impacts women's ability to use the product – period. Studies of EC use among young women show increased access to emergency contraception among adolescents does not result in inappropriate use of Plan B as a routine form of contraception, nor an increase in number of sexual partners, nor an increase in frequency of unprotected intercourse, nor an increase in the frequency of sexually transmitted diseases.1 2 3 Young women who have easier access to EC are also no more likely to use EC repeatedly, than women who obtain it from a clinic or healthcare provider. Furthermore, research show that a request for emergency contraception may actually lead to initiation of routine gynecologic care, including counseling about sexual behaviors and prevention strategies.4
Expert Position: A 2004 study by Dr. Melanie Gold5 suggests that not providing emergency contraception to adolescents in advance does not increase rates of abstinence or postponement of sexual activity. If adolescents perceive obstacles to obtaining contraception and condoms, they are more likely to experience negative outcomes to sexual activity, such as an unintended pregnancy or an STI. Making emergency contraception easily available does not cause adolescents to have more unprotected sex or to stop using hormonal contraception or condoms, but it does help adolescents use it sooner thereby increasing the efficacy of the treatment. 7
Would making Plan B emergency contraception available over-the-counter would increase young women’s risk to sexually transmitted infections (STIs)?
No. EC use is not associated with increased risk for future STIs or sexual risk taking behavior among adolescent women. Several studies confirm that adult women and teenagers who keep emergency contraception in their medicine cabinet or get it directly from a pharmacist continue to use regular birth control methods – including condoms. Having emergency contraception on hand does not encourage sexual risk-behaviors – like having more unprotected sex or more sex partners – or increase STD rates.6 7 8 9 Moreover, the FDA's Advisory Committee agreed that Plan B labeling is clear and comprehensible enough for women – regardless of age – to understand that Plan B does not protect against sexually transmitted infections or HIV.10
Expert Position: Leading health organizations including the American Academy of Pediatrics, the Society for Adolescent Medicine, and the American College of Obstetricians and Gynecologists observe that although emergency contraception does not prevent STIs, it can prevent pregnancy if it is readily available and used in a timely manner. While there does not appear to be an increased risk of STIs associated with easier access to emergency contraception, major medical and public health organizations are committed to ensuring that women know how protect themselves against STIs. 11 12 Furthermore, an over-the-counter switch may provide a new educational opportunity to reach teens that do not have timely access to a clinician, such as through the package insert.
Will making emergency contraception available over-the-counter eliminate the opportunity for healthcare providers to educate their young patients about abstinence and contraception?
No. Healthcare providers can and should still counsel their patients about sexual behavior and prevention strategies. If Plan B is available over-the-counter, healthcare providers can and should still counsel their patients about sexual behavior and prevention strategies. However, the reality is that adolescents rarely seek counseling from a health care provider prior to having sex for the first time. The reason: most teens never planned to have sex in the first place.13 Even when teens do receive health care services, few providers routinely discuss this option with their patients. Just 25% of gynecologists and 14% of general practice physicians say they always or usually discuss emergency contraception in routine counseling.14
Expert Position: The American Academy of Family Physicians states that over-the-counter access to emergency contraception will benefit patients, particularly if educational information is included concerning various birth control options and recommendations regarding the advantage of having a personal physician to help make these decisions and encourage healthy behaviors.
Does making emergency contraception more easily available to teens send a mixed message on abstinence?
No. Making emergency contraception more widely and easily available is consistent with a strong message to teens that abstinence from sex is their best option by far. A survey conducted by the non-profit, non-partisan National Campaign to Prevent Teen Pregnancy found that most adults (68%) and teens (77%) think making emergency contraception more widely and easily available is consistent with a strong message to teens that abstinence from sex is their best option by far. Removing the barriers to access ensures that teens who have sex when they do not want or do not plan to – as well as those who experience a contraceptive accident – are able to avoid unintended pregnancy.15 Both less sex and more contraception have driven rates of teen pregnancy down over the last decade. According to the National Survey of Family Growth, in 2002, only 13% of adolescent women had had sex before age 15 (compared to 19% in 1995) and the percent of teens ages 15-17 who had ever had sex declined significantly (to 30%, compared with 38% in 1995).
Expert Position: FDA Advisory Committee member, Dr. Leslie Clapp16 added that – while abstinence is the best option for teens – if an adolescent is having sex, she needs to have access to a back up method of contraception. She said, "if you are a sexually active ten… or eleven year old, it's certainly a bad situation, and I've had patients who are ten and eleven and pregnant, and I think their families and they would have far preferred this option than pregnancy, and it would have been safer. We know that the morbidity and mortality associated with teen pregnancies is quite high."17
Will parents be less likely to learn about the decisions their kids make about sex if emergency contraception is available over-the-counter?
No. Parents have a critical role to play in educating their children about sexuality and prevention strategies. 70% of teens have talked to their parents about how to say no to sex, about birth control, or about preventing STIs.18 In fact, most teens (88%) say it would be easier for them to postpone sexual activity and avoid teen pregnancy if they had more open, honest conversations about these topics with their parents. 10 Making Plan B available over-the-counter will ensure that – in an emergency – teens will have access to a safe, back-up method of contraception and be able to prevent unintended pregnancy.
Expert Opinion: Imposing age restrictions or requiring parental notice would only result in more negative health outcomes for teens. Committee member Dr. Abby Berenson,19 noted" …it is very important that the method if placed over the counter is accessible to all women at risk of unintended pregnancy. …Creating barriers to…use [will] ultimately…result in unintended pregnancies."7
Should the FDA or state regulators place an age restriction requirement for over-the counter approval of Plan B?
No. There is no medical or public health justification for restricting young women's access to Plan B. The FDA did not impose age restrictions Plan B when it was approved for prescription sale in 1998. At the Advisory Committee meeting, members of the FDA staff stated the FDA " …would have no reason to impose an age restriction for the product unless there were specific reasons to do so. Historically[,]… oral contraceptives…do not have an age restriction because most of the studies are done in a wide range of ages, and we have considered women of reproductive age who are capable of reproduction as one group." Furthermore Dr. John K. Jenkins, Director of the Office of New Drugs in the FDA, commented, "While OTC access to Plan B for adolescents may be controversial from a societal perspective, I cannot think of any age group where the benefit of preventing unplanned pregnancies and abortion is more important and more compelling."20
Expert Opinion: Most major medical and public health organizations oppose placing an age restriction on emergency contraception. In fact, twenty-two of the twenty-eight FDA Advisory Committee experts recommended not placing any limitations – age-related or otherwise – on access to Plan B. Committee, Dr. Alastair Wood21 said, ".. [I] would advocate strongly against introducing subtle barriers to access, such as raising flags about age and raising issues about behind the counter use. I think the issue of behind the counter is false one. The evidence that that has worked in any country is nonexistent, and it has only been suggested, I think, to introduce a barrier to access, which I think would be a disaster."
1 Raine T. et al, Increased Access to Emergency Contraception and Impact on Pregnancy and STIs: A Randomized Controlled Trial, Journal of the American Medical Association, 2005; 293:54-62.
2 Raine T, et al. Emergency Contraception: Advance Provision in a Young, High Risk Clinic Population. Obstetrics and Gynecology 2000; 96: 1-7.
3 Belzer M, Yoshida E, Tejirian T, Tucker D, Chung K, Sanchez K. Advanced supply of emergency contraception for adolescent mothers increased utilization without reducing condom or primary contraception use. Research Presentations. Journal of Adolescent Health 2003; 32: 122-123.
4 Stewart, HE, Gold MA, Parker AM. The Impact of Using Emergency Contraception on Reproductive Health Outcomes: A Retrospective Review in an Urban Adolescent Clinic. Journal of Pediatric Adolescent Gynecology (2003) 16:313–318.
5 Gold, MA, Wolford JE, Smith KA, Parker Am. The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors. Journal of Pediatric and Adolescent Gynecology. 2004 Apr; 17(2): 87-96.
6 Raine T, et al. Emergency Contraception: Advance Provision in a Young, High Risk Clinic Population. Obstetrics and Gynecology 2000; 96: 1-7.
7 Belzer M, Yoshida E, Tejirian T, Tucker D, Chung K, Sanchez K. Advanced supply of emergency contraception for adolescent mothers increased utilization without reducing condom or primary contraception use. Research Presentations. Journal of Adolescent Health 2003; 32: 122-123.
8 Gold, MA, Wolford JE, Smith KA, Parker Am. The effects of advance provision of emergency contraception on adolescent women’s sexual and contraceptive behaviors. Journal of Pediatric and Adolescent Gynecology. 2004 Apr; 17(2): 87-96.
9 Raine T. et al, Increased Access to Emergency Contraception and Impact on Pregnancy and STIs: A Randomized Controlled Trial, Journal of the American Medical Association, 2005; 293:54-62.
10 FDA, Nonprescription Drugs Advisory Committee and the Advisory Committee for Reproductive Health Drugs, December 16, 2003, Briefing Information. http://www.fda.gov/ohrms/dockets/ac/03/briefing/4015b1.htm
11 Dupont S, Webber J, Dass K, Thornton S. Emergency contraceptive pill (ECP) and sexual risk behaviour. International Journal of STD & AIDS 2002; 13: 482-485.
12 Bajos N, Goulard H, Job-Spira N. Emergency contraception: from accessibility to counseling. Contraception 2003 Jan; 67(1): 39-40.
13 National Campaign to Prevent Teen Pregnancy Website. http://www.teenpregnancy.org.
14 Henry J. Kaiser Family Foundation. National Survey of Women About Their Sexual Health, 2003, Menlo Park, CA: Kaiser Family Foundation, 2003.
15 FDA, Nonprescription Drugs Advisory Committee and the Advisory Committee for Reproductive Health Drugs, December 16, 2003, Meeting Documents. http://www.fda.gov/ohrms/dockets/ac/cder03.html#ReproductiveHealth
16 Dr. Leslie Clapp is a Pediatrician at Main Pediatrics in Buffalo New York.
17 FDA, Nonprescription Drugs Advisory Committee and the Advisory Committee for Reproductive Health Drugs, December 16, 2003, Transcript. http://www.fda.gov/ohrms/dockets/ac/03/transcripts/4015T1.htm
18 Abma JC, Martinez GM, Mosher WD, Dawson BS. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. National Center for Health Statistics. Vital Health Stat 23(24). 2004.
19 Abby B. Berenson, MD is Chief of the Division of Pediatrics and Adolescent Gynecology at the University of Texas Medical Branch in Galveston, TX.
20 Obtained from an Office Director Memorandum, Office of New Drugs, FDA. Jan.21, 2004.
21 Alastair Wood, MD is a Profess or of Medicine and Pharmacology at the Vanderbilt University School of Medicine in Nashville, TN.
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