Girls under 18 left behind

Bittersweet. It’s a good word to describe the anticipated U.S. Food and Drug Administration’s recent approval of the controversial contraceptive pill, Plan B.

The sweet part is the fact that, after nearly a three-year delay, a decision to allow the drug’s sale seems imminent. But the expected compromise — namely that Plan B will only be sold over the counter to women 18 or older — won’t be a complete victory. It’s worth noting that there are those who will be left behind.

We see them every day here at Johns Hopkins. They show up at the gynecology clinic: young, sexually active teens to whom we must “teach” birth control.

Yes, in a perfect world these kids would enjoy parental relationships in which admitting to being sexually active would be followed by a concerned, yet caring, mom or dad discussing their gynecologic options. But often these teens have either tenuous relationships with their parents or none at all. Many are uninsured and don’t regularly visit a primary care physician. Even fewer have ever even been to a gynecologist.

The ones we see, we educate about birth control and how to protect themselves from sexually transmitted diseases. And we offer them Plan B, “just in case” other birth control measures fail them. Sometimes, however, it is too late, and our first encounter occurs when they inquire about an abortion or show up for their first prenatal care visit.

If we are not careful, what will fail this population is an avoidable lack of knowledge and a lack of access to federally approved medication. For every teen we see, there are several others we don’t. These young women make the mistake of not using birth control. But we may make a terrible mistake, too, by not educating them about their options and by not making a drug, which could avoid an unwanted pregnancy and possibly an abortion, easily available to them.

With only about 72 hours after unprotected sex to take the pill, many of these young women may not have the time to have an uncomfortable chat with typically inaccessible parents, to set up a doctor’s appointment and to get a prescription filled.

In many cases, they simply won’t have the luxury of time, and, as health care providers, neither do we. The FDA should make Plan B available without an age restriction. But if the FDA requires young women under 18 to obtain a prescription for Plan B, then we must advocate for increased birth control education for this population, education that includes information about and access to this new drug.

To deny them that would be a bitter pill to swallow indeed.

Harold Fox is a medical doctor, professor and director of gynecology and obstetrics at Johns Hopkins University School of Medicine. This article is reprinted with the author’s permission.