From A to B: emergency contraception and adolescent accessibility.

ON AUGUST 24, 2006, after years of stalling by the Food and Drug Administration, the controversial morning-after pill, Plan B, was approved for over-the-counter sale to women eighteen and older. This is an important battle won in the ongoing struggle for expansion of reproductive freedom. No longer will women seeking access to the drug need to obtain a prescription from a doctor--a burdensome process any time but especially onerous in the case of Plan B, which decreases in effectiveness twenty-four hours after unprotected sex. That is a narrow window in which to schedule and make a doctor's visit, and many women's lives simply don't permit taking a day offwork on short notice. It is estimated that quick and easy access to Plan B will prevent up to 1.5 million unwanted pregnancies and 600,000 abortions a year in the United States. Everyone--whether pro-life or prochoice--can agree that this is a positive outcome.

However welcome this news is, over-the-counter access to Plan B is still denied to a vital subset of women: adolescents. This is particularly unfortunate because this is the age group for whom Plan B would be the most beneficial. Each year in the United States about 750,000 women age fifteen to nineteen become pregnant and about a third of these pregnancies end in abortion, accounting for about a fifth of all abortions. Moreover, the costs of carrying a pregnancy to term are highest for teenage girls who, as a result, are more likely to drop out of school and live in poverty.

Despite the assumed alleviation Plan B would have on these unhappy realities, the argument for barring teens from over-the-counter access to the drug should be closely considered. The reason cited by FDA officials is the concern over proper use. Interpretations of "proper use" have been debated, but it is likely that it was intended as concern about the concomitant effects Plan B's over-the-counter availability would have. Specifically, teenagers would become more promiscuous and would be less likely to use protection, resulting in an increased incidence of sexually transmitted diseases.

Though the concomitant societal effects of Plan B's availability shouldn't be a concern of the FDA it should be a concern to society at large, including Humanists. The administration's function, according to its website, is to determine a drug's safety and efficacy, and every study of Plan B shows that it passes the test with flying colors. However important the Humanist ideal of reproductive freedom is, a vital concern to all of us should also be the physical wellbeing of our youth. We should likewise be deeply invested in halting the spread of STDs that have devastating effects on individuals and the community. Thus the argument that allowing teens over-the-counter access to Plan B could result in the quicker spread of STDs deserves a fair and proper evaluation rather than quick dismissal.

On the one hand, there is some evidence to suggest that "remedy drugs" designed to mitigate the effects of risky behavior might actually lessen the perceived risks of those behaviors. A study conducted by Lisa E. Bolton, assistant professor of marketing at the University of Pennsylvania, that appeared in the June issue of the Journal of Consumer Research, shows exactly this in the case of nicotine patches for cigarette smokers. It follows that wider access to Plan B might lead teens to downplay the consequences of unsafe sex when considering the likelihood that it might lead to an unwanted pregnancy, which could in turn lead to a higher incidence of unsafe sex and STDs.

This potential effect is coupled with the fact that young people--who don't have the life experience of their adult counterparts, nor the insight that accompanies it--are more likely to downplay the consequences of their actions and are perhaps less likely to plan ahead. It makes sense, therefore, to adopt separate national and state policies for those under eighteen, but only so long as the validation for doing so rests on reason and empirical evidence and not on purely dogmatic notions of morality.

Despite these concerns, there is in fact little empirical evidence to suggest that easy access to Plan B would increase risky sexual behavior. A study conducted by Dr. Tina Raine of the University of California at San Francisco, published last year in the Journal of the American Medical Association, showed zero correlation between sexual behavior and access to emergency contraceptives. Moreover, another study published in 2001 by the Journal of Adolescent Health showed that the availability of emergency contraceptives doesn't decrease condom use. Based on these studies, it would appear that allowing teenagers over-the-counter access to Plan B wouldn't have the feared effect.

Even so, given the severity of the potential consequences, it is important to err on the side of caution. So, should Plan B remain available to teenagers only by prescription? Certainly not. Despite any of the negative effects such access might have on STD incidences, the beneficial influence over-the-counter access would have on teen pregnancy rates far outweighs these concerns. Though it is true that sometimes teenagers (as well as adults) won't always act in their best interests, the best way to protect our children from unforeseen consequences isn't to shield them from the choices they will inevitably have to make. Rather, since teenagers aren't always likely to have a "plan B" when it comes to sex, it becomes all the more important to equip them with the protection they truly need: knowledge. A comprehensive sex education curriculum, to help teens not only make smart choices but know what those choices are, should always be plan A.

Karen Frantz has a B.A. from the University of Virginia and is the public relations executive assistant at the American Humanist Association.