Prescribe Morning-After Pill to Teens Before Need, Says AAP

November 27, 2012

In another medical push to reduce unintended pregnancies, the American Academy of Pediatrics (AAP) is urging its members to prescribe emergency oral contraceptives — commonly known as "the morning-after pill" — for adolescent girls aged 16 years and younger before they need them.

And if a physician objects to prescribing emergency contraception to a teenager, he or she is morally obligated to refer the patient to a physician who will, the AAP asserted in a policy statement published online November 26 in Pediatrics.

The AAP policy comes 6 days after the American College of Obstetricians-Gynecologists (ACOG) recommended making oral contraceptives available over the counter (OTC).

Right now, emergency contraceptive formulations of levonorgestrel marketed as Plan B, Plan B One-Step (Teva Women's Health), and Next Choice (Watson Pharma) can be purchased OTC by women aged 17 years and older and men aged 18 years and older. Adolescent girls younger than 17 years must obtain a prescription for the drugs, which are unavailable entirely for boys younger than 18 years. The drugs can prevent an unintended pregnancy resulting from unprotected sex or contraceptive failure if taken within 120 hours of coitus.

Another emergency oral contraceptive — ulipristal (ella, Watson Pharma) — is available by prescription only regardless of age.

The AAP said that although teenage birth rates in the United States have declined substantially over the last 20 years, they nevertheless surpass those in other industrialized nations. Advanced prescribing of emergency oral contraceptives increases the likelihood that teenagers will use them when needed and reduces the interval between coitus and use, making them more effective, according to the AAP. The academy also noted that although ulipristal requires ruling out pregnancy, levonorgestrel-based emergency contraceptives do not.

Both the AAP and ACOG have supported OTC status for Plan B One-Step regardless of age. The US Food and Drug Administration was ready to grant their wish last year, but US Department of Health and Human Services Secretary Kathleen Sebelius overruled the agency, saying that girls who reach menarche at age 11 years lacked the maturity to use the drug.

Referrals a "Moral Obligation"

The AAP policy statement acknowledges that the subject of emergency contraception poses an ethical dilemma to clinicians who object to teenaged sex or sex outside marriage. Some physicians have refused to prescribe emergency contraceptives to teenage girls, and others do so only in the case of rape. Still others find their personal beliefs in conflict with "the need to prevent teen pregnancy."

"Pediatricians should strive to be aware of the ways in which the underlying beliefs they bring to clinical practice affect the care that they provide," the AAP writes.

If pediatricians refuse to provide any treatment or information on the basis of conscience, they have a "moral obligation" to steer patients to another physician "who will provide and educate about those services," the society noted. "Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients."

Pediatrics. Published online November 26, 2012. Full text