Sunday, December 11, 2011

My take on the Plan B controversy

I haven't written yet about the decision by HHS Secretary Sebelius to over rule the FDA recommendation that Plan B (the morning after pill) be made available OTC to young women under 17 years of age. The reason I've delayed doing so is that much of the commentary on the left about it seems to be coming from the pre-condition of whether or not folks support President Obama. I happen to think that's a lousy way to form an opinion about something like this.

So as much as I have and will continue to be a supporter of the President, I disagree with both he and Secretary Sebelius on this one. I'm not an expert on the science of this drug, but it seems to me that we always go a bit nuts in this country about anything that has to do with women and sex. This feels like one of those times.

Dr. Susan Wood, a former F.D.A. assistant commissioner who resigned in 2005 to protest the Bush administration’s handling of Plan B, said that there were many drugs available over the counter that had not been studied in pre-adolescents and that were far more dangerous to them.

“Acetaminophen can be fatal, but it’s available to everyone,” Dr. Wood noted. “So why are contraceptives singled out every single time when they’re actually far safer than what’s already out there?”

But I certainly don't want to align myself with those folks who are saying that President Obama was being paternalistic when he commented on the decision and I don't immediately jump to the conclusion that it was all political. Just because I disagree doesn't send me to those conclusions.

From my experience of working with teenage girls over many years, I'll also add that I don't think this decision right now will have much of an impact. That's because I don't think Plan B is something that many teenagers would use in the first place. It requires them to be concerned about pregnancy immediately after intercourse - something that doesn't happen very often. That's not a parternalistic statement...its a fact of brain development. And its not just my opinion.

Even when young women are given free emergency contraceptives, they rarely take them after unprotected sex, studies have found.

The kind of planning and forethought required to use Plan B immediately after intercourse is not something that most teenagers will exercise. And those that would are likely to use other forms of birth control. The one situation in which that would not apply would be in the case of rape/sexual abuse. It is in those situations where I especially think this drug should be available with as little stigma and hassle as possible.

So I'm not ready to jump on many of the bandwagons I see out there on this one. We have miles to go in terms of the changes I'd like to see that would provide young girls with the information and insight they need to traverse these issues during adolescence. Yes, this drug should be available to them. But overall, its a small part of the work we need to do in pursuit of that goal.


  1. If you look at the actual argument that Sebelius made, it's not about the safety of Plan B when used as directed - both she and POTUS affirmed that the FDA/science has shown that Plan B is safe when used as directed.

    The argument that Sebelius makes actually relates to what you said about brain development, that's she's concerned that the youngest girls who would have access to the drug would use it as directed. She said that the studies presented by the drug-maker to the FDA didn't include use cases for 11 and 12 year olds but that girls of these ages would in fact be able to buy Plan B OTC if the FDA's proposed change had gone ahead. Presumably if the drug maker did a new study that rigorously showed that 11 and 12 year old girls can in fact use Plan B as directed without having had any consultation with a doctor (which is what requiring a prescription does), then she might allow the FDA's proposed rule to go ahead after all.

    I wrote about this:

    In regard to the situation of rape or sexual abuse, several people that I respect highly have pointed out that a very young girl maybe SHOULD be put into a situation where she talks to a medical professional about why she needs to take this drug. Then the doctor can intervene. If she can just go to the pharmacy and buy Plan B without more than the transaction with the pharmacist, then the abuse remains hidden because only she and the abuser know about it.

    The point about whether an unusually large dose of hormones is safe for a girl that is still going through puberty is brought up by many people who support Sebelius, but as noted above was not Sebelius's actual stated reason. In general, most of the arguments I've seen by people who support Sebelius focus on the youngest girls. When critics of the decision say that it was "paternalistic", supporters would retort, "Right, 11 year olds are still kids not grown-ups and do need adult supervision."

    Part of the problem is that perhaps because Sebelius could only veto and not propose an alternative (I don't know if this is the case but think it might be), we aren't able to discuss compromise solutions. For instance, a lot of people might support allowing age 15 and above to buy Plan B OTC but they are concerned about the youngest girls. But that's not what the FDA proposed. Or maybe instead of requiring a doctor's prescription, there should just be counseling from the pharmacist (more than the couple minutes you usually get at the counter) or some type of adult consent (not necessarily the parent, who may be abusive). There's a lot of scope here for resolving the issue through reasonable compromise and I think that many of the people who supported Sebelius would also support one of these compromise solutions.

    A final point is that Plan B is not as effective as a birth control method as other methods that are used before or during intercourse. Some of the critics of Sebelius's decision almost seem to be acting like Plan B is the only option out there. Why not focus on making other methods more accessible or more affordable? Yes, Plan B is better than nothing, and if as you say young teenagers don't even have enough forethought to take a pill afterward they won't have enough forethought to take one beforehand. But it still seems like it would be better overall to focus on education and accessibility related to these other methods not just on Plan B.

    The division between supporters and critics of the decision has hardened now because certain very prominent feminist authors made it into a personal attack on Obama, but even before that happened, there was already a division because people are looking at the issue different ways and the arguments they are making aren't really addressing the other side's concerns.

  2. Correction to the above. The sentence "that she's concerned that the youngest girls who would have access to the drug would use it as directed" should say "would NOT use it". D'oh!

  3. Laura,

    My main thought is that - as the quote I included above says - we let even 10 year olds buy more dangerous drugs over the counter without supervision. I still think all the concerns come into play because we're talking about girls and sex.

    And in the case of rape/sexual abuse, I disagree with those who suggest that requiring a prescription is a good thing in that it might force an intervention. First of all, needing to go to a Dr. might just as likely keep her from doing anything to get the medication. And secondly, telling someone about something like that should happen because the young girl trusts the person she's telling...not because she is in a position where she feels pressured to do so. We need those young girls to feel empowered as much as possible with a sense of control over their lives after being victimized like that.

    When it comes to nuance and compromise, I hear you. The problem is that there are so many stories that will go along with each girl's situation. Its hard to acomodate all of that.

  4. Junior high school girls think you can get pregnant by French Kissing. I'm sorry, I don't think it should be OTC - It's a powerful drug, and anyone at that age should consult with a pharmacist.

    Especially for children who may be especially affected by the hormones in the drug.

  5. Girls who haven't even had a period, or even understand what it is may think they are pregnant - And I made a trip to the emergency room thinking if one pill was good, maybe I should take all of them as a child.

    I don't know which drugs are more dangerous that are OTC, but they should be taken of the shelf, as well.