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Minors and Pharmacy Access
Pharmacy Access to EC for Minors (Printer Friendly PDF-68K)
FDA Decision on Plan B: Impact on Minors
On August 24, 2006 the FDA approved Plan B for nonprescription sale to consumers 18 and older in the United States. Women under 18 will still need a prescription. Women in states with EC pharmacy access programs may continue to get EC directly from pharmacies without going to the doctor/clinic first for a prescription. For more information click here.
Young Women’s Need for EC
Over one-third of young women become pregnant at least once before they reach the age of 20.1 About 80% of these 820,000 teenage pregnancies a year are unintended,2, 3 and a third of these end in abortion.4 Pharmacy access to emergency contraception (EC) can greatly reduce this public health challenge. However, EC use by minors has often been cited as an argument to prohibit easier access to EC. In May 2004, the FDA rejected an application to make Plan B, a dedicated EC product, over-the-counter (OTC) citing concerns that there was not enough data to support that young teens could safely use the product. The following month, the governor of New Hampshire vetoed a bill to permit pharmacists to directly dispense EC, espousing concerns of irresponsible sexual behavior and a lack of parental involvement. Currently, the FDA is considering a proposal by Barr Laboratories, Inc., the owner of Plan B, to offer dual access to the product – over-the-counter for women 16 and older, and prescription for women younger than 16 years old.
Access to EC should not be any different for teens.
- There is no medical or public health reason for limiting access to EC for adolescents. When Plan B was approved for prescription sale in 1999, the FDA did not impose any age restrictions. In 2004, 22 of the 28 FDA Advisory Committee experts reviewing the application to make Plan B OTC recommended not placing any limitations, age related or otherwise, on access to Plan B.5
EC does not encourage promiscuity and sexual irresponsibility.
- Knowledge about contraception delays sexual activity among adolescents and increases contraceptive use among sexually active youth.6
- Research has demonstrated that there are no negative behavioral or health ramifications to making EC more readily available. A study of women ages 15-20 showed that advance provision of EC did not increase unprotected sex or reduce condom use.7 A UCSF study of young women showed that women with easier access to EC are not more likely to miss a pill, switch birth control methods, or forgo using a condom than women obtaining EC through a clinic. Frequency of intercourse, amount of unprotected sex, and the number of sexual partners were also similar among the study groups.8
- Even among women and teens who use a method consistently, accidents happen.
Pharmacy access to EC will not increase exposure to STIs.
- Easier access to EC is not associated with increased STIs or pregnancy among young women. A UCSF study showed that young women obtaining EC through pharmacy access are no more likely to get an STI.8
- Women, regardless of age, are able to understand that EC does not protect against STIs or HIV. The FDA Advisory Committee that reviewed the Plan B OTC application agreed that the product’s labeling is clear and comprehensible for women — regardless of age — to understand that it does not protect against STIs or HIV.9
- Women who have chosen hormonal methods for protection against unintended pregnancy remain at risk for STIs. They may feel more confident relying on condoms for birth control if EC was easily available as a back up if the condom breaks.
Pharmacy access to EC offers an opportunity for providers to educate and/or get women into care.
- For sexually active youth, EC provides an opportunity to learn about effective long term birth control methods and disease prevention. Studies show that a request for EC may lead to initiation of routine gynecological care, including counseling about sexual behaviors and prevention strategies.10
- EC pharmacists in states that provide pharmacy access to EC obtain special training that covers the pharmacology of EC, counseling issues, and the delivery of services to minors.
- Health care providers can and should still counsel their patients about sexual behavior and prevention strategies.
- Teens rarely seek counseling from a health care provider prior to having sex for the first time because most teens don’t plan their first sexual experience.11
Increasing EC access does not send a mixed message on abstinence to teens.
- The National Campaign to Prevent Teen Pregnancy found that most adults (68%) and teens (77%) think making EC more widely available is consistent with strong messages to teens that abstinence is their best option to prevent pregnancy.12
- Research has shown that both a decrease in sexual activity and an increase in contraceptive use have driven down rates of teen pregnancy over the last decade.13, 14
Pharmacy access to EC offers other public health benefits.
- Pharmacy access to EC will reduce unintended pregnancy, which will save the state money. Pregnant teens are less likely to access prenatal care early, are more likely to experience pregnancy-related problems, and are more likely to have sick infants. Teen pregnancies cost the United States at least $7 billion annually.15
- Teen pregnancies also create societal costs. A report on the costs of adolescent childbearing showed that only one-third of teen mothers receive a high school diploma16 and calculations by the National Campaign to Prevent Teen Pregnancy indicated that nearly 80 percent of unmarried teen mothers end up on welfare.17 The children of teenage mothers are more likely to perform poorly in school16 and are at greater risk of abuse and neglect.18
- Even if a state has an overall low teen pregnancy rate, it may have regions with high rates where improved access to EC can reduce teen pregnancy.
Teens can have confidential access to EC at pharmacies.
- Limiting adolescents from receiving confidential reproductive healthcare services produces significant and harmful health repercussions. In instances where private insurance is used to cover the product, a separate patient profile for EC patients can be established to protect confidentiality, mitigating concerns that teens may forgo obtaining EC.
- An increasing number of pharmacies are offering consultation rooms to provide a confidential location to conduct the EC assessment.
A very special thank you to Reproductive Health Technologies Project and Population Services International who developed materials that served as valuable resources for this document.
Additional Resources
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