PLAN B After Morning Pill Controversy Affects Young Girls & Families

Recently, U.S. Department of Health and Human Services Secretary Kathleen Sebelius countered recommendations by the U.S. Food and Drug Administration (FDA) by blocking the Plan B morning after pill from hitting drug store shelves as an over the counter (OTC) product. The original ruling would have made this contraceptive product available without restriction to women, men, boys and girls of all ages. The Secretary’s action surprised many observers because it is counter to this administration’s political ideology. Her stated reasons for making the ruling were that she did not believe the manufacturer had adequately demonstrated that people of all ages could comprehend the package insert. Some think this was actually a political move influenced by the President to prevent implementation of a controversial decision during an election year, and that if re-elected his administration would very likely make this product available OTC without restriction during a second term in office. Regardless of your political philosophy there are some significant medical and social concerns surrounding this decision.

Plan B is a single dose pill containing 1.5mg of levonorgestrel meant to be taken with 72 hours (3 days) of having unprotected sex. It is not as effective as combination contraceptive pills, intrauterine devices or contraceptive implants. It does not protect a woman from sexually transmitted diseases. It is meant to be used no more than once per menstrual cycle. It is not an abortifacient and it will not work if a woman is already pregnant. It may be less effective if taken after a woman has already ovulated that month. It is currently available without a prescription to anyone age 17 and older.

Making this product available OTC without a prescription or age restriction means that very young adolescent girls will be able to buy the product without involving parents or a licensed medical provider in the process. I am concerned about this because very young adolescent girls do not have the life experience or mature judgment to understand the health risks associated with sexual activity or the use of Plan B. The advice of a parent, a trusted adult guardian or a licensed medical provider can be in valuable to a young girl when it comes to making decisions about contraception and healthy sexual practices.

Plan B contains a high dose hormone with potential risks. When taken only once during a menstrual cycle, as directed, side effects are minimal. Common complaints include nausea and vomiting, abdominal pain, breast tenderness, headache, dizziness, and fatigue. Using the product more than once in a menstrual cycle is not recommended by the manufacturer because safety and effectiveness for use in this manner has not been evaluated. The hormone contained in Plan B is a potent hormone at more than 10 times the dose of a typical combination oral contraceptive pill. Prolonged, repeated use in the same menstrual cycle may result in more serious medical problems including menstrual cycle irregularities, elevated blood pressure, depression, anxiety and increases in cholesterol levels. All of this being said, a pregnancy is still a greater risk to a young girl’s health than taking the hormones in Plan B.

Providing Plan B as an OTC medication subverts family support by possibly removing the opportunity for parents or other caring adults to be involved in an adolescent girl's decision making. Some would argue that girls who lack a caring and supportive home environment would not feel comfortable approaching a parent or guardian and would therefore not have access to a morning after pill. And this might lead to more unintended pregnancies. However, granting easy access to OTC Plan B eliminates a powerful incentive for girls to involve any caring adult or seek a confidential consultation with a licensed medical provider. Strengthening family relationships should be an important objective in any government policy regarding family planning.

A visit with a licensed medical provider would facilitate counseling about the risks of adolescent sexual activity, screening for sexually transmitted diseases and initiation of more reliable forms of contraception. Young teenage girls having sex are likely to be the victims of abuse by older men. A visit with a medical provider allows for screening and intervention in cases of sexual abuse.

Finally, Making Plan B available OTC reduces or eliminates coverage by health insurance plans driving the average cost to users for a single dose from about $25 to about $45. Parents should be aware that Plan B may soon become available OTC to young girls if the Secretary lifts her restrictions and it is placed on store shelves for purchase without a prescription. The FDA has already recommended that she do so. This issue will now be resolved in the political arena. If you wish to express your wishes I suggest you contact your elected representatives and voice your opinion.

Terence Heath, MD is a board certified OB/GYN who practices in Cedar City at the Cedar City Institute of Women’s Health, (435) 865-9500. He also has clinic hours every other week in Richfield, Utah