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Wrong approach to Plan B



Published: Thu, May 9, 2013 @ 12:00 a.m.

As a mom, I can’t help but cringe.

As a thinking adult, I can’t help but reconsider.

I’m referring to the continuing controversy over making emergency contraceptives available, without a prescription, to — and here is the standard, incendiary formulation — girls as young as 11.

No mother — no parent — wants her 11-year-old, or her 16-year-old for that matter, using emergency contraception without her knowledge. No mother wants girls that young having unprotected sex. No mother wants girls that young having sex, period.

Except mothers, it turns out, don’t always get their way. It would be far preferable for a child — and they are children — who finds herself in need of emergency contraception to turn to her parents for help.

But the blunt facts are these: (a) that consultation isn’t always going to happen and (b) time is of the essence in taking emergency contraception.

The parent who does not want her teenage daughter pregnant should be relieved, not squeamish, at the thought of the drug available over the counter. As John Jenkins, director of the Food and Drug Administration’s Office of New Drugs, has observed, there is no “age group where the benefit of preventing unplanned pregnancies and abortion is more important and more compelling.”

By the way: The drug, marketed as Plan B One-Step, runs about $50. For those worried about its repeated use, that cost serves as a rather big deterrent.

Red herring

Meanwhile, the 11-year-old Plan B user is a red herring. Most 11-year-olds aren’t menstruating. Hardly any are sexually active. The price of stopping the imaginary 11-year-old from taking Plan B is preventing the actual 14- or 15-year-old from obtaining it.

But but but, you are sputtering. The school nurse can’t give my daughter Tylenol without my permission. And you want her to be able to take emergency contraception without my knowing?

Yes, and here’s why. In terms of risk, you should worry more about the Tylenol than Plan B. The school nurse can’t give Tylenol to your daughter unapproved, but your daughter can buy it at the pharmacy. Buy a lethal dose, actually.

She can also purchase all sorts of other medications that could cause far more harm, from aspirin to cough medicine to laxatives.

Indeed, as U.S. District Judge Edward Korman ruled last month, “These emergency contraceptives would be among the safest drugs sold over the counter.” He cited an article in the New England Journal of Medicine: “The only documented adverse effects of a $50 dose of levonorgestrel are nausea and delay of menses by several days. Any objective review makes it clear that Plan B is more dangerous to politicians than to adolescent girls.”

About those politicians: There are two current fronts in the battle over Plan B, administrative and legal.

On the administrative front, the Obama administration moved last week to approve the drug for over-the-counter sales to girls 15 and over without a prescription. The previous age limit was 17.

On the legal front, just hours later the administration moved to appeal the judge’s order that emergency contraception be available over the counter with no age limit whatsoever.

The administration got it wrong both times.

First, the age 15 limit sounds more sensible than it is. Girls would have to provide government-issued proof of their age. Most 15-year-olds don’t have passports or access to birth certificates. They don’t yet have driver’s licenses.

Deterrence

As with the voter identification laws that the administration has correctly cited as impermissible barriers to voting, the proof-of-age requirement will serve to deter the youngest girls from obtaining emergency contraception.

What makes sense in the context of cigarettes and alcohol doesn’t work in the context of emergency contraception. We want to discourage the use of the former, encourage the latter.

Second, the judge’s order — that Plan B be made fully available — offered the administration an easy way out. The administration should have taken it.

Generally, we don’t want judges telling agencies what drugs to approve. But when agencies behave arbitrarily and capriciously, as the FDA has done with Plan B, judicial intervention is warranted. In this case, the judge’s order supported the findings of agency scientists, who were repeatedly overruled by political superiors, most recently Health and Human Services Secretary Kathleen Sebelius.

I understand — I empathize — with parental concerns about Plan B. Yet this debate isn’t about the government coming between parents and children, or society condoning teen sex. It’s about preventing teen pregnancy.

On that score, easy access to Plan B should be Plan A.

Washington Post Writers Group


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