I'll be the latest person to pile on Mike Galanos's
in CNN about how Plan B shouldn't be available OTC to 17 year olds:
Think of a 17-year-old girl. Most of the time she's a high school
senior, still living at home with Mom and Dad. She still needs her
parents in the tough times. But they will be cut out of a traumatic
situation. All thanks to U.S. District Judge Edward Korman. Korman
stated in his order, "The record shows that FDA officials and staff
both agreed that 17-year-olds can use Plan B safely without a
Now keep in mind birth control pills require a doctor's prescription,
but a drug that is more powerful doesn't? The effective ingredient in
Plan B is the synthetic progestin levonorgestrel and this is also
found in daily oral contraceptives. Some forms of birth control that
require a prescription have levonorgestrel, while Plan B has
significantly more of the synthetic hormone. Do we really want our
daughters putting something like this in their bodies without a
doctor? I still want Mom and Dad in on this.
This is bogus on a number of levels.
First, oral contraceptives arguably should be sold OTC (Grimes
summarizes the debate here).
The only real arguments for requiring a prescription are (1) that it
forces women to get seen by their doctors, which is otherwise good,
but sort of paternalistic and (2) that compliance isn't as good if you
get them in a non-medical setting. As for the "more powerful"
argument, that doesn't follow at all. There's a difference between
occasional and acute usage. If I have a bad muscle sprain and need to
take 2400 mg/day of ibuprofen, even for a few days, I think nothing of
it, but I would see a doctor before settling into a regime of 1200
mg/day for the rest of my life. Third, pregnancy really is pretty
bad for you and there is plenty of evidence that emergency contraception
is safe, so it's not really like you need a doctor to make these
tradeoffs for you. Finally, what the heck do mom and
dad have to do with this medical argument? Unless they're doctors,
they're no more qualified than the woman/girl to have an opinion.
Some argue that a girl can get an abortion without parental
notification in some states, so why not Plan B? But just because those
states got it wrong by leaving parents out of the loop doesn't mean
others should follow suit. And the larger point is, society must help
parents, not undermine their rights by keeping them in the dark on
their child's life-changing decision.
Here's some perspective for you: In most states, minors can't get a
tattoo, body piercings or go to a tanning salon without a parent's
permission, but we are going to leave them alone to take Plan B.
I suppose there's legitimate room for discussion about whether or
not we should have parental notification laws for abortion, but
this just ignores the very real issues with them. To state the
obvious: many kids (especially girls) have sex even when their
parents disapprove or without their parents knowledge.
If they suddenly find themselves in a situation where they need
EC, either because they have a condom failure or (shocking, I know)
they had unprotected sex, having to ask their parents to get it comes
with a huge amount of baggage. And we haven't even gotten to situations
where the pregnancy is a result of abuse by a family member.
None of this applies to tattoos, body
piercings, or tanning salons. Again, it may be the case that it's
still better policy to require parental consent (I don't think so,
but that's not my point here), but it's disingenuous to suggest that
there's a straight line from tattoo parlors to Plan B.
I question that, when we are cutting a doctor out of the decision to
administer a powerful drug. Timing is essential to the drug's
effectiveness, Plan B supporters say, so getting parents and doctors
involved would unnecessarily delay the teen's ability to pop the pill
the "morning after." Does it really take that long to get a
This is a joke, right? Try to put yourself in the position of a 17-year-old
girl who just had a condom break. You've got to get up the nerve to
tell your parents you're having sex with your boyfriend and then calm them
down enough to get to the doctor and get a prescription, all within
72 hours? That doesn't seem like a lot to ask? Even if all you have
to do is see a doctor without your parents, might there not be some
logistical difficulties, like figuring out where to get one that
won't show up on your families insurance paperwork?
And because of the time limit, this essentially sentences some
girls to either an abortion or carrying the pregnancy to term,
neither of which is that attractive if you didn't want to
get pregnant in the first place.
I also don't buy the argument that this will help with unplanned
pregnancies and abortions. The Center for Reproductive Rights says
making Plan B more widely available could reduce them, but The New
York Times reports that since 18-year-olds were allowed to get Plan B
without a prescription in 2006, there has been no evidence of it
having an effect on the country's teen pregnancy or abortion rates.
This is distressing, but I don't see how this is an argument against
giving 17-year-old girls choices.
But let's get back to the first point: We are making it available to
high school girls. We're enabling teenagers to act carelessly with an
easy way out. During a recent discussion on my show, Jackie Morgan
MacDougall, supervising producer of the Web site Momlogic.com, said it
best. "Teenagers are known for thinking they're untouchable and here
we are saying that they can continue to do that and that there aren't
any consequences." With Plan B, they can do it now and deal with it
Don't tell me high school dynamics won't play in here. The boyfriend
will talk his girlfriend into unprotected sex with the promise of
buying the "morning after pill" the next day. Any 17-year-old boy will
be able to buy this drug, just as any 17-year-old girl will.
Yes, this could encourage unprotected sex and that means a greater
risk for sexually transmitted diseases. What about the 17-year-old
girl who may get Plan B for her 15-year-old sophomore friend? These
are the kind of decisions high school girls will make.
Wait, what? In my book, things that are fun (like sex) are
good. Things that aren't fun (like getting pregnant when you don't
want to) are bad. Things that make it possible to do things that are
fun without experiencing things that aren't fun are also good. This is
the part that makes me nuts about this kind of article (and also
William Saletan's article,
to some extent); what's careful and what's not is situation-dependent.
Just like you can safely climb more aggressively when you're roped up
than when you're not, a different level of care is appropriate if you
can get EC than if you can't. Having sex (or any other activity)
involves a certain level of risk, and it's not careless or irresponsible
to take such calculated risks, nor is it careless or irresponsible to
adjust your behavior when superior protection becomes available.
Now, clearly there's still a pretty significant level of residual risk in
terms of STDs to be concerned about, but consider that as an
argument against EC. The underlying logic of
Galanos's position is that we should deny girls EC
so they'll be more afraid of pregnancy and thus use protection
against STDs. That's a pretty crude kind of reasoning
(paternalistic again) and it's imposing a significant cost
on those girls who get pregnant when they otherwise would
not have for a more or less theoretical incentive benefit.
I think the 15-year old part is your hint to the real objection:
we don't want teenage girls having sex, so anything that makes
it less risky is bad. Needless to say, I don't subscribe to