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AAP says teen girls should get the morning-after-pill before they need it

Posted by Dr. Claire McCarthy  November 26, 2012 09:00 AM

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The morning-after pill (also known as Plan B): that’s the pill women can take when they’ve had unprotected sex—like when the condom breaks, or they didn’t use contraception for some reason, or, God forbid, they were forced into sex. Taken within 120 hours of intercourse, it can cut down the risk of pregnancy dramatically.

The American Academy of Pediatrics (AAP) would like doctors to give it to their teen patients before they need it. Like at checkups. Like, along with telling them to take vitamins, we should be giving them a prescription for Plan B. 

This sounds strange, but it makes abundant sense. 

I will never forget a conversation I had with my father when I was about fifteen years old. Out of pure curiosity--I wasn't even vaguely considering having sex at the time--I asked him what we would do if I got pregnant as a teenager. My father, who was one of the most laid-back, mild-mannered people I knew, said very sternly and brusquely, “I don’t ever want to find out what we would do.” End of conversation. 

As a teenager, I was taken aback by his reaction; as a mom, I totally get it.

I’m not saying that babies aren’t wonderful. They are incredible and worthy and life-changing. But it’s the life-changing part that is problematic with teen moms, of which I have seen many over the years as a pediatrician. It’s not just that they have to stop cheerleading or going out with friends. Having a baby as a teen throws school, college, graduate school and getting a good job into jeopardy. I’ve watched many girls give up their dreams and quit school and take minimum-wage jobs—or struggle to hold down a job and go to school while parenting a toddler. And then there’s everything it means to the child and the child’s future to have a mom who, frankly, isn’t really ready to handle the stresses of parenthood. 

All of us parents want to think that this happens to other people’s kids, not ours. Other people’s kids have sex, other people’s kids don’t use contraception. Ours are smarter and more, um, moral than that. But the statistics don’t back us up.  Just under half of 15- to 19-year-old girls report ever having had sex, ranging from 13 percent of 15-year-olds to 70 percent of 19-year-olds. And here’s a frightening fact: ten percent report being forced to have sex. As for birth control, condoms are the most common method, and they break. The second most common method is withdrawal, which leads to pregnancy really often. Oral contraceptives are third—but I’ve had patients forget to take them. These are teenagers, after all. 

Enter Plan B. 

Plan B is not an abortion. It works the way birth control pills work, by getting in the way of ovulation and messing up the hormones needed for early pregnancy. It stops things from getting started. And if you are already pregnant when you take it, or if it doesn’t work and you get pregnant, it’s not dangerous to the baby (if you use levonorgestrel, the most common kind of Plan B pill). 

But the key is getting it early. While it will work within 120 hours of the unprotected sex, it's better to get it within 72 hours--or, even better, 24. That’s why the AAP wants doctors to give it to girls ahead of time. Studies show that having a plan B prescription ahead of time makes teens more likely to use it when they need it (many teens delay getting in touch with the doctor, especially if they might have to tell a parent)—and it doesn’t make them more likely to have sex or less likely to use regular contraception. 

I know this will make a lot of parents uncomfortable. In an ideal world, we don’t want to have these conversations with our daughters—in an ideal world we don’t even want to think about them having sex.

But we don’t live in an ideal world. We live in the real world. And what we most want for our daughters is for them to have the best future possible. 

So if you are the parent of a teen girl, think about it. Talk to your daughter and your doctor about whether a prescription for Plan B makes sense.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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