As I close out medical charts for the day, I am reminded of the number of teens for whom I diagnosed pregnancy. Unfortunately, this diagnosis is not an uncommon one. In this context, the majority of youth are surprised, and all are scared. Each time I make the diagnosis, I revisit the question, “Was everything done that could have been to prevent this outcome?”
Right now, sexually active Minnesota teens remain at risk for an unplanned pregnancy in the current restrictive environment for access to emergency contraception.
For many, the idea of teens being sexually active is a difficult reality to face, and the concept of providing access to EC seems counterintuitive. However, regardless of individual preferences, if we can agree that having a baby as a teen before developmentally ready is not the goal, then perhaps we can agree we should be doing everything we can to prevent its occurrence.
Minnesota teens are having sex. According to Teenwise Minnesota, almost 20 percent of ninth graders and half of high school seniors are currently sexually active. Sex among teens is often spontaneous and absent of a context for consistent use of long-term hormonal birth control. Thus, Minnesota teens are at substantial risk for unplanned pregnancy, its associated health risks and socioeconomic consequences.
Teenwise Minnesota reports that three to four adolescents, 17 years of age and younger, gave birth each day in 2009. The National Campaign to Prevent Teen and Unplanned Pregnancy has broken down the costs of teen childbearing for Minnesota. According to their estimates, Minnesota spent $173 million related to teen childbearing in 2008. This included costs associated with the incarceration of the children of teen moms, lost tax revenue from declining earnings and spending of teen moms, public health care and child welfare.
Emergency contraception can prevent pregnancy when taken within a short window of time — up to five days — after unprotected sex. Plan B has been found to be a safe, effective and acceptable EC method among teens. It is currently approved by the Food and Drug Administration for purchase from pharmacies without a prescription by all individuals 17 years and older. However, misconceptions about its safety have been further fueled by the December decision of the Secretary of Health and Human Services to overrule the FDA recommendation to expand pharmacy access to Plan B without provider prescription. Given stalled action at the federal level, Minnesota legislators have an opportunity to facilitate teen access to an additional guard against unplanned pregnancy, licensed pharmacy provision of Plan B without requirement of a prescription for teens ages 14 to 16 years, via a state-approved EC protocol.
A state-approved EC protocol has much to offer teens and the Minnesota public, including protection against unplanned teen pregnancy and the risk of youth assuming a parental role before physical and socio-emotional readiness. It also offers reduced need for abortion services and fiscal savings from costs of public health care, child poverty and poor developmental and behavioral outcomes for children of teen moms. A state-approved protocol has the potential to impact a diverse population of teens and to provide more equitable access to Plan B as a contraceptive method.
According to the Kaiser Family Foundation, three states facilitate expanded access to EC via a state-approved protocol — California, Maine and New Mexico. Minnesota should be the fourth. By developing a protocol for expanded Plan B access for teens 14 to 16 years of age, Minnesota can provide an additional layer of protection against unplanned pregnancy and reduce individual and public costs of negative sexual health outcomes for its young people.
