Prescribe Morning-After Pill to Teens in Advance?
Talking About It
“It’s clear that the education around emergency contraception is lacking,” says Cora Breuner, MD, MPH, one of the policy statement’s authors.
Pediatricians “don’t want to bring up uncomfortable topics,” says Breuner, a professor in the adolescent medicine section at Seattle Children’s Hospital and the University of Washington. But, she says, it should be part of the routine conversation pediatricians have with their teen patients, along with telling them not to smoke or get into a car with someone who’s been drinking alcohol.
“Pediatricians who talk with adolescents about emergency contraception are providing much-needed medical advice,” says James Trussell, PhD, a faculty associate in the Office of Population Research at Princeton. In the mid-1990s, Trussell founded "The Emergency Contraception Web Site" and a toll-free hotline (888-NOT-2-LATE) to increase women’s knowledge about, and access to, emergency birth control. “Providing prescriptions in advance is even better medicine.”
Although multiple studies have shown that morning-after pills don’t increase risky sexual behavior or disrupt an established pregnancy, some doctors' personal values lead them to refuse to prescribe emergency birth control to teens, Breuner and her colleagues write.
Another American Academy of Pediatrics policy opinion states that such doctors have a duty to inform their patients about “relevant, legally available” options and refer them to doctors who will discuss and provide emergency contraception.
'Violation of Conscience'?
Steven Mosher, president of the Population Research Institute, based in Front Royal, Va., says he disagrees with that policy. “We reject this statement as a violation of conscience,” says Mosher, whose anti-abortion organization states that one of its goals is to "expose the myth of overpopulation."
Encouraging pediatricians to advocate for making emergency contraception available without a prescription to girls under 17, as the new policy statement does, “is a violation of parents’ rights and is also not in the best interest of the teenagers themselves,” Mosher says.
Elise Berlan, MD, MPH, an adolescent medicine specialist at Nationwide Children’s Hospital and the Ohio State University, says she’s rarely encountered a doctor whose personal beliefs prohibited discussion of emergency contraception. However, Berlan says, there’s been little research into why pediatricians do or don’t talk about sexual activity and birth control with their teen patients.
Some doctors might be concerned about being able to keep the conversation confidential, Berlan says. The federal HIPAA privacy rule protects confidential discussions between doctors and teen patients if their parents agree to leave the room, she says.