Should Plan B, Emergency Contraception, Be Available Without a Prescription to Consumers Younger than 18?

Article Outline

• Support for Women Younger than 18 Having Access to OTC Plan B
• Rationale Against Women Younger than 18 Having Access to OTC Plan B
• Copyright

Juliana Fehr, CNM, PhD, FACNM, has been a certified nurse-midwife for 24 years. She practiced in a private home birth practice, a hospital-based practice, and in a birth center. She received her PhD from George Mason University and her MSN from Georgetown University. Her BSN was completed at the University of Virginia. She is the founder and coordinator of the nurse-midwifery education program at Shenandoah University in Winchester, VA, where she currently teaches nurse-midwifery, family nurse practitioner, and health systems management students.

Patricia B. Krauskopf, PhD, RN, APRN, BC, FNP, is a family nurse practitioner and coordinator of the family nurse practitioner program at Shenandoah University in Winchester, VA. She maintains an active family practice in a West Virginia rural health clinic and volunteers at a free medical community clinic in Front Royal, VA, where her primary focus is women's health care. She received her BSN from West Virginia Wesleyan College, her MSN from the University of Colorado, and her PhD from the University of Virginia.

Plan B is emergency contraception (EC) that can reduce a woman's risk of pregnancy if taken orally after unprotected sex. On August 24, 2006, the US Food and Drug Administration (FDA) approved Plan B as an over-the-counter (OTC) option for all consumers 18 years and older, including men. (US Food and Drug Administration. FDA's Decision Regarding Plan B: Questions and Answers. Available at: www.fda.gov/cder/drug/infopage/planB/planBQandA.htm. Accessed March 30, 2007.)

Although the FDA approved Plan B as an OTC option, young women aged 17 and younger may have access to Plan B only by prescription. A supplemental application submitted by Barr Pharmaceuticals to sell Plan B OTC to women younger than 18 was rejected by the FDA, citing inadequate data to support a conclusion that young adolescent women can safely use Plan B without professional supervision of a licensed practitioner.

What do you think? Should women younger than 18 have the same access to Plan B as women older than 18? To comment on this matter, email section editor Jacqueline Rhoads at JRhoad@lsuhsc.edu.

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Support for Women Younger than 18 Having Access to OTC Plan B 

Juliana Fehr

An estimated 3 million American women have unplanned pregnancies, and more than half of these pregnancies end in abortion. In the United States, EC could potentially prevent approximately 1.5 million unintended pregnancies. The American Academy of Pediatrics and the Society for Adolescent Medicine state that Plan B is safe for use in adolescents and is needed to prevent teenage pregnancy. These organizations support the position that, even though adolescents should be encouraged to practice abstinence, sexually active adolescents should not have barriers to access to these contraceptives.

Both the American Medical Association and the American College of Obstetricians and Gynecologists approve OTC availability, and, because Plan B is most effective when taken as soon as possible after intercourse, these organizations recognize that OTC availability may be the only way for some women to obtain EC in time to prevent a pregnancy.

Some argue that making Plan B more readily available will increase a woman's likelihood of engaging in unprotected sex. Research does not support this argument and also shows that women who had access to EC did not report higher frequencies of unprotected sex.

Plan B is sold only in pharmacies or stores staffed by a licensed pharmacist. To purchase Plan B over the counter, personal identification showing proof of age is required. Plan B is available behind the pharmacy counter to manage both prescription and OTC dispensing.

Given that the use of EC can decrease the risk of pregnancy after unprotected intercourse by 89% and that a licensed pharmacist who is trained to provide scientifically valid information and advice to patients must be on staff where EC is sold, it would be prudent to increase access to OTC Plan B for women younger than 18.

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Rationale Against Women Younger than 18 Having Access to OTC Plan B 

Patricia B. Krauskopf

Persons in leadership positions within the FDA support the Plan B prescription-only access for women younger than 18. According to Steven Galson, MD, MPH, acting director for the FDA Center for Drug Evaluation and Research, the evidence to support the OTC use for women younger than the age of 16 is inadequate. In addition, Dr. Von Eschenbach, acting FDA commissioner, set the cutoff for OTC availability of Plan B at age 18 to comply with what he described as well-established state and private infrastructures to restrict certain products to consumers aged 18 and older. Citing the difficulty of enforcing age-based restrictions on Plan B, he argues that using this already existing infrastructure allows for a more comprehensive and effective enforcement of age-based restrictions.

With the requirement for women younger than 18 to have a prescription for access comes an opportunity for women's health care providers to assess their clients' current birth control adequacy and to counsel them not only on the use of Plan B but also on more effective birth control measures. If a client needs Plan B, something in her current birth control regimen failed, or she did not have a reliable birth control method in place; therefore, this golden opportunity for counseling may have an even greater long-term effect on this young woman's (and her partner's) life.

This limitation does encumber offices to have the means to expedite this visit and allow quick and convenient access to the practitioner when a woman younger than 18 calls with a request for an appointment for Plan B. Without prompt attention and easy access, the goal of Plan B will be defeated.