Tornado Alley (PROG)

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Prescribe morning-after pills in advance, say pediatricians

By Sharon Begley
Mon Nov 26, 2012 12:08am EST

NEW YORK (Reuters) - Wading into the incendiary subject of birth control for young teenagers, the American Academy of Pediatrics (AAP) on Monday called on the nation's pediatricians to counsel all of their adolescent patients about emergency contraception and make advance prescriptions for it available to girls under 17.

Because current federal policy bans over-the-counter sales of the pills to girls under 17, having a prescription on hand could help younger teens obtain emergency contraception more quickly than if they have to contact a physician only after they need it.

Calling the AAP decision "significant," Susan Wood, former assistant commissioner for women's health at the Food and Drug Administration (FDA), said, "it's not often you see physician organizations saying that their patients are better off without the physician involvement."

It is anyone's guess whether pediatricians will heed their organization's recommendation, but AAP leaders are optimistic.

"We do hope that pediatricians read the policy statement and follow the recommendations," said Dr. Cora Breuner, a pediatrician at Seattle Children's Hospital who led the AAP panel that produced the recommendations. "The Academy prides itself on a devoted membership."

Emergency contraception for adolescents has been one of the most politically fraught areas in healthcare for almost a decade.

In 2005 the FDA declined to approve any over-the-counter sales of Plan B, a "morning-after pill," overruling its panel of outside experts as well as its own scientists. Last December the FDA reversed that stance and moved to approve over-the-counter sales with no age limits. But Health and Human Services Secretary Kathleen Sebelius overruled it, ordering that for girls under 17 the pills remain available only by prescription.

The policy means that women in their 20s, 30s, or beyond must also present proof of age, and that teenagers "face a significant barrier if they suddenly need emergency contraception at midnight on a Saturday," said Wood, who resigned from the FDA in 2005 over its Plan B decision and is now director of the Jacobs Institute of Women's Health at George Washington University in Washington, D.C.

The most common form of emergency contraception is a high dose of a regular birth-control pill such as Plan B and Plan B One-Step from Teva Pharmaceutical Industries Ltd or Next Choice from Watson Pharmaceuticals Inc. They generally sell for $10 to $80 and, although they can work as long as 120 hours after unprotected sex, are most effective in the first 24 hours.

All work by preventing ovulation, not by stopping the implantation of a fertilized egg. "These are not abortifacients," said Breuner.

GREATER USE OF EMERGENCY CONTRACEPTION

A 2006-08 survey found that 14 percent of sexually experienced girls had used emergency contraception, up from 8 percent in a 2002 survey. The most common reason was condom failure, but 13 percent of the girls said it was because of rape.

A 2010 analysis of seven randomized studies of emergency contraception found that having a morning-after prescription in hand did not increase teens' sexual activity or decrease use of standard contraceptives but did increase use of the pill and shorten the time before a teenager used it after sex.

"It's just common sense that requiring a prescription is a barrier," said Bill Alpert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy. "If an august and respected medical group like AAP is suggesting providing emergency contraception to minors is OK, that is a big deal."

That is especially so when teens face other obstacles to getting emergency contraception. For instance, in a 2012 study that had 17-year-olds telephone pharmacies asking about morning-after pills, only 57 percent of them correctly told the caller that she could get the drugs without a prescription.

Another barrier is that some physicians refuse to provide the prescriptions to teenagers, while others do so only in cases of rape, AAP's research shows, suggesting that the refusal "may be related to the physician's beliefs about whether it is OK for teenagers to have sex."

But pediatricians, said AAP in its policy statement, "have a duty to inform their patients about relevant, legally available treatment options," even those "to which they object."

There are no good data on how many physicians write prescriptions ahead of time for emergency contraception. "But we do know that pediatricians don't even talk about it, let alone offer advance prescriptions," said Breuner. "We tend not to like bringing up stuff that's controversial."

One factor in the AAP's recommendation, which is being published in the journal "Pediatrics," is that although teen pregnancies in the United States have declined since 1991, the rate is higher than in most other developed countries. The percent of 15- to 18-year-olds who report ever having intercourse - just over 40 percent, according to the U.S. Centers for Disease Control and Prevention - is, however, lower than in many developed countries. In other words, fewer of America's teens are having sex but more are getting pregnant.

"We think this is a big deal," Breuner said of the new recommendation. "The mothership of pediatricians has come out in favor of encouraging routine counseling and advance emergency-contraception prescriptions as one part of a public health strategy to reduce teen pregnancy."

(Reporting by Sharon Begley; editing by Prudence Crowther)

Copyright 2012 Thomson Reuters

http://www.reuters.com/article/2012/11/26/us-contraception-emergency-idUSBRE8AP04420121126 [with comments]


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AAP: Teach Teens About Emergency Contraception
November 26, 2012
http://www.medpagetoday.com/OBGYN/Pregnancy/36091


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Emergency Contraception Safe For Teens


The AAP recommended advance prescriptions to increase the effectiveness of the drug by giving teens the ability to take it as soon as possible.
(Robert Couse-Baker)

Dawn Megli | November 25, 2012 | 10:16 p.m. PST

The American Academy of Pediatrics [ http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Recommends-Emergency-Contraception-Be-Available-to-Teens.aspx ] has recommended that doctors issue prescriptions for emergency contraceptives to teenage patients as a precautionary measure, as the over-the-counter drug is not available to anyone under 17 years of age, according to Reuters [ http://www.reuters.com/article/2012/11/26/us-contraception-emergency-idUSBRE8AP04420121126 (first item this post)].

The Academy also said emergency contraception should be available over-the-counter with no age restrictions.

The Journal of Pediatric and Adolescent Gynecology [ http://www.ncbi.nlm.nih.gov/pubmed/20869281 ] reviewed seven trials and concluded that advance prescribing decreased the time before usage, making the emergency contraception more effective. The review also found advanced prescribing did not increase sexual activity among teens.

© 2008-2010 USC Annenberg

http://www.neontommy.com/news/2012/11/emergency-contraception-safe-teens [no comments yet]


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Ob-gynecologists endorse over-the-counter birth control

By Kerry Grens
Tue Nov 20, 2012 5:38pm EST

NEW YORK (Reuters Health) - A leading group of women's physicians is urging drug regulators to make birth control pills available over-the-counter.

"We need to do something about the unintended pregnancy problem in the U.S. This is one way," said Dr. Kavita Nanda, one of the authors of the statement by the American College of Obstetricians and Gynecologists (ACOG) and a scientist at the nonprofit research group FHI 360.

As Nanda and her colleagues wrote in their opinion statement supporting over-the-counter access, about half of all pregnancies are unplanned and they lead to $11 billion in costs to taxpayers each year.

Diana Greene Foster, a professor at the University of California, San Francisco who studies the impact of birth control on unplanned pregnancies, told Reuters Health the new opinion is backed by evidence.

"It's been a long time that people (have felt) that over-the-counter makes sense," said Foster, who is not part of the ACOG committee. "It's clear that it would result in better access and fewer unintended pregnancies if women had better access to oral contraceptives."

Currently, the birth control pill requires a prescription in the U.S.

Emergency contraception, which goes by the brand name Plan B, is available without a prescription, but must be acquired from a pharmacist.

Nanda said several surveys have shown that women would be more likely to use the pill if it were available over-the-counter, and studies have shown that women are at least as good as doctors at screening themselves for health reasons why they shouldn't take the pill.

"There's just an accumulating body of evidence that's been published over the past three years that's really been documenting the safety and effectiveness of over-the-counter access," said Dr. Dan Grossman, the vice president for research at Ibis Reproductive Health.

Grossman sits on an ACOG committee, but not the one that penned the latest opinion.

One of the concerns about over-the-counter access is that the pill carries a small, increased risk of developing a potentially dangerous blood clot. But the risk of these clots is even greater during pregnancy.

"The pill is incredibly safe," Grossman told Reuters Health. "I don't have any safety concerns."

COST ANOTHER BARRIER?

Grossman said he worries more about cost and insurance coverage, so that if the pill does become available without a prescription, women could actually access it.

"As we saw with Plan B, when it went over-the-counter the price was really high, $50 for a one-time use. If a daily pill were priced that high, I don't think we would see the hoped-for increased use because the cost would create another barrier," he said.

Under a provision of the Patient Protection and Affordable Care Act, also called Obamacare, women with health insurance will become eligible to receive birth control without any additional co-pays.

It's not clear whether this would apply to over-the-counter birth control if the U.S. Food and Drug Administration approves such access.

The agency told Reuters Health it is willing to speak with drugmakers who wish to petition for a switch from prescription to over-the-counter availability.

"In order for a switch to occur, FDA determines whether the prescription requirements are necessary for the protection of the public health...Whether data would be needed for oral contraceptives to switch would require further review and discussion with (drug) sponsors," Stephanie Yao, an FDA spokesperson, wrote in an email.

Foster said that, for supporters of over-the-counter access, ACOG's opinion is encouraging.

"The fact that ACOG is coming out with a statement is a big deal, because they're currently the gatekeepers. So when the gatekeepers are willing to let women have access to (over-the-counter) oral contraceptives, it does support it," she said.

SOURCE: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives ( bit.ly/Ud6Y2v ) Obstetrics & Gynecology, online November 20, 2012.

Copyright 2012 Thomson Reuters

http://www.reuters.com/article/2012/11/20/us-ob-gyns-idUSBRE8AJ1IZ20121120


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How Over-the-Counter Birth Control Could Screw You
The nation’s top OB/GYNs have come out for allowing access to the pill without a prescription. Sounds good for the consumer, right? Not so fast, writes Dr. Kent Sepkowitz—you’d be paying a lot more.
Nov 24, 2012
http://www.thedailybeast.com/articles/2012/11/24/how-over-the-counter-birth-control-could-screw-you.html [with comments]


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