Oral, injectable contraceptives and Plan B are now staples in the nurses’ offices at 13 NYC public schools. The pills are part of CATCH, Connecting Adolescents To Comprehensive Health, a program to keep sexually active teens from having babies.
Of course, fourteen-year-olds shouldn’t be having babies, but handing hormones to little kids without a physical exam or even a medical history is really bad medicine in my book. Here’s why.
First, estrogen and progesterone are prescription medications for a reason: they’re dangerous for some girls. If, for instance, a young girl has one of several medical problems like a blood clotting disorder that she doesn’t know about, these hormones can cause her to have a stroke. Even if she doesn’t have an underlying medical problem, these hormones can still cause strokes in a very small percentage of users.
Those dispensing contraceptives know that but figure that the percentage is small enough to warrant mass use. Not if your daughter is in that percentage. So, be careful, NYC nurses who hand these out. Who’s going to take the heat when a fifteen-year-old suddenly can’t walk, smile, or think clearly after a few doses?
Second, there’s the issue of efficacy. Yes, birth control pills and Plan B work when taken correctly; but in my experience, many kids don’t do so. The girls who are having sex at fourteen are forgetful. They simply don’t take the pills regularly and therefore, birth control pills don’t work.
Plan B does prevent pregnancy if the girl takes it within 72 hours of having unprotected intercourse, but let’s look at what the medical data really says about Plan B. In three excellent, major medical studies (see links at the end of this post), the researchers found that yes, Plan B works to prevent pregnancy when girls take it; but overall, teen pregnancies weren’t reduced in a given population. What does this mean? Simply, that girls take it but continue to engage in unprotected sex and stop taking it.
So, ultimately, if the point of giving out plan B is to drive down teen pregnancy rates in a school full of girls, the best studies so far show that it doesn’t do that. Kids keep having sex. The problem isn’t the pregnancy; it’s the behavior of the kids. And all the estrogen and progesterone in the world won’t change that.
There’s another issue: sexually transmitted infections. (I’ve written lately a lot here about sex ed programs and STDs.) Just to remind you, there are over 30. In 2000, a whopping 15.3 million Americans contracted a new one each year, and now that number has risen to 20 million. Don’t believe me? Check out the CDC’s website; it’s front and center. So what happens to the young girls who swallow pills but keep having sex?
Like I tell my patients, if you’ve have more than three partners, you’ve got something. They don’t believe me because they don’t have symptoms. And it’s true; most of the time patients with infections don’t have symptoms.
My concern, though, is that handing out hormones may keep babies from being born, but it also encourages young kids to keep having sex. And then, it’s only a brief time before they’re infected. Remember, one in five Americans over age 12 tests positive for Herpes 2. That’s 20% of the population. Hormones don’t stop Herpes.
Those giving out pills may think they’re really doing girls a favor. Fifteen years ago, I dispensed oral contraceptives, and I thought the same thing. But it isn’t 1995 anymore, and pregnancy is no longer the worst problem sexually active kids face; it’s HIV, cervical cancer, or contracting herpes for life. Last time I looked, pregnancy doesn’t kill girls, but some diseases surely can.
I’m glad that my kids didn’t go to school in New York because there’s no way as a pediatrician that I would want anyone giving my kids contraceptives without my knowledge. And for that poor parent who may awaken one morning to find her daughter lying in bed with a stroke and doesn’t have a clue as to how it could have happened, who’s going to tell the mother that they gave her daughter pills behind her back? Not me.
For more information, here are links to the three studies I referenced in the post:
Population effect of increased access to emergency contraceptive pills
Advance provision of emergency contraception for pregnancy prevention
Advance provision of emergency contraception for pregnancy prevention: a meta-analysis.