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FDA Weighs Morning After Pill for Teens

By MARTHA IRVINE

CHICAGO (AP) - Some see easy access to emergency contraception as a way to
drastically reduce teen pregnancy, already on the decline since the early
1990s. Others worry that its long-term effects on young women are unknown or
argue that the drug, also known as the ``morning after pill,'' encourages
teens to have sex. Ultimately, it will be up to Food and Drug Administration
officials to decide: Should older teens be able to buy emergency contraception
over the counter?

Earlier this year, the FDA denied one drug company's request to sell its brand
of emergency contraception to anyone. Now that company, Barr Pharmaceuticals,
has submitted a second proposal - to sell its Plan B brand to people 16 and
older, but to require anyone younger than that to consult a physician. The
company expects a decision next year.

Over-the-counter sales have received support from both the American College of
Obstetricians and Gynecologists and American Medical Association.

Such access, some argue, would make it easier to get emergency contraception
on evenings and weekends, allowing more women to take it in the recommended
72-hour window after unprotected sex.

Others, including some young women, see it as a way for teens who don't want
their parents to know they're having sex to help prevent unwanted pregnancy.

``Kids are going to end up having kids because they're hiding from their
parents; they're too scared to tell them,'' says a 17-year-old in Brooklyn,
N.Y., who thinks over-the-counter access would ``definitely'' help teens like
her. She asked that her name not be used because her parents don't know she
used the morning-after pill in April after her boyfriend's condom broke.

The young woman is a patient of Dr. Bernadith Russell, the attending physician
at Long Island Hospital's obstetrics and gynecology department who also works
in private practice at teen clinics in Brooklyn. She says the topic of
unplanned pregnancy and emergency contraception comes up with her patients
nearly every day. But few want to discuss it with their parents - or use
insurance to buy emergency contraception out of fear their parents will find out.

``I can't begin to say how much of a barrier that is,'' Russell says.

However, a physician who opposes over-the-counter sale of emergency
contraception fears that young women would skip regular visits to the
gynecologist if they didn't need to see a doctor to get it.

``They're not going to get their pap smears; they're not going to get screened
for sexually transmitted disease,'' says Dr. Gene Rudd, a gynecologist who
serves as associate executive director of the Tennessee-based Christian
Medical Association.

He also says some young women might not want to use emergency contraception if
they knew how it worked.

A stronger dose of regular hormonal contraception, the morning-after pill can
prevent pregnancy by delaying a woman's ovulation or keeping sperm from
fertilizing an egg.

It also can thin the uterus lining, making it difficult for a fertilized egg
to implant. That's a major reason anti-abortion groups - from the American
Life League to the Pro-Life Action League - are among emergency
contraception's main opponents.

While many in the medical field do not share their view, they see interfering
with a fertilized egg as abortion.

``Emergency contraception is not true contraception,'' says Sierra Correa, the
22-year-old vice president of Collegians For Life, a student group that
opposes the morning-after pill. ``Drug companies have been getting away with
calling it contraception by redefining pregnancy to mean implantation'' of a
fertilized egg.

Some opponents also have argued that easier access to the morning-after pill
would make teens more likely to engage in risky sexual behavior - though some
doctors say that research done at the University of Pittsburgh School of
Medicine casts doubt on that argument.

The study, published in the April issue of the Journal of Pediatric and
Adolescent Gynecology, found that teens who had emergency contraception on
hand were not more likely to have unprotected sex. It also concluded that
those teens were more likely to use emergency contraception correctly and
sooner after sex, when it is most effective.

Such findings have motivated some nonprofits that serve youth to launch
information campaigns to let teens know emergency contraception exists.

Officials at one of those nonprofits, Washington, D.C.-based Advocates For
Youth, also point to the research of James Trussell, director of Princeton
University's Office of Population Research. Trussell has concluded that easy
access to emergency contraception could cut by half the number of unintended
pregnancies and abortions among U.S. women, ages 15 to 44.

Each year, there are about 3 million unintended pregnancies - and in about
800,000 of those cases the parents are teenagers, according to the federal
Centers for Disease Control.

Those statistics were cited last year when the FDA's scientific advisers
voted, 23-4, in favor of Barr Pharmaceuticals initial proposal to sell Plan B
with no age restriction.

Ultimately, however, FDA acting drug chief Dr. Steven Galson overruled the
vote due to concern about young teenagers' use of emergency contraception
without a doctor's guidance and the long-term effects of its use.

A young woman who has taken the morning-after pill - and has testified before
the FDA to ask for over-the-counter access - hopes the agency will reconsider.

``The sad thing is,'' says Vera Brown, a junior at the University of Florida,
``teenagers need it the most.''