Whatever Happened to Plan A?

Early this week the Food and Drug Administration will announce a new plan to lower the required age for obtaining the “Morning After” pill without a doctor’s prescription from 18 to 17.

Plan B is a godsend for women whose birth control unexpectedly fails.  But offering a reprieve for adult women is quite different from embarking on a slippery slope of “morning after” options to younger and younger women.  Shouldn’t we be teaching the next generation of women about the many options available to them at Plan A, like choosing a partner and using birth control, rather than teaching them that they only need face the music the Morning After?

For all of the hue and cry surrounding Plan B’s post-2006 availability, the pill’s increased availability has had no measurable effect on the nation’s teenage pregnancy or abortion rates.  While many variables contribute, those statistics demonstrate that before women had OTC access, they were not suffering from widespread pregnancies and abortions that were finally prevented with the 2006 measures.  Instead, women were somehow finding other measures to protect themselves prior to 2006, and in 2006 they switched to the morning after method.

While successful in 2006 at making Plan B available over the counter to women over age 18, supporters have long hoped to make the morning after pill available to all women, regardless of age.  “Any person who is sexually active should have access to plan B when plan A doesn’t work,” said associate professor of obstetrics and gynecology at Stanford University Medical Center Kay Daniels in a 2006 interview with the San Francisco Chronicle.  “In fact, any woman who comes to me and says she uses condoms, I say, ‘That’s great, and here’s your prescription for Plan B.  Fill it and put it in your closet.’”

Indeed, a couple trying to conceive stands only about an 82% change of becoming pregnant.  Various “Plan A” choices decrease the possibility of pregnancy to as low as 1%, if using condoms or the Pill.  Plan B merely represents the last bastion in the stand women may take to protect themselves form unwanted pregnancy, starting with refusing a second cocktail and ending, ceremoniously, the morning after.

The FDA’s announcement represents compliance with a federal drug’s order to lower the age limit by a year, the beginning of what may well be a very slippery slope.  On March 23, District Judge Edward Korman ordered that Plan B be made available over the counter to those 17 and up, and recommended that federal agents consider lifting age requirements altogether.  Judge Korman suggested that politicians had too long focused on politics rather than science in creating artificial age requirements for a drug that would not harm a 17 year old woman any more than it would a woman 18 or older.

Young women should take note that this further step towards protecting our reproductive rights does not alleviate the requirement that we consider our actions.  Yes, we may easily thwart unintended consequences.  But the fact that sales of Plan B have doubled since the pill became available over the counter in 2006 suggests that women are not stopping to consider their options at Plan A, but merely relying on the morning-after choices to protect themselves.

While “Plan A” includes such measures as condoms and prescription birth control, a more important element in women’s reproductive rights is our ability to determine when and with whom we will have sex.  Widely available morning after options merely lower the bar for decision-making at the critical moment when a woman decides whether or not she wishes to sleep with her partner.  Choice is a tremendous boon, but only if women consciously make that choice.

Making morning after choices so widely available to young teenagers changes the terms of this debate.  If parents forego birth control discussions in favor of abstinence-only talks, teens will more likely engage in unsafe practices and rely on Plan B the next day.  Plan B does not protect against sexually transmitted diseases.  Nor does Plan B protect young women in high school from the potential pitfalls of engaging before they are ready.

The fact that sales of Plan B increased so dramatically since becoming available over the counter suggests that women are relying on Plan B as their Plan A.   Rather than wait for Prince Charming—or even carry a condom!—women have begun counting on their morning after choices rather than engaging in the series of choices that are still available to us.  The fact that neither pregnancy nor abortion numbers have changed confirms that women have maintained the status quo: using only one method.  At one time that one method was waiting for Mr. Right.  Then for a long time women carried protection and used it properly.  Now, however, the statistics indicate that women prefer to forego those traditional methods.

Reproductive rights are only empowering if women choose to empower themselves.  Women should maintain a high bar for selectivity and not rely on Plan B to replace Plan A.  It is one thing for an adult to make these choices.  But shouldn’t we at least suggest to the next generation that they have a series of choices, up to and, yes, including, the morning after?

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