Menus Subscribe Search
plan-b

(ILLUSTRATION: DONSCARPO/SHUTTERSTOCK)

Why Everyone Should Have Access to Plan B

• May 17, 2013 • 10:00 AM

(ILLUSTRATION: DONSCARPO/SHUTTERSTOCK)

Give them the benefit of the doubt: Adolescents are more competent in thinking about their decisions than many people suspect, and the science suggests they won’t abuse over-the-counter contraceptives.

Last month, Judge Edward Korman ordered the Food and Drug Administration (FDA) to make the emergency contraceptive, Plan B, available over the counter to people of all ages, rather than requiring prescriptions for those under 17. Last week, he stood by that decision. In his harshly worded ruling, Korman rejected the claim that easier access to Plan B would allow adolescents to make decisions that were beyond their capabilities.

The scientific evidence supports his ruling. Indeed, it shows adolescents to be more competent in thinking about their decisions than many people suspect. However, the research also shows how social and emotional pressures can lead young people to act against their own better judgment.

There is little dispute about Plan B’s effectiveness. It greatly reduces the probability of pregnancy if taken within 72 hours of unprotected sex. Nor is there much question that easier access will help many women, especially those without regular access to physicians who can write prescriptions and those who need it over the weekend, when unprotected sexual encounters (and assaults) often occur. Serious side effects are too rare to consider.

As for older adolescents, the research shows little evidence of Plan B becoming their Plan A, used routinely so that they can have unprotected sex without getting pregnant.

In 2011, the FDA moved to make Plan B universally available. However, Secretary of Health and Human Services Kathleen Sebelius overruled that decision, citing “common knowledge that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age.” She left unchallenged an earlier claim that women under 16 might exhibit “impulsive behavior, without the cognitive ability to understand the etiology of their behavior.”

Judge Korman dismissed the relevance of those “youngest girls,” arguing that “the number of 11-year-olds using these drugs is likely to be minuscule.”

As for older adolescents, the research shows little evidence of Plan B becoming their Plan A, used routinely so that they can have unprotected sex without getting pregnant. However, the research also shows how unprotected sex can happen more often than young women intend—making it all the more important that they have access to Plan B when they need it.

Cognitive research suggests that, by age 15 or 16, teens and adults have similar decision-making abilities, strong in some ways, weak in others. Like adults, teens sometimes make decisions without much thought, and sometimes work hard to get it right. Contrary to folk wisdom, teens do not have a unique sense of invulnerability. Indeed, they often feel especially vulnerable. However, teens know much less about how seemingly safe acts can make them vulnerable, as when they stumble into situations where they are coerced by sexual partners.

How well teens, or adults, use their decision-making abilities depends on how well their thoughts control their impulses. Neuroscience research shows how the structures needed for impulse control evolve in adolescents’ brains. Whether teens have as much control as they need depends on the circumstances. They may have too little control in a moment of passion, but all that they need before or after.

As a result, where teens need help is in avoiding situations where they might lose control and in coping with situations when things have not gone as planned. Parental guidance can help with the former. Easy, informed access to Plan B can help with the latter.

In a study published in the journal Social Science and Medicine, we used in-depth interviews and surveys to learn how young women in Pittsburgh, aged 13-18, think about three key decisions that Plan B’s availability might affect: when to have sex, what contraceptives to use routinely, and what to do after unprotected sex.

As in other studies that let teens speak their minds, ours found them to be very thoughtful, as they navigated a complex, uncertain, sometimes unfriendly world. Although they all knew about Plan B, none described it as anything but an emergency measure. Those opposed to abortion reported having thought through what Plan B meant to them. Nothing that they said suggested that easy access would encourage them to have unprotected sex. Many underestimated its effectiveness and exaggerated its negative side effects.

Despite being unenthusiastic about Plan B, these teens wanted easier access and complained about being embarrassed to ask pharmacists about Plan B and worrying about having their privacy compromised. As a result, easier access would help young women to get the drug when they need it—and reduce the risk of unplanned pregnancy. It would leave the decisions about sex, health, and relationships to the private lives of teens and those who care about them.

Tamar Krishnamurti and Baruch Fischhoff
Baruch Fischhoff is the Howard Heinz University Professor of Social and Decision Sciences and Engineering and Public Policy at Carnegie Mellon University. Tamar Krishnamurti is a postdoctoral fellow within Carnegie Mellon University's Tepper School of Business and Department of Engineering and Public Policy.

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

July 23 • 4:00 PM

Who Doesn’t Like Atheists?

The Pew Research Center asked Americans of varying religious affiliations how they felt about each other.


July 23 • 2:00 PM

We Need to Start Tracking Patient Harm and Medical Mistakes Now

Top patient-safety experts call on Congress to step in and, among other steps, give the Centers for Disease Control and Prevention wider responsibility for measuring medical mistakes.


July 23 • 12:19 PM

How a CEO’s Fiery Battle Speeches Can Shape Ethical Behavior

CEO war speech might inspire ethical decisions internally and unethical ones among competing companies.


July 23 • 12:00 PM

Why Do We Love the ‘Kim Kardashian: Hollywood’ Game?

It’s easy enough to turn yourself into a virtual celebrity, complete with fame and mansions—but it will likely cost you.


July 23 • 11:49 AM

Modern Technology Still Doesn’t Protect Americans From Deadly Landslides

No landslide monitoring or warning systems are being used to protect vulnerable communities.


July 23 • 10:00 AM

Outing the Death-Drug Distributors

Calling all hackers: It’s time to go Assange on capital punishment.


July 23 • 8:00 AM

The Surprising Appeal of Products That Require Effort to Use

New research finds they enable consumers to re-establish a feeling that they’re in control of their lives.



July 23 • 6:00 AM

How the Other Half Lifts: What Your Workout Says About Your Social Class

Why can’t triathletes and weightlifters get along?


July 23 • 5:02 AM

Battle of the Public Intellectuals: Edward Glaeser vs. Richard Florida

On gentrification and housing costs.


July 23 • 4:00 AM

Our Fear of Immigrants

Why did a group of fourth graders rally in support of an undocumented classmate while the citizens of Murrieta, California, tried to stop immigrant children from entering their town?


July 22 • 4:00 PM

Can Meditation Really Slow Aging?

Is there real science in the spiritualism of meditation? Jo Marchant meets a Nobel Prize-winner who thinks so.



July 22 • 2:00 PM

The Alabama Judge Who Refuses to Let Desegregation Orders Go Ignored

A federal judge in Alabama says a local school board has failed to meet legal mandate to integrate.


July 22 • 12:00 PM

On the Destinations of Species

It’s almost always easier to cross international borders if you’re something other than human.


July 22 • 10:51 AM

The Link Between Carbs, Gut Microbes, and Colon Cancer

Reduced carb intake among mice protected them from colon cancer.


July 22 • 10:47 AM

Irrational Choice Theory: The LeBron James Migration From Miami to Cleveland

Return migrants to Cleveland have been coming home in large numbers for quite some time. It makes perfect sense.


July 22 • 9:32 AM

This Time, Scalia Was Right

President Obama’s recess appointments were wrong and, worse, dangerous.


July 22 • 8:00 AM

On Vegas Strip, Blackjack Rule Change Is Sleight of Hand

Casino operators are changing blackjack payouts to give the house an even greater advantage. Is this a sign that Vegas is on its way back from the recession, or that the Strip’s biggest players are trying to squeeze some more cash out of visitors before the well runs dry?


July 22 • 6:00 AM

Label Me Confused

How the words on a bag of food create more questions than answers.


July 22 • 5:07 AM

Doubly Victimized: The Shocking Prevalence of Violence Against Homeless Women

An especially vulnerable population is surveyed by researchers.


July 22 • 4:00 AM

New Evidence That Blacks Are Aging Faster Than Whites

A large study finds American blacks are, biologically, three years older than their white chronological counterparts.



July 21 • 4:00 PM

Do You Have to Learn How to Get High?

All drugs are socially constructed.


July 21 • 2:14 PM

The New Weapon Against Disease-Spreading Insects Is Big Data

Computer models that pinpoint the likely locations of mosquitoes and tsetse flies are helping officials target vector control efforts.


Follow us


Subscribe Now

How a CEO’s Fiery Battle Speeches Can Shape Ethical Behavior

CEO war speech might inspire ethical decisions internally and unethical ones among competing companies.

Modern Technology Still Doesn’t Protect Americans From Deadly Landslides

No landslide monitoring or warning systems are being used to protect vulnerable communities.

The Link Between Carbs, Gut Microbes, and Colon Cancer

Reduced carb intake among mice protected them from colon cancer.

The New Weapon Against Disease-Spreading Insects Is Big Data

Computer models that pinpoint the likely locations of mosquitoes and tsetse flies are helping officials target vector control efforts.

People Are Clueless About Placebos

Doctors know that sometimes the best medicine is no medicine at all. But how do patients feel about getting duped into recovery?

The Big One

Today, the United States produces less than two percent of the clothing purchased by Americans. In 1990, it produced nearly 50 percent. July/August 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.