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(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.

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