Menus Subscribe Search

Follow us



Why Everyone Should Have Access to Plan B

• May 17, 2013 • 10:00 AM


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, delivered straight to your inbox.

Recent Posts

October 31 • 4:00 PM

Should the Victims of the War on Drugs Receive Reparations?

A drug war Truth and Reconciliation Commission along the lines of post-apartheid South Africa is a radical idea proposed by the Green Party. asks their candidates for New York State’s gubernatorial election to tell us more.

October 31 • 2:00 PM

India’s Struggle to Get Reliable Power to Hundreds of Millions of People

India’s new Prime Minister Narendra Modi is known as a “big thinker” when it comes to energy. But in his country’s case, could thinking big be a huge mistake?

October 31 • 12:00 PM

In the Picture: SNAP Food Benefits, Birthday Cake, and Walmart

In every issue, we fix our gaze on an everyday photograph and chase down facts about details in the frame.

October 31 • 10:15 AM

Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.

October 31 • 8:00 AM

Who Wants a Cute Congressman?

You probably do—even if you won’t admit it. In politics, looks aren’t everything, but they’re definitely something.

October 31 • 7:00 AM

Why Scientists Make Promises They Can’t Keep

A research proposal that is totally upfront about the uncertainty of the scientific process and its potential benefits might never pass governmental muster.

October 31 • 6:12 AM

The Psychology of a Horror Movie Fan

Scientists have tried to figure out the appeal of axe murderers and creepy dolls, but it mostly remains a spooky mystery.

October 31 • 4:00 AM

The Power of Third Person Plural on Support for Public Policies

Researchers find citizens react differently to policy proposals when they’re framed as impacting “people,” as opposed to “you.”

October 30 • 4:00 PM

I Should Have Told My High School Students About My Struggle With Drinking

As a teacher, my students confided in me about many harrowing aspects of their lives. I never crossed the line and shared my biggest problem with them—but now I wish I had.

October 30 • 2:00 PM

How Dark Money Got a Mining Company Everything It Wanted

An accidentally released court filing reveals how one company secretly gave money to a non-profit that helped get favorable mining legislation passed.

October 30 • 12:00 PM

The Halloween Industrial Complex

The scariest thing about Halloween might be just how seriously we take it. For this week’s holiday, Americans of all ages will spend more than $5 billion on disposable costumes and bite-size candy.

October 30 • 10:00 AM

Sky’s the Limit: The Case for Selling Air Rights

Lower taxes and debt, increased revenue for the city, and a much better use of space in already dense environments: Selling air rights and encouraging upward growth seem like no-brainers, but NIMBY resistance and philosophical barriers remain.

October 30 • 9:00 AM

Cycles of Fear and Bias in the Criminal Justice System

Exploring the psychological roots of racial disparity in U.S. prisons.

October 30 • 8:00 AM

How Do You Make a Living, Email Newsletter Writer?

Noah Davis talks to Wait But Why writer Tim Urban about the newsletter concept, the research process, and escaping “money-flushing toilet” status.

October 30 • 6:00 AM

Dreamers of the Carbon-Free Dream

Can California go full-renewable?

October 30 • 5:08 AM

We’re Not So Great at Rejecting Each Other

And it’s probably something we should work on.

October 30 • 4:00 AM

He’s Definitely a Liberal—Just Check Out His Brain Scan

New research finds political ideology can be easily determined by examining how one’s brain reacts to disgusting images.

October 29 • 4:00 PM

Should We Prosecute Climate Change Protesters Who Break the Law?

A conversation with Bristol County, Massachusetts, District Attorney Sam Sutter, who dropped steep charges against two climate change protesters.

October 29 • 2:23 PM

Innovation Geography: The Beginning of the End for Silicon Valley

Will a lack of affordable housing hinder the growth of creative start-ups?

October 29 • 2:00 PM

Trapped in the Tobacco Debt Trap

A refinance of Niagara County, New York’s tobacco bonds was good news—but for investors, not taxpayers.

October 29 • 12:00 PM

Purity and Self-Mutilation in Thailand

During the nine-day Phuket Vegetarian Festival, a group of chosen ones known as the mah song torture themselves in order to redirect bad luck and misfortune away from their communities and ensure a year of prosperity.

October 29 • 10:00 AM

Can Proposition 47 Solve California’s Problem With Mass Incarceration?

Reducing penalties for low-level felonies could be the next step in rolling back draconian sentencing laws and addressing the criminal justice system’s long legacy of racism.

October 29 • 9:00 AM

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.

October 29 • 8:00 AM

America’s Bathrooms Are a Total Failure

No matter which American bathroom is crowned in this year’s America’s Best Restroom contest, it will still have a host of terrible flaws.

Follow us

Levels of Depression Could Be Evaluated Through Measurements of Acoustic Speech

Engineers find tell-tale signs in speech patterns of the depressed.

We’re Not So Great at Rejecting Each Other

And it's probably something we should work on.

Chronic Fatigue Syndrome and the Brain

Neuroscientists find less—but potentially stronger—white matter in the brains of patients with CFS.

Incumbents, Pray for Rain

Come next Tuesday, rain could push voters toward safer, more predictable candidates.

Could Economics Benefit From Computer Science Thinking?

Computational complexity could offer new insight into old ideas in biology and, yes, even the dismal science.

The Big One

One town, Champlain, New York, was the source of nearly half the scams targeting small businesses in the United States last year. November/December 2014

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