Hi there! For this entry I have decided to post an assignment I did for my reproductive health advocacy course that just ended. Our charge was to write an op-ed piece about a topic in reproductive health that is controversial, and work on framing the issue in a thoughtful way. I very much enjoyed writing about emergency contraception access for young teens, so here you are:
The Nature of Evidence: Emergency Contraception Access for Young
Teens
Bonnie, Guest Columnist
A fictitious newspaper like the New York Times, March 8, 2012
It is fascinating to examine the nature of evidence. As humans and
consumers, we trust the medical system to keep us healthy by providing us with
the right service at the right time. It is sound evidence, we hope, that allows
providers to do this in a way that maintains our health and well-being. We like
evidence because it helps us know that “cold-hard-science” is behind the
decisions that get made about what is best for us. Yet evidence can also be
used as a political tool to decide who gets what kind of medical services, and
the time at which they can access them. In no other recent event has this
happened more obviously than in US Health Secretary Kathleen Sebelius’s
decision to veto the FDA’s recommendation to allow women under 17 access to
emergency contraception.
Emergency contraception (EC) is a hormonal contraceptive pill that
prevents pregnancy. Not to be confused with medication that causes abortion
(such as RU-486), it does nothing to harm an existing pregnancy. A woman can take it up to 5 days (120 hours)
after unprotected intercourse, though its effectiveness declines with time. It
has been behind the counter for women (and men) over 18 since 2006, and over 17
since 2009. It has few side effects, and is not known to cause lasting
problems. The efficacy of EC in preventing pregnancy and other knowledge about
its use is gleaned from the results of many sound scientific studies. These
studies address medical side effects, access patterns and need for the drug, and
consumers’ ability to read and understand the drug packaging.
In Ms. Sebelius’s statement regarding her decision to maintain
current FDA guidelines and restrict access to EC for teens 16 and under, she
wrote that a small percentage of girls in the US are able to bear children by
11.1 years of age, therefore the evidence presented to the FDA council was not
sufficient to justify providing behind the counter access to women between the
ages of 11 and 16. Indeed, the studies considered by the council only provided
data for women 12 years of age and older. However, it is difficult to believe
that Ms. Sebelius, with her previous experience as an insurance lobbyist,
legislator, and governor, has the scientific authority to demand evidence on such
a minuscule subsection of the population, a subsection least likely to be
having sexual intercourse. If safety is her primary concern, might it instead
be more prudent to study the health effects of childbearing in 11.1 year olds?
Let us consider the evidence that does exist, that which was
considered adequate by the medical and scientific experts from the FDA Center
for Drug Evaluation and Research (CDER). Remember, this is the body that came
to the original conclusion that EC was safe for all women of childbearing age. These studies showed that younger teens
experience the same mild side effects from EC as older teens and adults. They
showed that teens are able to read and understand EC packaging. They showed that
EC does not cause an increase in risky behavior among teens. And they showed that
teens can use EC correctly without medical advice or counseling. While it is
perhaps true that the body and brain of an 11 year old is physiologically
different from that of a 12 or 13 year old, do we truly believe that this
difference is profound enough to cause earth-shaking changes in the way we allow
them to prevent pregnancy?
It is clear that Ms. Sebelius has used a scientific argument to
maintain the status quo of EC access in the United States, and this kind of
argument is difficult to counter. No person wants to claim we do not need more
evidence, especially not in a world which holds evidence to such high esteem. She
is correct in her statement that data is absent for this subpopulation, but do
we truly believe that evidence to support every combination of factors in the
universe is our task? Have we specifically tested all headache medications on
11 year olds? Should we? In considering the larger picture of what is at stake
for teens, this is an instance where more evidence may not be the answer, and
we are instead blinded by politics in a scientific disguise.