Op-Ed Piece: EC access for young teens

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.