DECEMBER 3, 2012
The American College of Pediatricians disputes the American Academy of Pediatrics’ recent recommendation that pediatricians provide younger adolescents with a prescription for “emergency contraception” and instruct all adolescent patients to use it “in case” of unprotected intercourse.
Research has consistently shown that increased access to “emergency contraception” (EC) does not result in lower pregnancy rates among adolescents and young adults, but can be associated with an increased incidence of sexually transmitted infections. Despite self-reports denying it; “ready access” to EC apparently increases the sexual activity of adolescents which is a risk factor for depression and suicide, poor school performance, more lifetime sexual partners, and an increased divorce rate.
How does emergency contraception work? Although some EC medications can prevent ovulation (egg production) in the adolescent female and thereby prevent fertilization by the sperm, it also works after an egg has been fertilized by aborting a newly formed human embryo. This may occur even when EC is taken promptly and nearly always when taken more than 48 hours after intercourse. This information must be presented to the adolescent in informed consent by a physician. Because the College advocates for life from the time of conception, it opposes all methods of EC that work after fertilization by killing a human embryo.
The human brain does not reach full maturity until early adulthood and, therefore, adolescents fundamentally need the guidance of their parents in decision-making. Bypassing parental involvement with advance prescriptions for emergency contraception is not best for adolescents as EC can cause adverse side effects including heavy/irregular menstrual bleeding and pelvic pain. Any use of EC requires close monitoring.
Ready access to EC may persuade an adolescent who has been sexually assaulted to avoid treatment by an emergency department, foregoing a forensic exam, and losing the benefit of sexual assault teams trained to counsel her. Such avoidance will only lead to more sexual assaults as the perpetrator is not pursued.
In summary, the American College of Pediatricians recommends against a policy of pre-prescribing “emergency contraceptives” to adolescents. Rather than facilitating adolescent sexual activity, health professionals need to encourage good adolescent-parental communication, teach adolescent patients the benefits of delaying sexual activity until marriage, and teach them how to avoid premature/promiscuous consensual sex and situations resulting in coerced sex.
College position on Emergency Contraception: The “Morning After” Pill