It isn’t always easy for adults to discuss, but the reality is that a majority of U.S. teens have sex by the time they turn 19. Given that reality, it is crucial that we provide all youth with the information and tools they need to prevent unwanted pregnancies. Giving teens easier access to various contraceptives does not lead to more sex, but does result in fewer unintended pregnancies. I encourage parents to think about using a discussion about contraception as an opportunity to have an authentic conversation about sex.
As a pediatrician who specializes in taking care of adolescents, I am keenly aware of the negative consequences for young people when it comes to restrictions on contraceptive access. All too often, adolescents who are anticipating or experiencing the start of intimate relationships don’t have access to a health care provider who is comfortable talking to them about sex, and many are also afraid to raise the subject with their parents resulting in unnecessary risks to their reproductive health.
As a researcher, I’m also always seeking innovative ways to safely expand access to contraception so that all youth in need have the means to prevent a pregnancy that they feel they can’t handle. Over-the-counter access to oral contraceptives is one approach that can reduce barriers to access and should be available for those of all ages who wish to use them.
When parents and health care providers miss the opportunity to prepare youth, difficult situations can result. I still vividly remember one of the first unplanned pregnancies that I diagnosed in a teen patient. She had actually come to the clinic with her mom for a checkup and to start on contraception that day. When I went to do a pregnancy test prior to providing the birth control shot she wanted, I was shocked as the pink plus sign developed; she was already pregnant.
I repeated the test three times to be sure I wasn’t doing something wrong before going back to the room to tell the patient. Her tearful response was heartbreaking as she processed her disbelief and the potential impact on her basketball season and school. I have unfortunately encountered too many similar scenarios in the more than 10 years that have elapsed since that encounter. It continues to motivate me to work with parents and other clinicians to ensure that the youth that they care for have access to contraception when they need it.
Over the past decade, there have been tremendous leaps in research and innovation when it comes to birth control. It is safer now than it has ever been. While there are risks, they are uncommon and even rarer for women under 35 years old. Data also continue to show that use of birth control methods is remarkably effective at reducing unwanted pregnancies. The Centers for Disease Control and Prevention (CDC) recently reported that “in 2015, a total of 229,715 babies were born to women aged 15–19 years, for a birth rate of 22.3 per 1,000 women in this age group. This is another record low for U.S. teens and a drop of 8% from 2014.” An analysis by one of the report’s authors found that the decline in pregnancy risk among U.S. teens between 2007 and 2012 was entirely attributable to the increased use of contraception.
The fact that the most commonly used birth control method by teens currently is condoms, already available over the counter, makes adding another safe OTC option a no-brainer. If safety is your primary concern, when compared to pregnancy and childbirth, the risks of birth control pills are miniscule.
In my opinion, the biggest obstacle to the more widespread use of birth control are unnecessary barriers to accessing it. Moving birth control pills over the counter is an ideal option taking down some of the major hurdles standing in people’s way. Modern birth control pills currently meet all the criteria the FDA sets forth for moving a prescription medication over the counter (OTC) — they are safe for self-administration, effective when self-administered, address a concern that is self-diagnosable, and can carry labels that are easily understood.
As a pediatrician, I obviously see value in clinical encounters with patients and feel that clinicians have something important to offer in the way of contraceptive counseling and expanded contraceptive method choices for patients that come in for office visits. I also recognize, however, that many patients experience barriers to visiting clinicians in the office either routinely or at the specific times they are in need of a health care service.
A national survey found that nearly a third of women desiring to use the birth control pill have faced a barrier to obtaining it, including cost of office visits and inflexible clinic hours. Those women who are often most vulnerable, including adolescents, non-English speakers, and women who are uninsured, are more likely to face these barriers. As such, I also see the benefit of providing access to contraceptive methods, when feasible and safe, in non-clinical settings.
Adults cannot hide under the covers and pretend as though young people don’t need birth control. Life is complicated enough as a teenager. Everything is changing rapidly inside and around them. An unintended pregnancy is difficult for adults to manage let alone someone who is just starting to figure out who they are and their place in the world. Let’s make this a little easier for both parents and young people ending unnecessary barriers to contraception.
Remarks are those of Dr. Upadhya and do not necessarily represent the views of Johns Hopkins Medicine.