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Women's Access to Contraception

Wallis, Laura

AJN, American Journal of Nursing: February 2013 - Volume 113 - Issue 2 - p 18
doi: 10.1097/01.NAJ.0000426677.67622.16
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About half of all pregnancies in the United States each year are unintended. Although birth rates among U.S. teens are declining, they are still significantly higher than rates among teens in other industrialized nations.

In an effort to address this staggering and expensive problem—which was recently estimated to cost U.S. taxpayers $11.1 billion annually—two groups issued new recommendations in December 2012. The American Congress of Obstetricians and Gynecologists (ACOG) proposed that oral contraceptives be made available over the counter, and the American Academy of Pediatrics (AAP) has recommended emergency contraception, such as Plan B, as one part of an overall public health strategy to reduce teen pregnancy.

ACOG argues that although oral contraceptives have some rare possible adverse effects (chiefly, venous thromboembolism), they are as safe as many over-the-counter medications. Further, there is good evidence that women can effectively screen themselves for contraindications using a checklist. And although issues of cost and reimbursement exist, as does the possibility of pharmacists refusing to dispense oral contraceptives because of their personal beliefs, ACOG notes that these concerns would need to be addressed in any plan to improve access to birth control. (For the full ACOG statement, go to

Increased use of both contraception and abstinence by teens has contributed to a decrease in pregnancies since the 1990s—and the AAP notes that those approaches remain the best ways to avoid pregnancy. But large numbers of teens are still having unprotected intercourse, using contraceptive methods inconsistently, or having sex against their will (approximately 10% report sexual assault). And in those cases, emergency contraception—used as soon as possible after intercourse but as late as 120 hours afterward—is a safe and fairly reliable backup.

The AAP stresses the importance of counseling teens about the use and availability of emergency contraception and providing prescriptions in advance so they can use it as soon as possible when needed—making sure they follow up with their primary care practitioners later to be tested for sexually transmitted diseases.

Many health care providers have to grapple with their own underlying beliefs when it comes to counseling teens about sex, pregnancy, and contraception, but according to the AAP policy statement, failing to educate patients regarding legally available treatments like emergency contraception (or failing to refer patients to someone who will) is a violation of a provider's duty to her or his patients.—Laura Wallis

© 2013 Lippincott Williams & Wilkins, Inc.