Will NYC Initiative to Give Morning-After Pill to Teens Increase STDs?

The problem with Plan B.

Students returning to classes this fall at 13 New York City high schools are finding more than pencils, books and dirty looks waiting for them. Under a recently approved Department of Education program, female students as young as 14 will now have free access to a controversial emergency contraceptive known as Plan B. The so-called “morning-after pill” prevents pregnancy for up to 72 hours after conception by either interfering with egg fertilization or, in at least some cases, by preventing implantation of a fertilized egg in the uterus.

The pioneering new program—the first in the nation by most accounts—is part of the New York City Department of Education’s Connecting Adolescents to Comprehensive Health, or CATCH, initiative—which is designed to reduce teen pregnancies in a city where roughly half of adolescents have sex before getting their diploma, more than a third of them without a condom. It was introduced quietly last year on a trial basis in five schools and is now being expanded to include high schools in all five boroughs. During the 2011 school year, 567 students received Plan B pills under the CATCH pilot, according to the New York Post.

To date, the plan has been greeted with enthusiasm by a majority of school health officials, but a few have expressed concern over what they see as the indiscriminate distribution of powerful hormonal drugs to kids without the expressed consent of their parents. In lieu of direct consent, the initiative—which will also dispense quarterly injections of the contraceptive Depo Provera—employs a sort of reverse approval mandate, whereby parents of children at participating schools will receive a letter allowing them to opt out. That’s not exactly a foolproof plan, as anyone who has ever intercepted a bad report card in the mail well knows.

“We can’t give out a Tylenol without a doctor’ s order,” one anonymous school staffer recently complained to the Post. “Why should we give out hormonal preparations with far more serious possible side effects … ?”

Well for one thing, unlike headaches, teen pregnancy in New York has reached crisis proportions and it has the potential to significantly disrupt the lives of teen mothers, not to mention their largely unwanted progeny. While teen pregnancies are down nationwide, they’re up in the Big Apple. According to the city’s Department of Health, 7,000 girls under the age of 17 became pregnant last year. Most of those pregnancies ended in abortion, while nearly three-quarters of the remaining 2,200 teen mothers dropped out of high school to raise their children.

Still, CATCH presents something of a conundrum for me; as a staunch advocate of reproductive freedom, I believe that women (and girls) are entitled to safe and legal options for terminating or preventing unwanted pregnancies. We’re doing no one any favors by forcing girls who are incapable or unwilling to raise children to carry them to term and begrudgingly play mommy.

On the other hand, I have serious reservations about giving publicly funded schools the authority to dispense powerful pharmaceuticals to children without their parents’ involvement. While Plan B is available over the counter for most people, you need a prescription if you’re under 18; Depo Provera, however, is only available with a prescription, and is rarely if ever dispensed without medical supervision. Under the CATCH program, Department of Health physicians—who will in all probability lack detailed information about their patients’ medical history—will be responsible for prescribing the drugs, both of which carry the potential for mild but not entirely innocuous side effects.

The least of my concerns, but one that deserves mentioning, is the fact that taxpayer dollars will be used to provide a controversial service that at least some New Yorkers no doubt find reprehensible. Given its ability to inhibit pregnancy post-conception, some in the anti-choice camp mistakenly refer to Plan B as an “abortion pill.” In fact, unlike RU486, which does act as an abortifacient, levonorgestrel—the active ingredient in Plan B—does not abort a fetus once it has begun growing in a woman’s womb. Instead, according to the Food and Drug Administration, it prevents pregnancy from developing in the first place—usually before, but in rare cases after an egg has been fertilized (although a recent analysis by the New York Times casts some doubt on that).

Putting the sensibilities of social conservative taxpayers aside, however, my main issue with CATCH is that providing such easy access to Plan B could make it easier—and seemingly less risky—for kids to treat the morning-after pill as Plan A instead. The Department of Health describes the pill as “a safe way to prevent pregnancy after unprotected sex” (emphasis mine). And therein lies the problem. By making Plan B easier to get than a Tylenol, aren’t schools also making it easier for teens to talk themselves into engaging in unprotected sex?

Data shows that sexually transmitted diseases are already running rampant among the nation’s adolescent community. A federal government survey conducted in 2008 found that a quarter of teenage girls were infected with at least one of four commonly occurring sexually transmitted diseases. For African-American girls ages 14 to 19, it was closer to half. According to the American Academy of Pediatrics, 55,000 of the more than 1.1 million Americans infected with HIV are between the ages of 13 and 24. And of the 1,268 U.S. teens diagnosed with HIV in 2005, more than 10 percent lived in New York City.

Given such grim statistics, the primary focus of youth sex education should be to promote safe sex, which is something most schools are already doing. New York City high schools dispense condoms to students for free; last year, the City of Philadelphia began providing specially designed “Freedom Condoms” to teens via mail order under its TakeControlPhilly initiative. These are bold initiatives that have the potential to decrease the number of unwanted pregnancies and new STD infections among teens. And while I’m not completely convinced New York’s CATCH program is an accident waiting to happen, the fact is, once a student comes asking the school nurse for the morning-after pill, these efforts have already failed.