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Why Plan B Gets an A: When It Comes to Birth Control, More Options Improve Reproductive Choices

I believe that more reproductive choice trumps the potential risks of synthetic hormones being available over the counter.
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The Food & Drug Administration recently decided that all women, even those under 17 years of age, deserve unrestricted access to emergency contraceptives. The ability to buy the Plan B One-Step version of the medication is now available without showing an ID. Up until now, anyone showing an ID that they were 17 or older could get Plan B from a pharmacist, but those younger than 17 needed a doctor's prescription.

First, a little myth busting: Plan B is not an "abortion pill." Some people confuse RU-486 (the so-called abortion pill) with Plan B, but they are completely different. Plan B prevents pregnancy after contraceptive failure (condom broke or slipped off, you skipped a pill or two from your oral contraceptive) or unprotected intercourse. Plan B does NOT affect an existing pregnancy -- it works the same way that a birth control pill does: prevents ovulation, preventing fertilization, and altering the uterine lining which may keep implantation from occurring.

Secondly, the FDA decision has some groups celebrating and others loudly protesting. Even doctors are divided on the issue. As a certified OB/GYN who strongly believes in responsible family planning, I'm in the first group. While Plan B is certainly not a perfect solution, I believe that the more options women have when it comes to managing their reproductive health, the better.

Let's look at the pros and cons of the Plan B arguments:

Plan B Cons
There are more than a few issues with Plan B as a form of widely-available birth control, but many of them are hypothetical and not yet proven with hard data.

1. Sex Scares
Some groups are against increasing the availability of Plan B out of of fear that underage teens will have more unprotected sex, resulting in an increase in teen pregnancies and STDs. They are also concerned that if Plan B is readily available, young girls who contract an unwanted pregnancy will be less inclined to talk about their options with their parents and health care providers.

2. Hormonal Havoc
The morning after pill contains a large dose of synthetic hormones, including the dreaded progestin -- much larger than in normal birth control pills. This leads some in the medical community to concerns about how such a large dose of artificial hormones will affect the hormonal balance of young women who are still going through puberty. The jury is still out.

3. Will It Work?
Plan B pills aren't a guarantee against getting pregnant. They may work for up to 72 hours, but are most effective when taken 24 hours after the unprotected sexual activity. One study from the Contraception Journal shows that Plan B prevents just two-thirds of pregnancies. Overall, you can expect Plan B to prevent 60-89 percent of pregnancies, which means that it's not foolproof -- you still need to perform a pregnancy test to make sure it worked.

Plan B Pros
So why should we offer Plan B to anyone who wants it?

1. Too Much Teen Pregnancy
In a survey performed by the CDC, among women aged 19 years and younger, more than 4 out of 5 pregnancies were unintended. Ouch! Any form of birth control that can help prevent unwanted teen pregnancies will lead to more families who are thrilled to welcome their child into the world at the appropriate time in their lives, not have their plans for college and career thrown off course by an unintended pregnancy.

2. Helping Out the Masses
Because the young women that are most likely to get pregnant are also women with lower education, low income, and unmarried, providing a well-known, affordable and easily procured method of birth control may be one of their only options.

3. Good Momentum
Although it's not as often discussed, the most effective form of emergency contraception is an intrauterine device. Inserted following unprotected intercourse, an IUD can prevent 95 percent of pregnancies and once inserted, IUDs provide protection for up to 10 years. On the flip side, IUDs do have to be inserted by a doctor or other health care professional and are a bit more costly. They also are not ideal in younger women who are not in long-term, monogamous relationships. Plan B is a good placeholder as we develop more reliable forms of birth control.

In summary, I believe that more reproductive choice trumps the potential risks of synthetic hormones being available over the counter. I'm favor of this decision, but I also encourage women to research their options and stay up-to-date regarding the birth control methods available. Science is only getting closer to a safer solution.

What do you think?

Are we going to encourage young girls to get emergency contraception with the recent FDA approval of unrestricted access to Plan B?

Have you tried emergency contraception, and how did it work for you?

Are you FOR or AGAINST the FDA decision?

Sara Gottfried, M.D., is a practicing integrative physician and author of the forthcoming book, The Hormone Cure (Scribner/Simon &Schuster, 2013). You can follow Dr. Sara on Twitter, connect with her on Facebook, watch her videos on Youtube, and subscribe to her newsletter.

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