STORY BYHealth care professionals hailed the March 23 federal court decision to give 17-year-olds access to Plan B emergency contraception without a prescription, saying that any step to help prevent unintended pregnancies is a good one.
But some parents and religious conservatives counter that giving 17-year-olds access to emergency contraception encourages promiscuity and eliminates parents from important decisions about their child's sexual health.
Much of the controversy surrounding Plan B comes from lack of information, says Jennifer Feldmann, MD, an assistant professor of pediatrics at The University of Texas Medical School at Houston, who specializes in treating adolescents. She says many teens she treats, like their parents, know little about emergency contraception.
“They usually don't know much about it or they mix it up with RU-486, 'the abortion pill,'” Feldmann explains.
Plan B and RU-486 employ distinctly different mechanisms and have different purposes, Feldmann adds. Plan B is an emergency contraceptive designed to prevent ovulation. RU-486 induces an abortion.
Like many birth control pills, Plan B uses the hormone levonorgestrel (a form of the synthetic hormone progestin) to prevent ovulation, and also to thicken the mucous around the uterus to make it harder for the sperm to reach the egg. Plan B contains two pills taken 12 hours apart. The drug works best when taken within 72 hours, but can be taken up to five days after unprotected sex to prevent an unplanned pregnancy. It will not interfere with an established pregnancy, which is what distinguishes Plan B from a pill to abort a fetus.
RU-486 causes a fertilized egg to separate from the lining of the uterus. It also induces uterine contractions, which expel the fertilized egg and abort the pregnancy.
Feldmann covers information about Plan B when she talks to patients about their sexual health, a conversation that commences with the onset of her patients’ first period, often as early as age 11. With older adolescents, Feldmann takes in the patient’s lifestyle and situation (if she is dating, does she express interest in sex or sexual behavior?) Feldmann emphasizes that Plan B should be used in emergency situations and not as a regular form of contraception.
“I think it is a great backup,” she says. “Condoms do break. Sometimes teens are being responsible and things just don't go their way. To avoid pregnancy, I think they should have every option available to them.”
Plan B is safe for a 17-year-old to take without a doctor's prescription, she adds, because it contains only the hormone progestin and has fewer side effects than earlier versions of emergency contraception, which contained both progestin and estrogen.
Ideally, teens would discuss their sexual health and need for emergency contraception with their parents, says Christine Markham, PhD, an assistant professor of health promotion and behavioral sciences at the UT School of Public Health, who has studied adolescent sexual behavior extensively. But not all teens have open communication and accepting relationships with their parents and may fear their reactions, and in some cases, parental abuse.
“We always encourage teens to talk with their parents,” Markham says. “However, some teens may feel uncomfortable doing that. They are trying to make the right decision by not becoming pregnant. I think we want to respect their rights and let them have some control over that part of their lives.”
But won't teens have more sex knowing that they can use emergency contraception and not get pregnant?
“There is no evidence to suggest that an emergency contraceptive will encourage sexual activity,” Markham says. “Studies show that it just provides one more tool for women, if they are trying to avoid pregnancy.”
Markham cites studies of teens and adult women who obtained advance prescriptions for emergency contraception. The study participants were not more likely to have unprotected intercourse or to use emergency contraception repeatedly.
While parents would like their children to wait as long as they could to begin having sex, in reality teens are having sex much younger than many parents think. Some teens (or preteens) begin having sex or engaging in sexual behavior in junior high. By the time they are seniors in high school, an estimated 65 percent of teens have had sex, according to the Center for Disease Control and Prevention’s Youth Risk Behavior Survey, 2007.
Unfortunately, a percentage of those teens will become pregnant. After more than a decade and a half of decline (a stunning 27 percent drop from 1991 to 2000), teen birth rates rose again in 2006—the last year for which data are available. Texas currently ranks third in the nation in teen pregnancy rates, but has consistently ranked number one in the past.
The jury is still out on what caused teen birth rates to rise again—with supporters of abstinence-only sex education programs and contraception-based programs each blaming the other side for the increase. However, a 2007 study in the Journal of American Public Health attributed the trend in decreasing pregnancy rates to improved contraception use among teens during that time.
Providing information about contraception and how to use contraceptives properly may also delay sex in adolescents, according to a recent study Markham conducted. The study, submitted for publication in the Journal of Adolescent Health, found that providing junior high school students with information on abstinence, as well as contraception and sex education, delayed initiation of oral, anal, and vaginal sex and reduced the frequency of sex for those who were sexually active.
Both Feldmann and Markham say that giving teens more information about their options to prevent unintended pregnancy, including emergency contraception, is as important as improving access to it.
“Now that emergency contraception is available we need to do a far better job of educating people about what it is, what it isn't and the benefits of having it available,” Markham says.
From coast to coast, Americans are experiencing record-breaking temperatures. Some states, including Texas, are reporting triple-digit numbers for 11 straight days, and the heat has been the cause of several reported deaths. “Children and the elderly are considered the most vulnerable population. It is harder for their bodies to respond to these high temperatures,” says Richard N. Bradley, MD, associate professor of emergency medicine and chief of EMS and disaster medicine at The University of Texas Medical School at Houston.
“The key is not to push it too hard. Stay inside a building with air conditioning when you can. If your home does not have A/C, go to a shopping center or library. Some cities are even offering ‘cooling stations’ to help those at-risk, especially the homeless,” Bradley says.
Those with pre-existing conditions like heart disease, lung disease or mental illness also should try and stay indoors. The hottest part of the day tends to be between 12 p.m. and 4 p.m., so it is best to get your outdoor activities done early in the morning or late in the evening. If you can get inside where it is cool for at least three to four hours a day, that also will help your body.
Bradley offers the following tips if you have to be outside:
Bradley also suggests to be alert to the symptoms of heat-related illnesses such as cramps, heat exhaustion and heat stroke.
Heat cramps are painful, brief muscle cramps that occur during exercise or work in a hot environment. The cramps are usually felt in the calves, thighs, abdomen or shoulders.
Heat exhaustion occurs when the body is not able to maintain normal function because of the excessive loss of body fluids and salts. In effect, the body is trying to protect itself from a greater rise in body temperature. The symptoms include: heavy sweating, intense thirst, dizziness, nausea and a weak or rapid pulse.
Heat stroke is a life-threatening emergency. It is the result of the body's inability to regulate its core temperature. As the body's water and salt supplies dwindle, its temperature rises to extreme levels. The symptoms include: a very high body temperature above 104 degrees (although heat stroke can occur at lower body temperatures), disorientation, confusion or coma. The skin may be hot and dry or sweaty.
“If you suspect someone may be experiencing any of those symptoms, it’s very important to get medical help right away,” Bradley said. “It could mean the difference in someone surviving the heat or not.”
Written by: Melissa McDonald
Last Updated 7-1-2009Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
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Dr. Jennifer Feldmann, is an assistant professor of pediatrics for the UT Medical School.
Dr. Christine Markham is an assistant professor of health promotion and behavioral sciences at the UT School of Public Health.
See Dr. Markham also at:
The mouth:
a window to the body
Researchers have found connections between periodontal (gum) infections and other diseases throughout the body, suggesting a link between gum disease, heart disease and other health conditions.
Research suggests that gum disease may be as serious a risk factor for heart disease as hypertension, smoking, cholesterol, gender and age. Those with gum disease seem to be at higher risk for heart attacks. Possible explanations involve mouth bacteria that loosen and flow to the arteries, creating arterial plaque.
If your dentist diagnoses you with gum disease, inform your medical health care professional, as well.
