June 1, 2004

But what about those sluts in the Times Magazine?

Even if you thought you had a good sense of the controversy over the FDA's rejection of over-the-counter emergency contraception, this Slate article explains exactly why all those concerns about 11-14-year-olds was such a crock: they're not having sex.

If you don't have a good sense of the issue, it will also get you up to speed.

The data were so conclusive that the over-the-counter switch was backed by major medical associations, including the American Academy of Pediatrics and the Society for Adolescent Medicine. The FDA advisory panel—which consisted of doctors, health experts, and social scientists—judged Barr's data to clinch the case. One panel member called it the "safest drug that we have seen brought before us." But the data didn't satisfy Galson. Denying any suggestion that he'd been swayed by objections from red-state congressmen and far-right organizations, he took Barr to task for what he termed a major omission: the failure to consider Plan B's effects on girls between 11 and 14, particularly their condom use. "One in five are sexually active, as opposed to older adolescents, where it has leveled off," Galson explained in an interview recently. "If girls in this age group were not sexually active, it would not be an issue."

It may be that Galson's concerns are genuine, rather than, say, political cover in an election year, but they have scant basis in fact. Earlier this month, the FDA's own sister agency, the Centers for Disease Control and Prevention, published its latest Youth Risk Behavior Surveillance report. According to the 2003 data, just 7 percent of today's adolescents have sexual intercourse before the age of 13. Among these, the vast majority are boys. For girls—the population Galson is talking about—the figure is much lower: The 2003 data show that only 4 percent of girls have sex before they are 13.


And let's consider those few: young, at-risk girls who are having sex despite efforts of right and left alike to dissuade them. Among this cohort, sex is least likely to be planned and least likely to be protected; stocking birth control "requires a level of planfulness that is not common at that age," as Kristen Moore, president of the research group Child Trends, puts it. For these girls, an after-the-fact form of contraception could be more crucial than for anybody.

It's also important to remember that the younger the girl, the more likely sex is to be coercive, usually forced on her by an older partner. According to the Alan Guttmacher Institute, seven out of 10 girls who have sex before the age of 13 do so involuntarily. These vulnerable teens are hardly in a position to make their partners wear a condom. Emergency contraception would give them a shot at staving off the consequences—consequences that hit young teenagers the hardest. It's often difficult for a young teen to get an abortion, thanks in part to parental notification and parental consent laws. Childbirth, too, is a terrible thing for this age group. Young teen mothers are least likely to get prenatal care, most likely to deliver low birth-weight babies, and totally unprepared to be parents.

Yet flimsy as it is, the young teen excuse is the one that Barr's company is going to have to deal with as it scrounges for the new information required to get the FDA to reconsider its "nonapprovable letter." One possibility Galson held out was for Barr to do a study assessing the effect of over-the-counter Plan B on the youngest girls. The trouble is that the federal government itself forbids researchers from talking about sex with this age group. CDC researchers, for example, must gather their data on young teens by asking older teens, retrospectively, about their first sexual encounter. Barr's researchers, when they first fanned out into those malls, were forbidden from interviewing unaccompanied teenagers, even older ones, which meant excluding what is arguably the most relevant portion of that age group. Even in family-planning clinics, Barr could not interview any lone teen under 14. In inviting further teen studies, Galson was asking the near-impossible.

Posted by Daniel Radosh


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