Wake-up call on morning-after pill

By Chiang Sheng 江盛  / 

Fri, Apr 19, 2013 - Page 8

On April 5, New York Federal District Court Judge Edward Korman ruled that a regulation barring girls under the age of 17 from purchasing the “morning-after” contraceptive pill over the counter without a prescription was “arbitrary, capricious and unreasonable,” and ordered the US government to repeal the ban within 30 days.

In 2009, Korman said that a 2006 regulation implemented by former US president George W. Bush’s administration requiring girls under 18 to have a prescription to buy the morning-after pill was based primarily on political — not scientific — considerations, and ruled that 17-year-olds should also be able to buy this pill without a prescription.

The April 5 ruling was a development of this earlier ruling and shows that the US judiciary is above politics.

If the US Department of Justice decides not to appeal Korman’s decision within the next 30 days, the debate over the emergency contraceptive — also known as the “Plan B” pill — will be settled and in the future, girls in the US will be able to purchase the pill at a drugstore without a prescription, regardless of their age.

The teenage pregnancy rate in the 15-to-19-years-old age group in New York City has consistently been higher than the US national average. Nevertheless, the rate fell by 27 percent in the city’s public high schools in the decade from 2001 through 2010, primarily because of the availability of sex education and contraception.

The city’s educational authorities believe that this combination is important for making teenagers aware of the potential consequences of sexual intercourse, such as unwanted pregnancies or contracting a sexually transmitted infection.

The result of this two-pronged approach has been that the percentage of the city’s high-school students within that age group that reported being sexually active fell from 51 percent in 2001 to 39 percent in 2010. In addition, the number of sexually active female high-school students taking “Plan B” contraception or using a contraceptive device rose from 17 percent to 27 percent between 2009 and 2011.

Encouraged by these statistics, New York City embarked upon a new initiative in 2011 to provide free contraception, including the Plan B pill, to students. Parents were notified and given the choice of opting out of the scheme, but less than 20 percent chose to do so. Since the scheme’s implementation, the city has distributed more than 12,000 pills.

New York City’s success in lowering its teen pregnancy rate and Korman’s ruling make interesting reading for Taiwanese policymakers looking to lower this nation’s teenage pregnancy rate, and even for dealing with unwanted pregnancies among adults — an issue that has not really received the attention it deserves.

The legal definition of an “adult” differs from country to country: In Taiwan and Japan the age at which one is considered an adult is 20; in South Korea it is 19; in the US, England, India and China, it is 18; and in Scotland it is 16. Despite the age threshold in the UK and US, there is a general consensus among medical experts in both countries on the importance of confidentiality and respecting the privacy of the teenagers who consult doctors, because they believe that the vast majority of teens, and even pre-adolescents, are more than capable of understanding the issues they are facing.

So why does a disjunction between the law and medicine suddenly emerge the moment that the discussion turns to the contraceptive pill, the morning-after pill or the abortion pill? Are there any guidelines out there for medical professionals and the public?

For example, in Taiwan, contraceptive pills are legally available only with a prescription, so the first issue is whether it is acceptable for doctors in Taiwan to prescribe the pill or the morning-after pill to underage girls without their parents’ consent. The second issue is whether parental consent should be required when the pill is being prescribed to treat conditions such as acne, polycystic ovary syndrome, endometriosis or primary dysmenorrhea in girls of this age. If one consulted Taiwanese doctors on these two questions, they would give a wide range of responses.

The British Medical Association recommends that doctors observe the same degree of confidentiality for patients under 16 as they would with adults, with the exception of cases involving child abuse or child welfare considerations. The association’s guidelines also say that if under-16s are capable of seeking medical advice on their own initiative, then they should be allowed to use their right of consent to any medical treatment the doctor sees fit to administer. As regards to birth control advice and provision of treatment, the association is of the opinion that adolescents should not be pushed to tell their parents about their decisions.

Courts in the US and the UK have intervened in many cases involving procreation and the right to life, including on birth control policy and on cases of paralyzed individuals or those in vegetative states to be allowed to die or to be taken off life support. By comparison, Taiwanese courts have had very little to say on the legal philosophy, ethics or effects on individual freedoms surrounding these issues, suggesting that there is still much room for improvement in Taiwan in terms of the public’s understanding of their medical rights and the law.

Chiang Sheng is an attending physician at Mackay Memorial Hospital’s obstetrics and gynecology department.

Translated by Paul Cooper