All EC ≠ All Female Bodies

Alexandra Eisler

Alexandra Eisler

The name of the game is to make “the healthy choice, the easy choice.” And we’re excited women can (finally) buy emergency contraception (EC) over the counter! More options, more resources, and removing barriers = awesome, right?!

Not so fast.

We talk about EC as a workable option for just about anyone who wants it. Seems easy enough. The problem is that research shows not all ECs are good for all female bodies. There are three kinds of EC we hear about in the U.S.: Levonorgestrel (LNG; i.e., Plan B, Next Plan, Postinor), ulipristal acetate (UPA; i.e., ella), and the copper IUD (i.e., Paragard):

  • LNG is available over the counter without a prescription.
  • UPA requires a prescription.
  • The copper IUD must be inserted by a medical professional and accessibility varies widely among clinicians (sometimes taking several visits to be acquired and inserted).

As far as “patient friendly” goes, LNG may be the best choice with no doctor’s visit and no prescription. And everyone knows what Plan B is thanks to its sassy purple-hued commercials (brand recognition goes a long way—just ask teens how they feel about Trojan condoms over other brands). This is why in our field we keep the EC-talk simple: if you unprotected sex within this timeframe, go get EC—the sooner the better!

What we don’t talk about is that LNG is not effective for women whose body mass index (BMI) is over 25. (Check out more information about BMI here.) Now, it’s true that BMI is a somewhat controversial measurement of health, but it’s one that was correlated with EC failure.

LNG works for women whose BMI is 25 and lower, UPA works for women whose BMI is 35 and lower (and can be taken up to 120 hours after unprotected sex—longer than LNG), and the copper IUD works for most women if it can be inserted soon enough after sex. The take away is that the research shows that once a woman’s BMI reaches 26 and above, LNG becomes so ineffective, it’s basically a placebo.

So what does this mean? It means a few things. First, the most accessible methods of EC don’t work for a large portion of Americans who might want to use it. Second, we need to wholly reconsider how we talk about EC being a safe and effective method to prevent pregnancy when other methods fail.

Our clients, our students, and our patients have a low tolerance for “bad” information and by removing the required prescription from Plan B, there’s not a good line of defense to make sure folks are getting a good back-up method. There’s no easy way to explain the intersection of sex, hormones, body composition, and family planning, so how will you talk to young people about handling EC?

(Note: The study found two other covariate of EC failure in addition to BMI: existing probability of conception and the occurrence of further acts of unprotected intercourse after using EC.)

Alexandra Eisler is a Training and Technical Assistance Manager at Healthy Teen Network.

Healthy Teen Network Applauds Decision to Increase Access to Over the Counter Emergency Contraception

Today, Judge Edward R. Korman of Federal District Court ruled that the government must make the most common morning-after pill available over the counter for all ages, instead of requiring a prescription for girls 16 and younger. According to the New York Times, “[Korman] also accused the federal government of ‘bad faith’ in dealing with the requests to make the pill universally available.” His ruling counteracts Health and Human Services secretary Kathleen Sebelius’ unprecedented overruling of an FDA recommendation to make the pill available over the counter to all ages in 2011.

Emergency contraception is most effective if used within the first 24 hours following sexual activity. The time sensitive nature of its effectiveness makes widespread availability a critical issue for all women and men. Without over the counter access to emergency contraception, those 17 and older are dependent on pharmacist availability (to verify age), and those 16 and younger are dependent on first obtaining a prescription, as well as pharmacist availability. Increased access to emergency contraception could reduce the number of unintended and/or terminated pregnancies that occur in this country each year. Therefore, emergency contraception should be widely and easily available to all whom can safely use it. The lifting of these age restrictions—which the judge ordered to happen within 30 days of today’s ruling—is a major victory for those who have advocated for this access for many years.

“Critics have expressed concern that adolescents’ access to and use of emergency contraception will increase sexual promiscuity and risky sexual behavior, however, research has shown that this is not the case,” says Healthy Teen Network President/CEO Pat Paluzzi. “We are pleased that the judge’s ruling will allow young people to have easy access to emergency contraception and hope to see teen pregnancy and abortion rates continue to decrease as a result.”

Opportunity Knocks: Important Information to Share During a Teachable Moment

Gina Desiderio

This blog post is the third part of a series (Part 1, Part 2) highlighting Healthy Teen Network’s resources on using teachable moments to reach youth, through our Opportunity Knocks resources, including a fact sheet and pre-packaged, fully designed presentation, ready for you to use.  The Opportunity Knocks series is based on Healthy Teen Network’s belief that: With accurate information and adequate support, young people can make healthy and responsible decisions about having sex and using contraception. Adults can be most effective by providing the information and support needed to promote responsible decision-making in youth and help ensure transition to adulthood is safe and healthy.

In order to make the most out of a teachable moment, here is some important information about sex you should know to share with youth

“It’s important to protect yourself.”

  • Many types of protection are available and can be low cost (contraception, condoms, etc.): a clinician can help a teen identify the right type.
  • Remember that all youth need information about protection, even abstinent youth.  You should still first convey the message that abstinence from vaginal, anal, and oral sex is the only 100% way to prevent pregnancy, STIs, and HIV, but it’s important for all youth to have this information.  Youth may currently be abstinent, but it’s important for them to be prepared for when they do engage in sex, which will happen at some point in their lives.  They may be thinking about or preparing to engage in sex.  Also, youth may be defining “abstinent” differently—they may not realize that engaging in oral sex, for example, still puts them at risk.
  • All youth—girls AND boys—need this information.   For example, often, girls are the focus of teen pregnancy, STI, and HIV prevention messages, but it’s obviously important that boys are engaged in the conversation and receive this information too.
  • It’s important to recognize that, for example, a young woman who identifies as a lesbian and lets the trusted adult know this will probably not be interested in hearing about contraception.  If you do provide information on contraception, she may feel as if you are not listening to her.  However, youth who may be questioning their sexual orientation may engage in sexual risk-taking behaviors.  For example, a girl may engage in sexual activity with a boy, but she may not protect herself.  Therefore, it’s important to tailor your approach and information provided to the individual.
  • Plan ahead: it is much easier for teens (or anyone, for that matter!) to think about protection ahead of time, and there are many more options before having sex.
  • Teens need to choose the contraceptive method that is right for them: methods that may not have worked for a friend or relative may work well for another teen.
  • Youth should talk to partners to make it easier to make decisions together.  For example, youth can use these techniques when talking to partners:
    • Say “no” to sexual risk-taking behaviors.
    • Explain why they want to make safer decisions (i.e., prevent pregnancy, STI, HIV).
    • Offer alternatives or strategies to show they still care about their partners and want to have a relationship with them.  Talking through feelings together can help grow a relationship and ease any tension.
  • An integrated message is best: discussion of both pregnancy prevention and reducing sexually transmitted infections is crucial.  Both partners should use protection (such as condoms and/or birth control) to increase protection against pregnancy and STIs.  However, it is not safe to use two condoms at a time.  This is sometimes referred to as double bagging and can actually increase the likelihood of the condom breaking

Emergency contraception (EC) is safe, highly effective, and available.

  • It’s the only existing way to prevent pregnancy after having unprotected sex[1].  EC is now available without a prescription for 17 year olds.  Healthy Teen Network has an Advocacy Resource Guide on Emergency Contraception, available online for free download.

It’s Confidential!

  • Youth can feel comfortable seeking medical advice about protection because confidentiality laws protect their privacy.  Youth have rights; confidentiality laws protect their privacy to access confidential health care services. It’s okay to talk about sex!  Healthy Teen Network has a series of resources on Confidential Access to Contraception, but here are some important points to remember:
  • Many young people indicate that they would not use the services of a family planning clinic if their parents had to be informed, but few say they would stop having sex.[2], [3]
  • A majority of young people share information about sensitive issues such as sexual activity with their parents and other adults in their lives,[4] but sometimes adolescents need or want confidential services.
  • When adolescents are discouraged from seeking health care because their care will not be confidential, the result can lead to adverse health outcomes and significant social and economic costs.[5], [6]
  • At least two recent studies have estimated the potential increase in pregnancies and sexually transmitted infections (STIs)—with the likelihood of significant increases in public financial costs—when adolescents are discouraged from seeking health care.[7]

It can be intimidating for adults to share this important information during a teachable moment.  However, there are some helpful hints and steps you can take to prepare yourself:

  • Know your own limitations and comfort level; it’s okay to refer a young person to another trusted adult if the conversation moves outside of your personal boundaries, but check in with the young person to make sure that someone did indeed answer all of his/her questions.
  • Use humor, when appropriate, as it can go a long way.
  • It is okay to say “I don’t know” and look up answers together; be sure to use a credible source of information.
  • Know other trusted allies and youth friendly professionals for referral.
  • Build a network of trusted adults in your community.
  • Make condoms readily available in your office/home.
  • Be prepared to talk about sex to all youth (e.g., LGBTQ youth, straight youth, abstinent youth, etc.).

What is other important information you always make sure to share during a teachable moment?

What are some other helpful hints or steps you take to prepare for teachable moments?

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.


[1] Emergency Contraception (2009). Office of Population Research, Princeton University. Retrieved online from: http://www.not-2-late.com

[2] Reddy, D.M., Fleming, R., & Swain, C. (2002). Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. The Journal of the American Medical Association, 288(6), 710-714.

[3]Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[4] Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[5] Ford, C.A., & English, A. (2002). Limiting confidentiality of adolescent health services: What are the risks? The Journal of the American Medical Association, 288(6), 752-753.

[6] English A. & Ford, C.A. (2004). The HIPAA privacy rule and adolescents: Legal questions and clinical challenges. Perspectives on Sexual and Reproductive Health, 36(2), 80-86.

[7] Franzini, L., Marks, E., Cromwell, P.F., Risser, J., McGill, L. Markham, C., Selwyn, B., & Shapiro, C. (2004). Projected economic costs due to health consequences of teenagers’ loss of confidentiality in obtaining reproductive health care services in Texas. Archives of Pediatrics and Adolescent Medicine, 158(12), 1140-1146.

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