It was probably obvious yesterday that we earnestly thought the FDA might finally turn around a longtime decision, one largely against all advice, information and recommendations from sexual, reproductive and adolescent health and rights experts and advocates, when it came to unfounded restrictions long put on teen access to Plan B.
And that was going to actually happen. The FDA was on board this time around and made the decision to ditch those restrictions. People under 17 were finally going to have the same kind of access to a safe, important kind of contraception those over 17 had, a kind of access there is simply no sound reason to restrict.
And yet.
In what Jodi Jacobson of RH Reality Check so rightfully said can, "only be called an astounding move by an Administration that pledged on inauguration day that medical and health decisions would be based on fact not ideology and for which women are a major constituency, today Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS) overruled a much-awaited decision by the U.S. Food and Drug Administration (FDA) to make emergency contraception (EC) available over-the-counter (OTC) to women of all ages."
I don't think we can express enough how tremendously and deeply frustrated and infuriated we are here that our optimism was in vain and was so outrageously gutted.
You can read more about it here, here and here and see the memorandum from Kathleen Sebelius here.
If you're like many of our readers and Facebook fans, reading those things will leave you feeling just as angry as we feel about it, if not more so.
It's so tremendously important your frustrations and opposition be heard (perhaps particularly by an administration which rallied youth for their support in getting elected and were so greatly benefitted when young people stood up for them).
It's so tremendously important that your requests for rights like these be heard. And that the incredibly sound, sage things you say like this from reader Arai, "These politicians really need to get on the same CENTURY as the one young people live. All the questioning for contraceptives, abortion rights, gay marriage are real in today's society," or this from reader Katrina, "Politicians on both sides of the aisle reach unheard of levels of cluelessness when it comes to youth reproductive rights and needs," are heard and seen. It is, of course just as important that they are also very thoughtfully and with great intention considered in choices like this, but we can't help much with that part, save continuing to say things like that and continuing to be ardent supporters of youth rights, including reproductive rights.
But what we can certainly help with is to provide at least one place where you can speak your mind about this and be seen and heard, and then take those comments and get more eyes on them from there.
Please leave your comments here about this decision if you are unhappy with it. Please pitch in to help add your voice to other youth voices about this issue if you want to do one of the most basic things you can, the most important things you can, to work towards a different, better, fairer, outcome.
Like we told one of our readers today when she asked why young people should have to ask, beg even, for rights you should have in the first place, the only answer we have is that you shouldn't. But just like other groups have had to voice a strong desire for rights they never should have -- like women and people of color seeking the right to vote, people of color seeking the same essential useful rights white people had, LGBT people asking for the same rights, freedoms and protections cisgender or straight people have -- you've got to keep doing the same with rights like this if you want them.
You shouldn't have to: you absolutely shouldn't have to. But, for now, you do.
Speak your mind: we want to hear you and other people, including this administration -- whether you're a citizen or not -- need to start hearing you. And listening.
P.S.: Would you rather blog about it in a different place? If you do, leave a link!
P.P.S.: The Change.org petition in protest of Secretary Sebelius' action is here.
You may have heard that the FDA may finally remove age restrictions for the morning-after emergency contraception pill in the United States. If you've heard that, you may have started to hear some panic or fear-factoring, not just gratitude and relief.
Currently, in the United States, someone must be over the age of 17 in order to get Plan B at a pharmacy without a prescription. Until two years ago, the age limit was 18. It's still kept behind the pharmacy counter for people of all ages, but those over 17 do not need a prescription from a doctor or a clinic to purchase it.
For a long time now, organizations like ours and many, many other reproductive choice, justice and health organizations, have been lobbying to remove that age restriction, something other nations -- like Canada, Australia, Denmark, Norway, Sweden, Israel and others -- do not apply; a restriction which has never been supported by sound health data. The restriction per age has long been about politics, not health.
In fact, a medical council formed expressly to inform the FDA about Plan B in 2003 recommended it be provided without prescription regardless of age then, a recommendation the FDA did not follow. More than one staff member at the FDA during the years this has been an issue, including the highly dedicated Susan Wood, resigned in protest of decisions about Plan B access and the political motives for those decisions, which stood counter to sound medical information, what the basis of FDA decisions are supposed to be about.
We feel, like so many other sexual health and adolescent health organizations feel, like you might yourself, that young people should have the same rights with their reproductive choices that those over the age of majority do, including the ability to access safe contraceptive methods the same way as those over the age of majority do. We feel that decisions for all citizens like this need to be centered on credible health information, not political or personal agendas or religious beliefs.
Given this possible sea change, you may find yourself, not unlike some former members of the FDA, having discussions or heated arguments about this with people who really do not get it for a while, and in those, you're probably going to face a serious lack of facts. In case you need them, here's a quick and dirty roundup of some typically uninformed statements with some factual information and context to counter them with.
But Plan B is so unsafe! It's like a GIANT dose of birth control pills!
A lot of over the counter medications, also without age restrictions are not only dangerous, but far more associated with serious health risks.
For instance, you can get all of the following over the counter here in the U.S., none of which have any age restrictions (links are to informational listings about them, including health risks): ibuprofen, acetaminophen, cough syrups or cold medications which contain dextromethorphan or pseudoephedrine, sleeping pills or energy drinks. Heck, you can get candy bars within reach even if you are still only crawling around in footie pajamas, but we don't hear people talking about putting them behind the counter for the safety of diabetic kids.
Plan B is a medication just as safe or safer than some of those things, especially when those things aren't used as directed, which happens a lot, no matter how young or old people are. No deaths have been linked to Plan B, and we can't say that about any of the other things I put on that list above.
It's also not quite right to say that it's a "giant dose of birth control pills."
Most people who use the pill use combined oral contraceptives: a combination of a synthetic estrogen and a synthetic progestin. And while both of those things carry potential health risks, especially for people who have health or lifestyle issues that heighten those risks, the larger risks tend to lie with the estrogens or the combination of estrogen and progestin. Plan B does not contain any estrogen, only levonorgestrel, a progestin. That matters and makes it tough to compare to the most common daily-use oral contraceptives. That's also some of why reputable medical organizations assert that emergency contraceptive pills are usually safe even for people for whom regular contraceptive pills are unsafe. The World Health Organization lists no medical condition for which the risks of emergency contraceptive pills outweigh the benefits.
Too, people who use either combined birth control pills or minipills tend to use them for longer than one or two days like with emergency contraceptive pills, but instead will take a pill every day for weeks, months, years or decades, depending on how long they use them for. Very few people will start using birth control pills and only take two out of a pack.
Most oral contraceptives have 100 to 150 micrograms of levonorgestrel per pill; emergency contraceptive pills contain either two two 750 microgram levonorgestrel pills to be taken 12 hours apart (or together: taking them apart is mostly about reducing the chance of feeling nauseated) or one 1500 microgram pill, to be taken 12 hours apart. Almost everyone who uses a birth control pill for more than a week or two is taking in as much of the hormone in Plan B or, and most typically, far more. And these medications aren't like a sleeping pill or even an advil when it comes to overdose, if that concerns someone about the amount of hormone in Plan B. Not only do we know this is a safe amount to be used as directed, "overdosing" with oral contraceptives does not present the kinds of dangers we see with other kinds of medications. It might also help to take a look at the facts about frequent use of emergency contraception: in a word, we have no evidence so far, after more than decade of research, that has found any more or different risks than ongoing, proper use of other hormonal contraceptives.
Let's not forget that pregnancy can be one of the riskiest things there is when it comes to people's health. Preventing pregnancy with a safe medication like Plan B poses far less risk to someone's health, especially a young teen's health, than a pregnancy does.
But, but... it is SO DANGEROUS for TEENS!
But, but... it isn't. Not that anyone has discovered so far with many years of scientific study, anyhow. There has NEVER been broad medical or scientific support for the decision to require a prescription for minors, but not older people. It's been the other way around: most healthcare professionals and medical organizations, like the World Health Organization, the American Academy of Pediatrics, the American Medical Association and the American College of Obstetricians & Gynecologists, as well as, again, many doctors at the FDA, have objected to these age restrictions. The people who tend to oppose it most are people like this. (Note: that link is to an anti-choice site, the American Life League, which is hopefully obvious from the first sentence, but may become more so by the total lack of contextualization with the information given there, such as a lack of mention that all the risks they list for the MAP exist with a pregnancy. And maybe when reading their website.)
So much of what people know and have heard about emergency contraception has been informed and greatly influenced by people and organizations who are anti-choice, and who oppose Plan B and often other kinds of contraception, not because of concerns for anyone's health, but because of their political agendas to limit the control people -- most commonly women -- have over their bodies and reproduction.
Again, know what's dangerous, sometimes truly, earnestly dangerous? Pregnancy. Now, that doesn't mean people need to be afraid of pregnancy or that we're saying people who want to become pregnant shouldn't make that choice if it's a wanted choice. But there's a reason why maternal mortality rates are so high in places where pregnant people can't get sound, consistent care during pregnancy, labor and deliver from healthcare providers, including educated midwives. That's because pregnancy is dangerous. Preventing pregnancy with safe, studied contraceptives is always statistically safer than becoming pregnant. So, if someone wants to flip their lid about how dangerous contraceptives like Plan B are, they better at least be pulling out all the same stops and more about how potentially dangerous being pregnant and giving birth can be, too.
And even though legal abortion is also very safe, and in the first trimester, safer than a full-term pregnancy, emergency contraception is safer than abortion, too.
Some people have concerns that teens will not be able to understand how to use EC properly without getting a prescription from a doctor. While it doesn't make much sense to have that concern about EC and not all the other medications a young person can currently get over the counter, some studies have found that concern also is not sound. "Two studies were published in 2009 regarding emergency contraceptive label comprehension for teens. Raymond et al. found that 79% or more of adolescents aged 12-17 correctly understood six key concepts found in labeling: 1) EC prevents pregnancy after unprotected sex 2) it should be taken as soon as possible 3) it should be taken within 72 hours 4) it should not replace regular contraception 5) it does not protect against sexually transmitted infections (STIs) 6) it should not be used by women who are already pregnant." (The Reproductive Health Technologies Project, Tough Questions and Answers about Adolescents and Over-the-Counter Emergency Contraception, 2009) By all means, patient and consumer literacy is always something to be concerned with, but we have no reason to believe this is a greater concern with teens regarding Plan B than it is with people of all ages.
It might also help to know that there are already some contraceptive methods as available to teens as to those over the age of majority which we know or suspect may pose different or greater risks for them, like Depo-Provera, which may present risks around bone density for younger teens. And young people should be informed by their doctors or pharmacists of any risks these or other medications or devices present to them based on age, when there are any, just like people should be informed when older age increases a risk, or when a given health condition or lifestyle issue may increase risks.
And if there were different or greater risks with Plan B for young people than those one, three or ten years older, those same standards should be applied and, you can be certain, would be applies. Thing is, based on all the study of these medications so far, we don't have any data to suggest the risks are different or greater for those under 17.
I am not okay with teenagers being able to give themselves an abortion by just walking all willy-nilly into a pharmacy.
Even as a strongly pro-choice person, I don't know if I'd feel comfortable with that, either. I am, however, a fan of walking willy-nilly. It's much more fun than just plain old walking, that's for sure.
But that's moot, since no one of any age can give themselves an abortion by just walking into a pharmacy and getting Plan B, including in places where people of every age can access emergency contraception without a prescription. That's because you can't use emergency contraception to terminate pregnancy.
A lot of people -- some out of ignorance, some who know better but know how easy it is to obscure the facts by just muttering the A-word -- have the odd idea that emergency contraceptive pills and a medical abortion, or "the abortion pill" are the same thing. They're not. Plan B and other emergency contraception not only is a very different medication, it does very different things. Even if someone wanted to terminate a pregnancy with Plan B, this medication can't do that: it lacks that capacity.
You can get information on the "abortion pill" -- a bit of a misnomer by itself, since medical abortion involves two medications, not just one -- here.
But more people will have sex without using birth control if they can just get EC easily.
Emergency contraception has the word contraception in it because that is what it is: it, like other methods, is contraception. Is it as effective as several other methods? Nope. It's also more expensive, too, especially if people are using it often.
I'm not sure why anyone is this concerned about people choosing this method of contraception rather than others by this token, but for those who are, so far, we also don't have any data that shows that when EC is made more available, including giving minors the same access those older have, that there's any basis for that concern. As reported by the Alan Guttmacher Institute years ago, providing adolescents with advance doses of emergency contraception neither increases their likelihood of having unprotected sex nor negatively affects their use of condoms or hormonal contraceptives.
Perhaps more to the point, if one is worried about people not using contraception, then it's tough to figure how it makes sense to limit their access to contraception.
Want more information about emergency contraception, including teen health concerns? Check out these links:
If and when you get tired or arguing with someone about this who just will not let go of the non-facts, do yourself a favor and just print them out, pass them on, and give yourself a breather. Bashing one's head into walls is something we know isn't healthy. :) If, on the other hand, like some of us (coughcough) you seem to have dedicated much of your life to arguments like this and you find what we gave you here isn't enough? Leave a comment with an aspect or issue you want more information about or help voicing. We're glad to help you out.
Here in the hemisphere I live in, we're into the swing of summer. Ah, summer, my personal favorite season. I love the sun, the warmth, everything blooming, the energy, the spirit of the season. As an alternative educator all my life, though, I miss out on that thing where teachers get summers off (though I've also known few teachers in the public sector who could afford to take the summer off, anyway), and as the Executive Director and lead educator at Scarleteen, I really don't get downtime. Summer is and has always been our busiest season. Eh, so it goes.
It's also the time of year when we tend to see the most new users coming to us because they're in a crisis or a panic, or are just really, really feeling down in the dumps. I'm a lot more concerned about those of you in that space than I am about my feeling occasionally gypped out of a summer vacation. We know that the idea of summer as a happy, carefree time for all young people doesn't square with the reality that for plenty, it's not, whether that's about tough stuff happening, or about having experiences that aren't negative, but are just super-challenging.
With that in mind, here are a few tips and things to think about as you get into (or grapple with) your summer groove:
If you're doing any partying this summer, party safe. Potential legal issues aside, we all know that when we're partying, particularly if that involves any kind of drugs or alcohol, that it can be pretty easy to cross the line from letting go a little to things winding up really out of control, sometimes to the point where people get hurt in very serious ways, whether that's about alcohol poisoning or drug overdoses, injuries, or sexual or other assaults or abuses. Around sexual assault and other kinds of intimate partner violence specifically, it's important to be very aware than even when just booze is part of the picture, the rate of abuse or assault goes up exponentially. The US Bureau of Justice Statistics, Alcohol and Crime, documented (1998) that two-thirds of victims of intimate partner violence reported that alcohol was involved in the incident, and that perpetrators of violence had been drinking in an estimated 45 percent of cases and their victims had been drinking in 20 percent of cases. In 2002 alone, over 70,000 students between the ages of 18 and 24 were victims of alcohol-related sexual assault in the U.S. (Hingson, R., Heeren, T., et al. "Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24." Journal of Studies on Alcohol, 63)
When drugs or alcohol are on the scene, we've just got to know that while they may make us feel like we can be more relaxed, they're actually reasons we need to be more vigilant and mindful of our safety and the safety of others.
If you're hanging out with people you don't know well and trust -- it's pretty common to find oneself in or around new social circles when out of school -- bring someone with you who you do know and trust well, and you can look out for each other. Looking out for each other means helping each other to avoid being harmed, but also helping each other to avoid doing harm. Looking out for each other can also involve helping each other to stay moderate in your consumption of any substances, rather than binging or otherwise going overboard. Make a pact with whoever your party is that if either one of you seems like you're getting out of control or someone else seems to be aiming their out-of-control towards you, you'll help get both of you out of there, and to a safe space, ASAP. Don't forget that you, like everyone else, also always has the option to just opt out of parties where there's drinking or drugs, which can be a particularly smart choice if you don't feel confident about dealing with the tough stuff that can happen in those situations or don't have anyone you know will have your back, without question.
Avoid choosing to get sexual with someone when you're intoxicated in any way, especially someone you don't already have some kind of solid history with where you know you both can do a good job looking out for one another and have a good sense of each other's boundaries and nonverbal consent and nonconsent cues. If you're feeling the sexy vibes and want to pursue some kind of sex with someone in that situation, the better bet is to just trade numbers then, and connect again later when you're both sober. Not only does that help keep you safe, it also helps you avoid choosing to be sexual with someone who seems awesome and amazing when you're blitzed, but in the light of day, without the beer goggles, is the last person on earth you'd want to get down with.
Want extra tips on partying safely? Check out the following resources for some helps:
Summer can mean having more time where your parents or guardians aren't around, which can often mean more private time. For sex. It's great not to have any kind of sex in a five-minute rush or a back-of-the-mind panic around people coming home, but just because you might finally have the chance for some real lone time doesn't mean that's what you or a partner are ready for, or what's right right now, just because you have more space and place for it.
So, know what else you have extra time for? Opening your mouth. Communicating clearly, openly and well with current or potential sexual partners. Asking each other the big questions, and making sure that your sex life isn't just about feeling things out with your hands or other body parts, but also about feeling things out in hearts and minds, together. Take advantage of that extra space for talking more about sex instead of just having more sex. Not only does more communication tend to result in smarter choices and less STI, pregnancy and iffy emotional risks, it also tends to result in better sex that people enjoy a lot more. Part of talking more is about protecting each other from the crummy stuff, but it's also about nurturing the fun stuff, about communication that expresses what you've been enjoying, what you want to explore, and all the positive ways you're feeling. feeling tongue-tied? We can help.
Our users also often voice that during the school year, finding the time or space to get the sexual healthcare they need can be tough. So, how about taking advantage of the extra time during summer for that? If you're already sexually active make sure you make time this summer to get up-to-date with STI testing, other preventative care, and with your method of contraception if you need one. If you're not sexually active now, but think you might be soon, how about scheduling en educational visit with a sexual healthcare provider to find out ahead of time what you need to know to make your own best choices and be prepared to be sexual while still reducing your risks of unwanted or unhealthy outcomes? Need help finding a provider? We can help with that, either through our youth services database here, or can give you one-on-one help via our message boards or text service to find someone you can access and afford near you.
Remember, you also have some extra time to get the sex information and education that you need. So, that thing or issue you feel like you don't know that much about, or aren't sure you have the right information on? That occasional rainy day is a time when you can really take time going through a site and resource like this one.
Grand romance...stuffed into five minutes. If we do get involved in a summer romance (or lustmance, or both), especially if we're away from home, or the other person is, it can be easy to feel like we have to try and cram things that would part of a longer relationship into a very short time, or rush into things because we worry the opportunity we've got is the only one we have. It can feel sometimes like we need to have or create the Cliff's Notes version of a relationship.
By all means, if you feel good about being spontaneous, and you and whoever else is involved can have things move a little faster than usual while still feeling prepared, emotionally and practically, to deal with that and the outcomes, it's not like there has to be anything wrong with a taste of the whirlwind. Just be sure that you do try and check in with yourself and the other person often and thoughtfully, rather than getting too caught up in the flow. There's always time for talking and negotiating, and if and when there's not, that's often the signal of a bad-news scenario you'll probably regret, rather than the makings of a lovely, wistful summer memory. The really good stuff in life rarely is something that won't wait when we need to wait or feel like we or the other person would feel a lot better if we did, or like what we'd do in a hurry would be a lot more fun and beneficial if we slowed it all down some.
Need some help with that? We've got a piece that can help you out.
Sex couldn't possibly be more boring than this. Oh, sure it could.
You don't need me to tell you that sometimes life is boring, and that it's easier to get really, really bored if you're out of school and don't have anything, or enough, to do. Sometimes that winds up resulting in having sex because we're bored.
Often, that tends to be a pretty crummy motivation to have sex, no matter how old people are, and one that often results in sex that isn't that exciting, either, or which we wouldn't otherwise choose if we were not So. Very. Freaking. Bored. If and when we feel apathetic and super-whatever about life, we can also wind up taking some sexual risks we'd rather not, too.
This is just another place to check in with yourself and someone else. If you or they seem or feel like you're settling, just accepting sex because it's there and nothing else really is, or besides being sexual time spent together is a total yawner, find something ELSE to do that isn't so boring, something that engages you, that you earnestly feel passionate about. Once you do that, you can review a potential sexual situation through clearer eyes, eyes without the murky, milky haze of nothing to do. And then if you do choose to be sexual, still, chances are good it's not only going to be safer and sounder, but also a lot more interesting, rather than just one more thing to feel bored with.
Summer lovin'...when it's about everyone but you. Speaking of summer romances, maybe it's not you having one. Maybe it's your best friend. or a few of your friends, Or, good gawd, all of your friends. Except you. You might feel lousy about that, both because they seem to be having such an amazing experience, and because on top of that, you've wound up with less to do and experience yourself this summer with your friends all tied up in romances.
We're not going to say that can't suck, because it really can. But do try and keep it in perspective, and remember that falling in love or in list aren't the only great adventures out there or ways to have awesome life experiences in summer or at any other time. In fact, when those are our only great adventures, it makes for a pretty blah life, usually with pretty blah people.
Figure out ways you can also get immersed and engaged in something great that really makes you stretch this summer, whether it's some travel, a summer job or volunteer gig (if your folks are paying your rent, take advantage of a time in life when you can work for free and thus, do anything you want!), or starting or finishing a creative project you can give loads of time to, whether that's starting or joining a band, making a zine, building a website, taking a self-defense class, constructing the world's largest sand castles, or forging a new trail in some nearby wilderness. Even just getting outside, without any real purpose or great aim, sure beats the alternative of not doing anything else at all but feeling lonely. It can also make getting through next winter feel like less of a drag.
If you're looking to meet new people for potential relationships, many of those things are also way better ways to do that than being the perpetual third wheel of your best friend and her girlfriend or sitting in your room being bitter and pissed.
If you're looking for volunteer opportunities or internships, here are some organizations we really like, and some resources to help get you started (we also can always use volunteers, too!):
How did last year go for you as far as having the kind of support and community you need? Summer can be a good time to set yourself up now to be better supported for the summer and the coming school year, and a good time to get help if we're stuck with anything in life, or struggling with things that we just don't seem to be making any headway with on our own. So, if you know you felt like you didn't have squat when it came to, say, LGBTQ community and backup last year, use some spare time now to find out what's around for you that you can use. Did you grapple with depression or anxiety last year? Why not talk to your doctor or community center about counseling resources while you have some extra time so that you can better enjoy the rest of the summer, and walk into the school year feeling more able to deal with it right from day one. Not sure what your new college offers in terms of any kind of support resources? Do some research now, before you go, so you know what those resources are before you need them in a pinch. Summer can be a really great time to take care of ourselves and feel great about it.
Don't forget: we're always available to help you, and not just in crisis, but with ways to help prevent being in crisis in the first place. We're glad to help you think through sexual and relationship choices carefully and with some extra perspective. We can help you better communicate your wants, needs, limits and boundaries to new partners or potential partners. We can help you figure out if a given kind of relationship or sexual situation really fits who you are, where you're at right now in your life, and if it does or doesn't seem likely to really fit what you know you want and need. We can also help you tweak things a bit when those relationships or situations seem mostly good, but when you know or get the sense that you or a partner want or need something a little different or extra for everything to shift from good to great.
Happy summer!
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