Should teens be given emergency contraception in advance of sex?

In late November of this year, the American Academy of Pediatrics (AAP) published a policy statement on emergency contraception that is sure to be rejected outright by the pro-life community.

Emergency contraception (EC) is just that-- various pharmacologic methods of preventing pregnancy up to 120 hours after unprotected or under-protected sex. Plan B and ella are two well-known brands of emergency contraceptives; there are three major chemical methods for achieving the desired result.

As it is now, most states require that adolescents under the age of 17 get a doctor's prescription to obtain emergency contraception. Given that EC works best the earlier it is taken, the prescription requirement could delay its effective use, or prevent a teen from accessing it altogether.

As a result, the AAP published its policy statement as part of an attempt to continue to lower the teen birth rate in the United States. Their major recommendations are

1. "encourage" doctors to engage in "routine counseling" of teenagers regarding emergency contraception, how it works, safety questions, etc.; and 
2. prescribe emergency contraception to teenage patients in advance of sexual activity, so that they will already have the emergency contraception product and know how to use it, in the event that they have unprotected or under-protected sex.  

Four pieces of information jumped out at me as I read the policy statement:

1. 80% of teen pregnancies are unwanted. This is extremely high; in contrast, among all American women aged 15-44, 49% of pregnancies are unwanted. Furthermore, 27% of teen pregnancies are ended through abortion. Access to EC, therefore, could reduce the number of abortions in the United States. Consider also how many teenagers are having unwanted children-- 27% of the 80% of unwanted pregnancies are aborted, so a significant number of young women and families every year are dealing with the short-term and long-term disruptions of a new baby.
2. Teenagers are more likely to be sexually assaulted than adult women, so they are more likely as a cohort to need access to EC. Given the trauma of sexual assault, many women do not report being sexually assaulted right away, if at all. Having to obtain an EC prescription from a doctor within a day or two of being sexually assaulted may be traumatic for a young woman and prevent her from stopping a rape-caused pregnancy. 
3. The three most common contraceptive methods of teenagers are condoms, withdrawl, and the pill, in that order. The first two methods are not the best in terms of preventing pregnancy, especially where subject to imperfect use. If teenagers under the age of 17 are having sex, my guess is that the failure rates of condoms and withdrawl are even higher than they are among the general population. 
4. Adolescents are more likely to use EC if prescribed in advance.

Given these facts, the AAP recommends that teens under 17 are given EC in advance, along with information and advice.

So why are pro-lifers opposed to the AAP recommendation?

First, pro-life groups argue that, in rare cases, emergency contraceptives do not prevent fertilization but instead prevent the implantation of an already fertilized egg, making Plan B and other emergency contraceptives abortifacients.

Second, it is a common belief among pro-lifers that providing contraceptives to teens, and giving them information and advice on their use, essentially encourages them to have sex. The reasoning is of at least two types:

1. If you give a teenager EC and show her how to use it, aren't you implicitly suggesting that you expect her to have sex, which she will take as a form of permission?
2. If a teenager knows that she can access emergency contraception, then sex to her will be consequence-free. As a result, access to EC would increase the number of teens having sex.

The 'permission to have sex' line of argument has a common sense appeal but is empirically doubtful. A certain percentage of teens are having sex, regardless of what their parents, teachers, and doctors tell them. There appears to be little empirical evidence to show, for example, that sex education programs that discuss contraceptive use result in more teens having sex than abstinence-only sex education curricula.

If one accepts that a certain percentage of teens will have sex regardless of parental views, etc., then withholding access to EC and contraceptive information in sex education programs is an unnecessary and ineffective disincentive. Put another way, teenage pregnancy as a 'punishment' for having sex is ineffective, disproportionate, and harmful. In this light, the American Academy of Pediatrics recommendation makes a lot of sense. 

Links:

Policy statement by the American Academy of Pediatrics, published in Pediatrics (November 26, 2012): Policy Statement: Emergency Contraception 

Article at ABC News (November 26, 2012): Pediatrics Group Calls for Easier Access to Emergency Contraception 

Article at National Review Online (December 3, 2012): Care for a Plan B? 

Article by Bloomberg News, reprinted in the San Francisco Chronicle (November 26, 2012): Teens Need Contraception Prescriptions in Hand, U.S. Doctors Say

A different article by Bloomberg News, reprinted in The Seattle Times (November 27, 2012): Doctors: Teens should have access to emergency contraception 

Heritage Foundation editorial published at LifeSiteNews.com (December 3, 2012): Teens need parental involvement, not 'emergency contraception'