Table of Contents
Introduction: What Statistics Say on Teen Pregnancy and Plan B?
Sexuality and sexual activity are basic parts of human development. Decades of research shows that teens are in greater need of holistic sexual education and contraceptive healthcare.In the United States (U.S), over half of the teens have had sexual intercourse by the time they turn 18 (Center for Disease Control and Prevention (CDC), 2017), and about 0.35 million teenagers become pregnant each year (ACLU, 2023). Although the CDC data shows that teen birth rate (TBR) in the U.S has declined since 1990s, teen pregnancy (TP) and TBR still remains higher than many other developed countries such as Canada and the UK.
Texas has one of the highest rates of TP in the U.S, and the highest rate of repeat teen pregnancy (RTP). One in six teenagers who gave birth in 2020 in Texas already had a child (Varney, 2023). TBR is also high among teens of color (OASH) with about 2/3rds seeking abortions (CDC). These high ratios draw attention to the need of conscientious sexual and reproductive health policies, especially for teens, that would focus on un-stigmatized sexual healthcare and emergency contraception (EC) availability.
However, there has been an uproar over EC availability such as Plan-B due to a legislation on reproductive rights in the U.S. The decision that overruled Roe v. Wade in June 2022 “paved way for many conservative states like Texas “to curtail or outright ban abortion rights” (Housman, 2022).
Though the ruling does not change the existing accessibility of EC like Plan-B, given a state that has been out rightly apathetic and hostile to its public with its “anti-sexual and reproductive health policies” (Guttmacher Institute), it is difficult to presume if Plan-B would be easily accessible to teens in future without any hindrance.
This article looks into the impact of the legislation on teens access to ECs like Plan-B. By examining the issues unfolding as a result of the ruling, the essay explores potential consequences of limited access to Plan-B on the teen population in Texas. The aim is to contribute to the ongoing conversation on the contraception access and provide valuable insights to improve teen access to contraception in Texas.
Plan B and the Legal Considerations in the Texas, U.S
With the overruling of Roe v. Wade, states became free to exercise their control on aspects of abortion not protected by law. As a result, trigger laws already in place in Texas, outlawed abortion and made it a crime. It is not unknown that Texas have been hostile to reproductive health rights. Texas laws have long required that teens have parents’ permission to get access to prescription contraception. Though people of any age can still access EC with a prescription over-the-counter (OTC), access to Plan-B is restricted to individuals above 17 or older.
Minors under 17 are required to have prescription from healthcare provider to purchase Plan-B. Changes in the state law, might raise possibility that “some providers use it as an excuse to exercise reproductive control” (Santilli, 2022). According to Drillinger from Healthline, it “could put other rights at risk, including access… to emergency contraceptives”. That could also mean the further throttling of rights of teens to access EC like Plan-B in the “most conservative state in the union” (Jeffers Jr. 2021), especially in Texas where TPR and TBR are already high, and access to Plan-B is limited.
It is imperative to understand the repercussion on teens who fail to get access to Plan-B due to reasons such as parental disapproval to EC due to religious tenets, abusive or unsupportive households, privacy infringement to sexual health needs due to permission requirements, etc. Some teens may have supportive parents but how do they access permission if they don’t live with their legal parents or guardians? There may be some who are uncomfortable to talk about sexual health. Not able to take timely advice might delay contraception measures, with increased chances of getting pregnant, or other health complications creating unnecessary burden on teens who otherwise wanted to prevent unintended pregnancy.
Medicine, Morality, and Misunderstanding
Also there exists other factors that restrict easy access to Plan-B in Texas. As per Pediatric Academic Societies (2018), pharmacies’ refusal to provide Plan-B without prescription, pharmacy staff giving misleading information due to their own lack of knowledge, refusal to fill prescription or confiscating a written prescription even denying receipt of electronic prescription, lack of knowledge of staff about exact age requirement, pharmacy staff citing ethical reasons for not stocking or dispensing Plan-B (Health Behavior News Service, 2013), etc. are matters of concern.
The cost of contraceptives can vary depending on the location and the type of insurance coverage a person has. Not all teens have access to a doctor or can afford to see one, especially if they don’t have insurance. In Texas, a vast majority are without health insurance (Varney, 2023). This means that even if a teenager wants to obtain Plan B, they may not be able to do so because of the cost.
Teens living in rural areas, those who don’t have transportation to visit a doctor, or those who may not be able to bear the cost of traveling long distances to access medical care are impacted the most. The delay arising due to such logistical issues may increase the chances of unintended pregnancies.
What is Plan B?
Plan B, also known as the morning-after pill, can prevent pregnancy when taken within 72 hours of unprotected sex. Its legislative history in the U.S has remained contentious since it was initially approved in 1999 by the FDA for prescription use only. In 2006, it was allowed OTC for 18 years and above ages with restriction further lowered to 17 in 2009 (LU, Vanessa,2010) and later altogether removed in 2013 for use among all ages.
As per Dr. Woodcock, Director of FDA’s Center for Drug Evaluation and Research, this move was taken in realization to the fact that OTC access to emergency contraception has the potential to decrease the rate of unintended pregnancies. The legal developments, over the years, led to an increase in its demand among young people. As per Smyth and Roeder’s article in Financial Times, with abortion restrictions spreading each day, demand for Plan-B has increased substantially with over 15 million units sold last year.
This seems to be a news to rejoice for the Plan-B medicine companies. But does this development mean that Texas teens are also getting easy access to this reproductive health pill considering the age restriction, parental consent rules and limited availability of medical centers and clinics? Let us not forget that Texas is known for its stringent regulations on abortion and teens getting easy access to Plan B. The Texas SB 8, or the Heart Bill passed in March 2021 bans all abortions after 6 weeks of pregnancy before the woman even realizes that she is pregnant. It allows any private person to sue anyone who aids or abets an abortion.
Societal Control or Protection? What Care Givers and Civil Society Think about Plan B
Dr. Ivey says that “aiding and abetting” is “so loosely defined that it could be construed to ban related counseling, information, and referrals for care”. Of course, this will make any medical practitioner and sexual health provider like her feel scary. They might be unwilling to suggest or provide emergency contraceptives even to those teens who have parental consent due to fear of prosecution.
Physicians performing an abortion for life-threatening conditions like ectopic pregnancy will become fearful as it’s foreseeable that their actions will result in the removal of a developing fetus. Though the bill does not intend so, they would fear that the statutes could be used against them. Similarly, the “Human Life Protection Act”, signed by Governor of Texas in May, 2021, if passed, may bring further obstacles in future in accessing reproductive and sexual healthcare, especially by the teens.
The law that seeks to establish that human life begins at fertilization and unborn children should be protected by law is much celebrated by pro-Act organizations like Texas Alliance for Life. According to them, the move defends unborn children from the “agonizing act of abortion” (Sosa, 2022). But what about the agony it may bring to the young bodies and minds of teens who may have to continue their pregnancies due to lack of access to easy contraceptives like Plan-B?
Voices in the Debate: Stakeholders and Their Ethical Claims
While supporters argue that it protects parental rights and encourages communication between children and parents, opponents believe that it only decreases access to reproductive healthcare by controlling right to choose. More or less, it seems that such bill is only intended to change the way abortion is penalized. Prof. Chandler of the University of Houston Law Center believes that this move would “equate embryos and born children in the eyes of the law” which will modify the definition of an “individual” (Noel, 2023).
By replacing “gestation” with development,” the bill does not necessarily establish the necessity of implantation. It requires only that fertilization has occurred. The implications could mean penalties for the use of EC or in-vitro fertilization treatments. EC pills like Plan-B are different than abortion pills. However, this Bill could create confusion about the legalities of using Plan-B. Though the core of the Bill is to crack down on pharmacists and individuals who provide and use pills for abortion, it eventually threatens those who sell EC like Plan B.
The law will have a chilling effect on healthcare providers. They may be hesitant to provide Plan B or other reproductive healthcare services for fear of being sued. This implies that teens who take precautionary measures to prevent pregnancies are deprived of the medication. The requirement of a prescription will likely deter others from seeking out contraception altogether. The ultimate results will be rising rates of pregnancy among teens. At present, the sunshine is that even in the most restrictive antiabortion laws, Plan B is protected (Cuellar, 2023) in law but its regulatory mechanisms are confusing.
The overturning of Roe v. Wade has opened Pandora’s box in the reproductive and sexual health rights debate. A recent ruling by a Texas Judge made it further difficult for teens to access contraceptives when he wrote that minors would need parental consent even at federally funded clinics under the Title X program (Coronado, Acacia 2023). This came after a father sued the Dept. of Health and Human Services in Texas stating that the Government has violated his constitutional right to direct the upbringing of his children as per the tenets of his faith.
While it may not be completely wrong for conservative parents to think this way, but the issue is due to its biasedness towards parents’ rights. It is the outcome of the legislation that gave judge’s the power to control a minor’s individual and reproductive rights. Rulings as such may not be an appropriate thing, and might bring further barriers for teens to access Plan-B in limited medical centers and clinics funded under federal programs.
According to Eleanor Granor, Director of Jane’s Due Process, working on reproductive health, the ruling took away the reproductive rights of teens. Such changes to legislation can restrict funding for certain reproductive health services which can further limit ability of clinics to offer services like Plan-B to teens. Many minor girls from culturally orthodox or abusive and unsupportive households would be bereft of the medication.
The Individual Teen: Privacy, Agency, and Existential Responsibility.
Unintended teen pregnancies become a major concern in Texas wherein the society is confronting high number of forcible rape cases (Melhado, 2022) as well. As per SB 8, rape victims are permitted to take Plan B to prevent pregnancy. However, due to under-reporting, lack of wide accessibility to Plan-B, and the criminalization of abortion, teens may be at the receiving end. Unintended “teenage pregnancy” due to lack of freedom to use contraceptives can have a negative impact on the “arc of a woman’s life” (Varney, 2023).
Only 50% of teenage mothers receive a high school diploma by age 22 compared to 90% of women who do not give birth as teens (CDC). The numbers should make legislators worry as high TP and TBRs can lead to poor outcomes for the next generation. Legislators need to question themselves if it’s not a dent created due to their control over reproductive rights of individuals. Current legislation only increases teen worries about “safety issues” such as Plan-B rather than giving them their bodily rights and freedom.
Legislative Rigidity and Consequences of Restricting Access
Another complex situation arising as aftermath of the legislation is the leaning towards SMAs (Self-Managed Abortions). “With the law in effect, Plan-B becomes inaccessible, individuals show growing interests in Plan C that educate people on abortion pills” (Vesoulis 2021); not to forget, that includes teens too. Research by Abigail et al. (2019) shows that phone calls to online telemedicine abortion services were maximum from hostile states. Restrictive laws are “fueling the rise of alternative forms of abortion care” (Vesoulis, 2021).
Rigid laws are putting lives in danger, especially teens, and there needs to be acknowledgement about this issue among policymakers. WHO statistics repeatedly highlight unsafe abortions as leading cause of maternal mortality and morbidity. Rigid policies are only increasing unsafe abortions by restricting woman’s access to abortion. There was 12 times increase in abortions sought outside Texas as an after-effect of the law (Sanger-Katz, et al. 2022). But what about those who cannot afford it? Are the legislations not forcing women to carry the risks of unwanted pregnancies to the full term impacting their psychological health?
The Moral Compass and Compassionate Ethics and Policy-making
While proponents of the Bill are many, opponents are also vocal about ensuring bodily and reproductive justice for women and teens. They are emphasizing the need for “empathetic” legislations instead of “apathy and outright hostility” (Hasstedt, Guttmacher Institute) that have long been the policy of conservative politicians’ and lawmakers’. Pro-choice policymakers have a good role to play here. State representatives like Donna Howard have already filed proposals to see provisions of easy birth control measures in the Bill.
Under the federal Children’s Health Insurance Program (CHIP), she wants a provision for free contraceptives for teens who otherwise don’t qualify for Medicaid (Cuellar, 2023). If passed, it will be a good move to ensure easy access to Plan-B. Ramos and Johnson’s My Body, My Future Act intends to allow teens to have “contraceptives at any clinic without parental consent”. Removing the legality of parental consent can further reduce teens’ barrier to access EC. Pro legislations are the need of the hour.
Pro-choice advocates cite the references to “unborn humans” as opposed to fetuses by a Texas judge as inflammatory (Noel, 2023). They are right in doing so for the debate on life within a life is still an unresolved issue. It does not seem just to identify a fetus in early stages as an “individual” and take away the rights of a grownup individual carrying it. Instead, it will be worth for conservative policymakers to acknowledge that banning abortion and tightening contraceptive access won’t stop abortions.
Overlooking the state’s “lackluster” reproductive” “health indicators” (Hasstedt, Guttmacher Institute) and passing stringent laws would only exacerbate the situation. In words of Dr. Ivey, it will be counteractive to eliminate abortion “while ignoring the overwhelming evidence that improved access to contraception would be more effective in decreasing elective termination rates”. Instead, legislations need to be unambiguous.
Reimagining Justice for the Young: The Need for Inclusive, Reflective Lawmaking.
Laws should not make it terrifying for individuals to access their sexual health requirements. At the same time, health providers should also not find the laws unduly restrictive to turn away a patient for fear of being prosecuted. Current legislations are awful as providers feel compelled to say they “can’t take care of (you) because the government says (they) can’t’, whereas they know that “its bodily autonomy (is) first and foremost”.
Individuals deserve to be in charge of their medical decisions rather than lawmakers controlling their freedoms. The answer lies in not restricting access to Plan-B but opening the “doors to other types of contraception (such as Plan-B), and make it easier for people to access information,” (Dr. Kate White, Boston University Chobanian & Avedisian, School of Medicine).
References
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