Silver lining, they say: Doctors will be better able to educate teens.
Minnesota clinic directors and advocates reacted with disappointment Thursday to news that Plan B emergency contraception will remain behind pharmacy counters and unavailable to some teens who don't have a prescription.
Several expressed puzzlement that the Obama administration would overrule the Food and Drug Administration, which found Plan B to be safe for over-the-counter sales to all women, and said Minnesota will have to seek other ways to further reduce its teen pregnancy and abortion rates.
Putting Plan B on store shelves next to condoms could have made it easier for teens to prevent unwanted pregnancies, said Brian Russ, executive director of the Annex Teen Clinic in Brooklyn Center.
The silver lining, however, is that teens will have to come to clinics to get Plan B prescriptions, giving doctors a chance to talk with them about their sexual health.
"It may be the first thing that they come to the clinic for," he said. "So there really is a benefit to them having an opportunity to talk about, 'Well, if you are sexually active, maybe you should consider some methods of long-term birth control that could alleviate some of the stress of unprotected sex.'"
The benefit of channeling teens to clinics before they get emergency contraception, or EC, is one reason why Kathleen Sebelius, U.S. secretary of Health and Human Services, opted to keep Plan B as a prescription drug for those under 17.
The problem, advocates said, is that teen clinics aren't in every city, nor are clinics open 24 hours. Given that Plan B must be taken within 72 hours of sex -- and preferably within 24 hours -- that increases the chance that teens and older women won't get the pill in time.
"The 30-year-old woman who goes looking to buy emergency contraception at 10 p.m. on Saturday is also not going to have it available" because of this decision, said Jennifer Aulwes of the Planned Parenthood chapter for Minnesota and the Dakotas.
Planned Parenthood has seen interest in emergency contraception increase; the organization dispensed 83,941 doses in 2010, up from 30,124 doses in 2006. Those figures are for all patients, though, not just teens, who make up 6 percent of Planned Parenthood's patients.
State Health Commissioner Ed Ehlinger also expressed disappointment. "We know it's safe, we know it's effective," said Ehlinger, who previously managed the University of Minnesota's student health service.
"It seems punitive not to have it available to the people who could most benefit from it."
Ehlinger also said there is no research to support one of the fears associated with EC -- that it encourages promiscuity.
Teen pregnancies down
Whether the ruling will change sexual behavior or the number of pregnancies in Minnesota is unclear. The state has seen historic drops in key measures of teen sex over the past 20 years. The 1,119 teen births in Minnesota last year were the fewest since at least 1990, and a 29 percent drop from 2007. The number of teen abortions also has fallen sharply, from a high of 838 in 2001 to 482 last year.
Those trends, however, can't necessarily be linked to levels of sexual activity. The Minnesota Student Survey indicates little change in the number of high school seniors who say they have had sex -- 48.2 percent in 2007 and 49.5 percent last year.
If teens are still having sex, then the reason for the decline in births is likely increased access to birth control, Aulwes said. "Making EC available to young people under 17 would have had an even further positive impact."
Plan B is one of three forms of emergency contraception. It contains a high dose of the same female hormone that's in regular birth control pills, and works by preventing fertilized eggs from attaching to the uterine wall. The other two EC options are Next Choice, a generic drug also kept behind pharmacy counters, and ella, a prescription drug.
Although it can reduce the chance of a pregnancy shortly after sex, emergency birth control doesn't protect against the rising problem of sexually transmitted diseases. The number of STDs reported among teens has reached record levels in Minnesota in recent years.
In supporting Sebelius' decision, President Obama evoked the concerns of many parents: "As the father of two daughters, I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine."
The president said that Sebelius made the decision independently. Russ wasn't buying that the decision was apolitical, though.
"We really were encouraged when we started having conversations about public policy being driven by evidence and research," he said. "It's discouraging that a decision about sexual health would be made, you know, with some election year politics in mind -- which I assume is what's going on here."
The 16-year-old, who serves on the Annex clinic's youth council, worries more that teens might not seek EC when they need it because they have to see a doctor first.
"You're already embarrassed enough that it could have happened to you," she said. "Then you have to go and tell what happened to a bunch of doctors? You don't know what they're going to think about you. ... It makes it even more embarrassing."
Her mother, Linda Langham, agreed. The concern expressed by Sebelius -- that confused 11-year-olds might be buying Plan B off store shelves -- seemed implausible, she said, compared with the needs of teenagers if they have unprotected sex.
"I've been to Target many times," she said. "That's where our pharmacy is. I have yet to see an 11-year-old standing in front of the contraception, browsing alone."
Jeremy Olson • 612-673-7744