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ss triple helix - summer 2004,  US contraception furore - Despite the hype, abstinence works

US contraception furore - Despite the hype, abstinence works

The American College of Obstetricians and Gynaecologists called it 'morally repugnant'. In an editorial the New York Times called it 'politically motivated'. The BMJ couldn't say a word in its favour.

The USA's Food and Drug Administration's refusal to permit sales over the counter (without a prescription) of an emergency pill called Plan B certainly caused some shock waves in the family planning establishment. The reason given was that Barr Research, the company applying for OTC status, had not shown that adolescent women could understand the product instructions. The BMJ wryly commented that 'The FDA has never previously required such information before granting over the counter status'.[1]

This decision coincided with a great deal of mostly negative UK media comment about advocates of 'The Silver Ring Thing'[2] crossing the pond to peddle their dangerous brand of virginity over here. Gill Frances the deputy chair of the Government's Teenage Pregnancy Unit (TPU) wasted no time in labeling the scheme as 'potty'.

In fact 'Silver Ring Thing' is not an educationally designed sex education programme anyway but a one night road-show aiming to encourage teens to pledge to remain virgins until they marry. Its advent in Britain however did provoke a lot of cant from sex educationalists about how badly the USA is doing in terms of teenage pregnancies. The usual bar-charts appeared in the BMJ[1] and The Economist (15 May) showing the USA teen birth rate is over twice that in the UK.

The birth rate however gives a very misleading picture of teen sexual health unless you believe that abortion is healthy. In fact, the USA is doing rather well and certainly better than we are doing over here. Over the period from 1990-2000, the conception rate for 15-19 yr olds per 1000 in the UK[3] fell by 7.6.% from 68 to 62.8; in the USA[4] it fell 28.8% from 120.2 to 85.[6]. The abortion rate for 15-19 yr olds in the USA[4] has fallen even more steeply by 40.9% over the same period (from 40.5 to 24) whilst in the UK[3] it remained virtually unchanged, falling only 2.6% (from 26 to 25.3).

In an unpublished paper by Rebekah Saul,[5] the Alan Guttmacher Institute attributes 80% of this success to increased use of contraception and is quick to denounce as 'methodologically flawed' another unpublished paper[6] that had attributed it to an increase in abstinence amongst teens. In the only peer-reviewed paper of which I am aware, the methodological flaws in the Alan Guttmacher Institute's own paper are systematically identified and corrected and this more recent research[7] attributes 67% of the decline in teen conceptions among single 15-19-year-olds to increased rates of abstinence.

It seems to me that, even without OTC emergency pills, the USA has a lot to teach the TPU about reducing teen conception rates.

  1. Tanne J. FDA rejects over the counter status for emergency contraception. BMJ 2004; 328:1219
  3. See, and specifically their report on adolescent sexual health, available in PDF at
  7. Mohn J et al. Adoles and Fam Health 2003;3:39-47.
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