Democratic waters are still roiled by last week’s decision by Health and Human Services Secretary Kathleen Sebelius to overturn an FDA recommendation and continue to restrict access to the Plan B contraceptive pill for girls under 17. Now 14 members of the Senate Democratic Caucus have expressed their displeasure in a letter to the beleaguered Sebelius urging her to stop playing politics and follow the “medical and scientific evidence.”
I get the playing politics. There is little question that the Obama administration’s sudden sympathy for a cause near and dear to the conservative heart is — shall we say? — time sensitive. But “medical and scientific evidence”? That one sounds as if the critics themselves are playing politics.
Liberals have a long tradition of framing culture-war battles as a struggle of enlightened, scientifically informed reason versus ignorant and backward bigotry. But the framework can’t hold in the case of morning-after pills for middle-schoolers. Science can tell us that a drug is “safe and effective” for a 14-year-old. It can also tell us that the average age of puberty for girls is a little over 12. It can tell us that 10 percent of girls hit puberty at 11. But last I saw, science had not told us that an 11-year-old — or even a 12- or 13-year-old — is a woman.
The conventional talk from Sebelius’s critics about “women’s health” and “reproductive decisions” is an Orwellian effort to cover up the fact that we’re talking about girls, all too often girls who are in kinds of trouble that go well beyond their missed periods. The critics seem to imagine a reasonably competent, self-aware teen who knows what she needs, if only we would let her have it. The scenario they sometimes present goes along these lines: A 14-year-old has unprotected sex with her boyfriend. Though she knows about Plan B and really wants to buy it within the prescribed 72 hours, she is afraid to go to her parents for help. She gets pregnant. In this story, the only problem facing our teenage girl is Kathleen Sebelius — or, as some would put it, “politics.”
Let me amend this scenario in ways that conform more closely to reality. A 14-year-old girl living with a poor single mother (early sex is far more common among the children of low-income, less-educated, single parents) has sex with an 18-year-old guy. (The research suggests that younger sexually active teenage girls, particularly Latinas, are more likely to be involved with, and often coerced by, considerably older men.) She knows in theory that she could get pregnant, but figures that wouldn’t happen to her. (Even “evidence-based” sex-education programs have only a modest impact on younger teens.) Still, her guy insists that she take Plan B, which he gets hold of through a friend. Six months later, she has sex with another guy with more or less the same results. (The earlier the sexual initiation, the more risky the behavior, including not just unprotected sex with multiple partners, but drug and alcohol abuse.) In fact, for her, emergency contraception isn’t “plan B”; it’s her only plan. In this story, unrestricted access to Plan B is an enabler of familial and social dysfunction, not a solution to it.
The ambiguity about the question when a teen becomes a competent adult has been apparent throughout the journey of Plan B through the regulatory system. In 2006, the FDA allowed Plan B to be sold without a prescription to women 18 and older. Three years later, a federal court evidently determined that 17- year-olds were women as well, because it dropped the age at which the drug would be available without prescription to 17. If all this seems somewhat arbitrary, that’s because it has to be. It’s the nature of law and regulations to draw bright lines and create categories that most people find at least somewhat recognizable.
But if the line is arbitrary, its fundamental purpose is not. Decisions like Sebelius’s reinforce the notion that the young teen is not yet an adult, a distinction undermined by a chronically hyper-sexualized popular culture. A substantial minority of Americans, of course, would like to deny the morning-after pill to everyone, not just 12-year-olds. But for many of us, the operative issue is that a young teen is still a child, a creature with little self-awareness, limited understanding of the ways of the opposite sex, and, at best, erratic insight into likely future events.
And come to think of it, on that point there’s plenty of science.