An open letter to her pediatrician on the occasion of my daughter, 15, being denied Emergency Contraception

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Dear Pediatrician:

On Monday my daughter, who is 15 years old, came in to your office for a prescription for Emergency Contraception (EC) and was denied.  She was actually subjected to 20 minutes of “scary and abrasive interrogation” (her words) and then denied.

Perhaps your office has never given any serious thought to this issue before.  Since pediatrics is also designed to serve adolescents, how could this possibly be the case?

First, she was asked if her mother knew…to which she replied “yes.” In fact, I had made an appointment for the express purpose, besides routine vaccine, of getting this Rx.  She was told, repeatedly, that it would show up on her insurance.  Well, obviously.  While this is important info to be aware of, in case she was concerned with confidentiality, she was clearly already aware and unconcerned.  No luck in dissuading the child in this manner, she was then left alone for a good ten to fifteen minutes (“to think about my actions” -again, her words).

She was then told that they “could not give EC to just anyone.” Perhaps not.   But an under 17 female of childbearing age, who believes that she needs it, would seem to be the target population.  You did not seem to believe that having an EC Rx, in case of emergencies, was a justifiably good reason. It seems to me that a young person with the self-possession to know that it would be a good idea to take precautions, whether or not she is currently sexually active, should be encouraged, not shamed.

In addition, may I point out that teen girls are at the highest risk of sexual assault than any other group?  Perhaps you would prefer her to go to the ordeal of an ER visit if this ever were to happen? Also, teen girls are at the highest risk of any group of contraceptive failure.  It seemed that your staff was suggesting that she should come in again if this were the case.  At 15, she is not old enough to drive and accessing your office on her own, without a car, or an adult’s wherewithal to make an emergency visit, or perhaps being busy with school, is cruelly unrealistic.  Also, it is imperative that EC be taken ASAP after unprotected sex and that having immediate access is critical, especially for a young person.  Your office is apparently unaware that EC is most effective if taken in the first 12 hours because she was repeatedly told that she had up to 3 days to get it if she needed it.

Imagine that she had already had unprotected intercourse.  It is not unthinkable that a young person would say that she needed it “just in case,” when she in fact needed it immediately.  Young people are notoriously ashamed of their mistakes and unwilling to talk about sexual matters with adults, especially when those adults are “scary and abrasive.” (again, her words)

Assuming that she would be willing to talk to pediatric staff again about this issue, which is unlikely given her experience, she was told that she would need to come in to give a urine sample to get the Rx.  Whatever for?  As EC is not dangerous, and there are no contraindications, I can think of no medical reason for this.  This must have been a further attempt to discourage the child; what could you possibly need to check the child’s pee for?  They no longer even recommend checking for a pre-existing pregnancy, because it has no effect on pregnancy. Surely you know this.

She was also told that she could always get EC over the counter, to which she pointed out that no, she can’t until she is 17 (also shocking that pediatric staff might not know this) Also, it costs $50 OTC, which is not easily come by for a 15 year old.

So you panicked and clearly tried to dissuade her with misinformation. Perhaps you justified this decision by the idea that she could always get it on her own, but legally she cannot.  Also, think for just a moment how a teenager operates.   Do you think that after 20 minutes of shaming in her own pediatrician’s office, when she was just trying to be responsible, that she would be likely to try this again, anywhere, in an emergency?

Take a moment to imagine how you would feel treating a pregnant 15 year old that, just a few months earlier, had been denied by you the reproductive care that she has a legal and ethical right to?  How does that feel?

As an educator who works with adolescents, I am forever talking about being open and honest with their health care providers, and that they will not be judged or shamed. Imagine my horror that their worst fears are true.  The message that you are sending is that you cannot communicate with your health care providers for fear of being shamed, lied to, and then denied health care that you deserve.  It is no wonder that so many teens, and even many adults, are afraid to talk openly and honestly about issues of sexuality in a health care setting.  Perhaps if they just don’t talk about it, it isn’t happening?

My daughter is responsible, self-possessed, knowledgeable and has the full support of her informed parents.  Imagine if this were not the case.  Imagine if she were scared, misinformed, ashamed, intimidated and desperate.  Do you think that she would have been able to negotiate this conversation? No. Pediatrics should be giving every female teen an actual box of EC to take home in case of emergencies* and having a frank and non-judgmental talk about sex, safety and responsibility, setting up a climate of trust rather than denying the extremely rare teen that has the audacity to ask.  Maybe then we could begin to address the tragically high teen pregnancy rate in the U.S.

It is shocking to me that a pediatrician’s office is so ill-prepared to deal with adolescent issues.  If your general staff is unable or unwilling to do so, please refer them to someone who can. I ask you to seriously review your office policies to prevent something like this, or worse, from ever happening again.

Sincerely,

Megara Bell

*my eldest daughter’s pediatrician did just that, sent her home with a dose of Plan B.  Just imagine.  And this is why I could not have guessed that we would meet such resistance at Pediatric Health Care.

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