The “Morning After” Pill: A Risk to Pediatric Patients

American College of Pediatricians – January 2010

The American College of Pediatricians strongly opposes adolescents’ over-the-counter (OTC) access to the “morning-after” pill (MAP), a form of emergency contraception. While no conclusive data yet exists, there is concern that ease of access to this drug may increase unprotected sexual activity among teens. This would logically increase the risk of contracting sexually transmitted infections (STI). MAP use can cause significant adverse effects such as heavy menstrual bleeding, irregular menstruation, and pelvic pain. It also interacts with a wide variety of drugs, a fact unlikely to be known by unsupervised users. 1,2 Under physician supervision, these effects are better managed, including the potentially dangerous possibility of MAP use with ectopic pregnancy. The long-term risk of breast and cervical cancer with the use or overuse of this high-dose synthetic hormone (up to 15 ties that of oral contraceptives), is largely unknown. Lower-dose oral contraceptives are available only by prescription; the MAP deserves at the least the same physician oversight.

Furthermore, while the MAP is chemically different from the “abortion pill” (RU-486) and does not abort an embryo already implanted in the uterus, it can act as an abortifacient since it “may also prevent…attachment of a fertilized egg to the uterus (implantation).3,4 Therefore, by this mechanism, in can, in fact, terminate the life of a human child.

Society has long recognized that adolescents possess immature reasoning skills. This is why adolescents are not allowed to buy tobacco or alcohol products, to vote, or to consent to most medical procedures. Research has now documented that important decision-making areas of the human brain are not fully developed until the mid-twenties.5,6,7,8 Consequently, the College is concerned that adolescents may carelessly use the MAP as a routine form of birth-control at a time in their lives when they are less capable of dealing with the subsequent negative consequences. In a recent report9 that described adolescent attitudes regarding Plan B (one form of the MAP), the authors stated that, “Some (interviewed) participants felt that having more access to emergency contraception (EC) would cause teens to act promiscuously and irresponsibly…” and “Participants also acknowledged that over-the-counter availability might increase misuse of EC, with some youth taking EC without fully understanding the directions and the potential side effects.”

For the well-being of adolescents and the protection of human life, the College urges the FDA, Congress, and other policy makers to enact policy to halt the over-the-counter sale of the morning-after pill.

The Board of Directors Comment: This statement should in no way be interpreted as an
endorsement by the American College of Pediatricians of the “morning-after” pill.

January 1, 2004; Updated January 21, 2010

The American College of Pediatricians is a national medical association of licensed physicians and
healthcare professionals who specialize in the care of infants, children, and adolescents. The mission
of the College is to enable all children to reach their optimal, physical and emotional health and wellbeing.

A printable Adobe Acrobat (pdf) copy of this position is available by clicking here.

1. Levonorgestrel: Drug information in the package insert found at (accessed January 18, 2010).

2. Vasilakis C, Jick H, Melero-Montes M. Risk of idiopathic venous thromboembolism in users of progestagens alone. Lancet 1999;345:1610-11.

3. PDR Health. Prescription Drugs: Plan B
(accessed January 18, 2010).

4. Physicians Desk Reference. Edition 64. Montvale, NJ: PDR Network; 2009:3416.

5.Giedd JN. Structural magnetic resonance imaging of the adolescent brain. Ann NY Acad Sci 2004; 1021:77-81.

6. Thompson PM, Giedd JN, Woods RP, et al. Growth patterns in the developing brain detected by using continuum mechanical tensor maps Nature 2000; 404(6774):190-3 as quoted in NIH. Teenage brain: A work in progress: A brief overview of research into brain development during adolescence 2001. Publication No. 01-4929.

7. NIH. Teenage brain: A work in progress: A brief overview of research into brain development during adolescence 2001. Publication No. 01-4929.

8. Sowell ER, Thompson PM, Holmes CJ, et al. In vivo evidence for post-adolescent brain maturation in frontal and striatal regions.
Nature Neuroscience 1999; 2(10):859-61.

9. Johnson R, Montsine N, Nye AM, Cohall AT. There’s always Plan B: adolescent knowledge, attitudes and intention to use
emergency contraception. Contraception 2010; 81:128-132.