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Last night I went to the pharmacy to see if I could pin down something that would speak to Abby's worry that Plan B might change teenage sexual behavior if/when it becomes available OTC to 17-year-olds. That would be the price. I knew the morning-after pill was expensive, and it's been my assumption that a contraceptive for which teenagers have to shell out a lot of money is not a contraceptive that is going to radically change teenage lifestyles. Turned out it is even more expensive than I thought: $49.50, according to the CVS pharmacist leaning discreetly toward me at the "consulting" alcove. "For a single dose?" I kept asking, my voice getting louder so that the man in the other alcove began to look alarmed. One might argue that the real danger of the morning-after-pill is that, at half the price of a pair of Uggs—OK, a third the price—teenagers won't use it at all. It's a little less expensive in some other stores, I think, but not much.
I've always thought Plan B is an important addition to the contraceptive array, because it does something no other pill or device does: contracept after the fact, rather than before. It's the only contraceptive that can stave off unintended pregnancy after a mishap has occurred, forestalling a lot of difficult decisions. This seems distinctive and invaluable—maybe especially for teenagers. The younger a girl is when she has sex, the more likely the sex is coercive rather than consensual, so younger teenagers might have particular need of this. If they can get that kind of money.
But I should also say that the pharmacist provided a gloss that might revive Abby's concerns. When I told her I was writing about girls younger than 18 having easier access, she said, "I think a lot of them are already getting it." She said she sees a number of males 18 and over buying it for their younger girlfriends, "sometimes more regularly than I would like." She thought it would be better if the girls got a prescription for the pill. When I voiced surprise that young men would pay $50 over and over for emergency contraception, she said maybe they were old enough that it didn't seem so much. I am way older than they are, and that sticker price certainly gives me pause. I think it would be interesting to report out how the price affects use.
As for Gardasil, like Megan I am bemused by the fact that sex educators and public health experts worry less about promiscuity among boys. In a way, boys have always seemed to me more vulnerable than girls. If a girl gets unintentionally pregnant, she, at least, has some control over the outcome. If a boy gets a girl unintentionally pregnant, he has none. I'm not saying he should have control, but the consequences, for him, are profound. Maybe that's why those 18-year-old boys are paying big bucks for those pills.
In answer to Jessica's question, I'm not sure whether Gardasil should be mandatory. I am not yet convinced that it should. I do have a problem making it mandatory too young. And I think that doctors who administer it should have some training in how to talk to the really still quite young children they are thinking about administering it to. As the parent of kids who have just recently survived their yearly dose of Family Life Education, I have always believed in erring on the side of too much information: When they come home looking shellshocked I listen, explain, correct, commiserate, whatever. But my frankness is nothing compared to the gory detail that one pediatrician went into when my daughter, who was barely older than 12, went for her last checkup. The doctor brought up the topic of Gardasil and when my daughter asked what it was, I was prepared to say simply that it is a shot that can prevent cervical cancer, which seemed to me, as her parent, really all she needed to know just then. But helpful Doc took this opportunity to go into an excruciating level of detail about genital warts, multiple sex partners, and how it would be good if you were always monogamous, but we all know how things work in reality, and my daughter's eyes kept getting bigger and more horrified, and I wanted to take one of those vaudeville crooks to TMI Doc's neck. I kept expecting the good doctor to add something like, "And then there are the nights when you get so drunk you don't even remember his name in the morning."
It's true that all these good innovations do have unforeseen consequences, in the case of Gardasil the possibility that young girls given the vaccine may end up scarred, in other ways, even as they're being protected. Their mothers, too.
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Jess, I'm glad you brought up the Gardasil news. I'm amazed (if not surprised) by how different the rhetoric surrounding boys getting it is. A while back, I wrote about the totally bizarre idea that an HPV vaccine for girls would somehow promote promiscuity. As you may remember, this was the conservative critique opponents of the HPV vaccine: Having one would turn girls into sluts, and even allowing your teen daughter to getone somehow besmirched her purity. Never mind that according to the National Cancer Institute nearly 3700 women die a year of cervical cancer, which sometimes develops from the HPV virus; implicit in the opponents' critique was the idea that it was only "loose" girls who got HPV. (And I guess they don't matter as much. Or, serves them right.)
What was so strange was how the conservative firestorm somehow ignited another kind of anxiety, one more typically associated with crunchy liberal types: namely, vaccine anxiety. When Gardasil began to be administered, there were widespread reports of group fainting fits among the girls who received it. And so even liberals began to wary about the drug. I can't help but feel that the liberal anxiety grew out of the conservative one, partly because teenage girls, so quick to internalize external cues, were picking up on the fact that this particular vaccine had...drama at the heart of it. Every vaccine produces a few adverse reactions in those to whom it's administered; but in this case, those adverse reactions were being magnified, it seems, by the reactions of parents primed to be nervous about the vaccine, and by suggestible teenage girls who (in some cases, at least) had more of a psychosomatic response than a purely physical one.
The libertarian in me at times resists the idea of making any vaccine mandatory. But this vaccine will save women's lives. Cancer is not pretty. And it would be awful if our collective squeamishness about female adolescent sexuality meant that this vaccine never became as effective as it could be. To me, the great irony is this: We have been trying to come up with vaccines for cancer for decades. We have spent millions of dollars doing so. Now we found one. And no one wants to use it. Is teen sexuality that scary?
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With all this talk about OTC birth control, we've ignored another recent story about reproductive health: the news that Merck is trying to peddle Gardasil, the HPV vaccine, to boys. According to the Washington Post, when Gardasil was initially recommended for girls as young as 9, the argument against it focused on promiscuity and whether or not the vaccine would encourage girls to have sex. "Now the vaccine's maker is trying to get approval to sell the vaccine for boys," according to the WaPo, "and the debate is focusing on something else entirely: Is it worth the money, and is it safe and effective enough?"
It makes sense to give boys the vaccine as long as its safe, as they are carriers of HPV even though it primarily affects women's health. However, Merck is also lobbying for Gardasil to become mandatory for school attendance for girls—something that gives conservative organizations like the Family Research Council palpitations. "We do not oppose the development or distribution of the vaccine," the FRC's Peter S. Sprigg tells the WaPo. "The only concern we have is about proposals to make vaccination mandatory for school attendance. It's a parental rights issue." So I ask you ladies, should the administration of the vaccine be left to the parents? Or is HPV a public health nuisance on the level of measles and should Gardasil be mandatory?
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