Of condoms, Clinton, Obama and McCain

Sex education regressed into the Dark Ages under Bush. Which candidate will now stand up for young persons' health?

Editor's note: Vital Signs by Dr. Parikh is a new Salon series on current issues in health and medicine.

By Rahul K. Parikh, M.D.

Read more: Health, Birth Control, Teenagers, Safe Sex, Life, Vital Signs

March 24, 2008 | According to the Centers for Disease Control and Prevention, almost two-thirds of female adolescents have had sex by the time they reach their senior year of high school. As a pediatrician, doing my job well means I talk with teens about their sex lives. In many cases, an adolescent will reveal she's sexually active and probably has had one to three partners. That means I'm testing them for sexually transmitted diseases, performing pelvic exams to make sure they don't have signs that can lead to cervical cancer later, and discussing and prescribing contraception -- abstinence, condoms, Plan B and birth control pills.

This kind of comprehensive approach to teen sex has been successful. Teens have been waiting longer to have sex, and teen pregnancy rates dropped by almost 30 percent between 1990 and 2000. If they are sexually active, teenage girls have reported having fewer partners and are more likely to use some form of contraception than in the past.

So it's been perplexing and frustrating to see that over the past eight years, the tide has shifted so drastically against adolescents. Since 2000, teens have faced a rise in abstinence-only education, hurdles to obtaining Plan B emergency contraception and a hike in the price of birth control pills. In a campaign season notable for so much youth participation, it's worth exploring which of the presidential candidates is standing up for this important age group.

Shortly after President Bush took office, he began pushing abstinence-only sex education, where teens learn that the only way to prevent STDs and pregnancy is to wait to have sex until they're married. If or when abstinence proponents do mention contraceptives, they greatly exaggerate their failure rates to scare teens into believing they are useless. Funding for abstinence programs has grown to around $180 million annually.

While Bush has been signing checks, doctors have spent the better part of his terms reviewing the science behind his dogma. According to the Longitudinal Study of Adolescent Health, the nation's largest study of teen behavior, kids who took abstinence vows kept them for just a little over one year. Worse, pledgers who failed at abstinence were less likely to use contraception when they had sex. Further, the study shows that in the past six years, the prevalence of STDs has been similar between pledgers and nonpledgers.

It doesn't get any better as we look at access to emergency contraception. In 2002, Plan B's maker applied to the Food and Drug Administration for approval to sell it over the counter, something that just about every medical organization in the country supported, based on sound science. Several studies have demonstrated that girls who have access to Plan B use it properly and do not change their safe-sex practices; that is, they still use condoms or oral contraceptives.

So it was good news in 2003 when an FDA panel overwhelmingly approved the idea. But when the decision reached the agency's highest levels, the FDA balked, bowing to political pressure from congressional Republicans and religious groups. Thankfully, the Democratic minority in Congress fought back, and in the end got what it wanted -- sort of.

In late 2006, Plan B was approved to be sold over the counter, but with two caveats. First, Plan B was approved only for women over age 18. Minors still need a prescription. Second, "over the counter" meant over the pharmacists' counter. Today, reports persist of pharmacists refusing to provide the drugs to customers, usually on religious grounds. One instance, in Texas, occurred after a woman who had been raped came to a pharmacy with a prescription from her doctor.

Finally, as if politicos were going for a hat trick, there was last summer's revelation that the price of oral contraceptives was going up for college students. Traditionally, Big Pharma has given campuses a break on the price of birth control pills. But the 2005 Deficit Reduction Act put an end to that, as the government cut drug reimbursements to pharmacies. Suddenly, an $8 to $12 charge for a month's worth of birth control spiked to between $30 and $50. That priced out a whole lot of young women from protecting themselves.

While a dreamy religious conservative might argue that the spike will also price teenage girls out of having sex, think again. Most first-person reports tell us that women's sex lives haven't changed. Now, however, they're having riskier sex, relying only on condoms or depending on Plan B as birth control, taking it after each episode of intercourse, something it's not approved for.

Next page: Comparing the three candidates