Maybe it was a momentary lapse of judgment, a mistake, or even something she was forced into. The how and why are irrelevant. If a 14-year-old freshman in New York City has unprotected sex or her birth control fails, she also has a backup plan: The school nurse will give her the morning-after pill—at no cost and without notifying her parents.
It's part of a program called CATCH, or Connecting Adolescents to Comprehensive Health, designed to combat teen pregnancy in the nation's largest city. The program, quietly implemented in five NYC public schools in January 2011, now allows nurses at 13 high schools to distribute emergency contraceptives following unprotected sex or a contraceptive failure. Between 2011 and 2012, 567 students received Plan B, says Alexandra Waldhorn, deputy press secretary with the New York City Department of Health and Mental Hygiene. (Meanwhile, 580 students received the birth-control pill Reclipsin as part of the same program.)
Officials heard few complaints about CATCH until last month, when the New York Post published a piece with the headline "NYC Schools Give Out Morning-After Pills to Students—Without Telling Parents" splashed on the cover. An explosion of media coverage has since sparked a birth control battle: Is the campaign a smart way to prevent teen pregnancies? Or will it lead to careless behavior and perhaps more sexually transmitted infections?
"I think it's a really good idea," says Cora Breuner, a Seattle physician and member of an American Academy of Pediatrics (AAP) committee on teen health, who hopes to see schools nationwide implement similar programs. "Young girls, for whatever reason—whether it was a mistake, they thought they were protected and weren't—don't need to have their entire lives changed, possibly in a negative way." She adds that school nurses are "extremely qualified" to dispense Plan B, and that the pill brings few side effects. If taken within 72 hours of intercourse, research suggests it's both safe and effective.
That's why advocates believe CATCH will help lower pregnancy rates in New York City, where more than 7,000 young women become pregnant by age 17. Typically, 90 percent of those pregnancies are unplanned, and 64 percent are aborted. The 13 high schools where the program is being implemented were chosen because of a dearth of health services nearby, and because they serve a student population known to have a higher risk of pregnancy.
"We believe that our young peoples' health and safety come first, and that's why we support a program like CATCH," says Joan Malin, president and CEO of Planned Parenthood of New York City. "NYC's teen pregnancy rate still exceeds the national average. And it's 2.6 times higher in high-poverty neighborhoods than in other parts of the city."
Parents were alerted about CATCH before it started, and given the choice to opt out if they didn't want their children to receive the confidential services. Only 1 percent to 2 percent returned an opt-out form, Waldhorn says. "We made a major effort to inform parents through mail, student backpacks, freshman orientation, and parent-teacher meetings," she says. "And we waited four weeks after sending letters before beginning the service, to assure parents were informed and had time to respond."
Still, some critics say the schools should adopt an opt-in policy, rather than requiring parents to opt out. Even Breuner, who supports the program, acknowledges that it can be difficult to reach parents in low socioeconomic status areas. "Sadly, a lot of letters might not have made it to the address," she says. "It's very hard to figure out what's going on with the school—I get it. Loud and clear, if more schools do this, it's important to be completely transparent, because families need to know it's happening."
Another concern: Those who oppose the program worry that easy access to Plan B will encourage careless behavior; if students know a backup plan exists, why bother protecting themselves in the first place? But research suggests that's not the case. A 2005 American Academy of Pediatrics report, for example, concluded that "an increase in awareness and availability of emergency contraception to teens does not change reported rates of sexual activity or increase the frequency of unprotected intercourse." Breuner, who wrote an AAP policy statement on emergency contraception that will be published in December, adds: "No studies have shown that access to Plan B causes kids to be sexually active."