The squeamish factor shadows Plan B debate

The squeamishness? I get it. If you’re a parent — or if you know anything about the judgment skills of teenagers — it’s not easy to imagine a 15-year-old walking into a drugstore and walking out with a powerful birth control drug.

But that’s precisely the reason Plan B needs to be available over the counter. Because talking to teens about sex isn’t easy, either.

It was a complicated week in the history of Plan B. A federal judge ruled the morning-after pill should be available to everyone, regardless of age. But the Obama administration plans to appeal. And last week, the FDA announced what looks like a compromise policy: It will allow over-the-counter Plan B sales to girls 15 and over, as long as they show ID.

So far, no one seems pleased. Public health advocates — who understand that contraception is always better than unplanned pregnancy — say the new policy won’t help girls in need. How many 15-year-olds do you know, they point out, who walk around with their passports?

Opponents, meanwhile, say a 15-year-old, who can’t get her ears pierced in a mall store without her parent’s signature, really shouldn’t be handling her sex life alone.

“We’re telling girls, ‘It’s OK, you don’t need to ask your mother, the pharmacist doesn’t have to ask any questions,’ ” Maureen Vacca, the director of public policy for the Massachusetts Family Institute, told me last week.

On many levels, she’s right, and she represents a common idea behind the opposition to Plan B for teens. It’s not simply a knee-jerk effort to control girls’ bodies. It’s more of a well-meaning wish for girls’ lives, a realization that they’d be better off if they could navigate the treacherous territory of sex with help from caring adults.

But not every teenager has that kind of support — particularly kids from at-risk homes, who face economic pressure and cultural barriers.

“The reality is we have young people who are not in families where that kind of connection exists,” said Patricia Quinn, executive director of the Massachusetts Alliance on Teen Pregnancy. “That just seems like a really unfair bargain to say, ‘Because the adults have failed, we are going to say this has to happen to you.’ ”

And affluent families can’t count on perfect communication, either. Tara Cousineau, a clinical psychologist from Milton who runs workshops for mothers and teen girls, had a conversation last week about Plan B with three 15-year-old girls while on their way to a suburban soccer game. She asked them if they talked to their mothers about sex. They didn’t. Not really. Not even her own daughter.

Maybe, Cousineau later told me by e-mail, that’s because girls from more affluent families face different sorts of pressures. They want their relationships with their mothers to be “good,” “safe,” drama-free. They’d rather lie or sneak around than risk being scolded or punished.

“Of course, many moms would be shocked and disappointed to find out their girls think or behave this way,” Cousineau told me. “How many moms say, ‘My daughter tells me everything’? Maybe everything but.”

This isn’t an indictment of parents. It’s a description of communications boundaries. Parents are squeamish. They’re competing with religion and pop culture. Their own parents weren’t always great models for talking about sex.

And they might, indeed, be shocked to know what their kids are doing. According to data collected in 2011 in the state’s Youth Risk Behavior Survey, about 25 percent of Massachusetts teenagers report having had sex before age 15. In Boston, that number is closer to 39 percent. And the city is battling a chlamydia epidemic.

So where does that leave teenagers? At the mercy of adults who don’t know them personally: judges, federal bureaucrats, school system policy makers. Plan B is only the beginning. In Boston, a collection of advocacy groups — along with City Councilor Ayanna Pressley — has been working for three years to develop a school wellness policy that would include comprehensive sex education, along with in-school health resource centers for students, in which condoms would be available, no questions asked.

It’s an uncomfortable, sensible, realistic policy. But progress has been slow. Squeamishness is a powerful force.