It's a campaign believed to be unprecedented in its size and aggressiveness: New York City is dispensing the morning-after pill to girls as young as 14 at more than 50 public high schools, sometimes even before they have had sex.
The effort to combat teen pregnancy in the nation's largest city contrasts sharply with the views of politicians and school systems in more conservative parts of the country.
Valerie Huber, president of the National Abstinence Education Association in Washington, calls it "a terrible case once again of bigotry of low expectations" — presuming that teen girls will have sex anyway, and effectively endorsing that.
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But some doctors say more schools should follow New York's lead.
Emergency contraception is safe and effective "if you use it in a timely fashion. It provides relief or solace to a young woman or man who has made a mistake but doesn't want to have to live with that mistake for the rest of their lives," said Dr. Cora Breuner, a Seattle physician and member of an American Academy of Pediatrics' committee on teen health.
Plan B emergency contraception is about 90 percent effective at preventing pregnancy if taken within 72 hours after unprotected sex.
New York's program was phased in at health clinics at about 40 schools in the 1-million-student school system starting about four years ago. Since January 2011, it has expanded to 13 additional schools that don't have clinics. The little-known program was reported on Sunday by the New York Post.
Nurse practitioners or physicians dispense the pills, and parents can sign an opt-out form preventing their daughters from taking part. Only about 1 to 2 percent of parents have opted out, according to the city Health Department.
The program is seen as a way to reduce a startling number: More than 7,000 New York City girls ages 15 to 17 get pregnant each year. More than two-thirds of those pregnancies end in abortions.
"We are committed to trying new approaches ... to improve a situation that can have lifelong consequences," the Health Department said in a statement.
In the 2011-12 school year, 576 girls got the pills at the 13 added schools, said Deborah Kaplan, an assistant health commissioner.
Felicia Regina, Parent Association president at Port Richmond High on Staten Island, has two teens at the school, a junior and a senior, and said she has never heard any parents voice objections.
"I do think it's a good idea," she said. "The children nowadays are not going to abstain from sexual intercourse. How many unwed mothers do we need?"
But Mona Davids, president of the New York City Parents Union, a volunteer group, opposes the program. She has a daughter who attends Laguardia High, not among the schools where Plan B is available.
She said parents should have to sign an "opt-in" form granting permission for Plan B instead. "When your daughter has gone on a trip, didn't you have to sign that it's OK for her to go on a trip?" she said.
Davids said emergency contraceptive is too serious a drug to give without parents' permission: "They can't even give our kids aspirin or Motrin without informed consent. This is a chemical hormonal drug cocktail."
Anne Leary, a conservative blogger in Chicago whose children are in their 20s, also said the idea is ill-advised and undermines parents' authority. Her own children attended high school in a Chicago suburb and were not offered emergency contraception at school.
"These kids are under 16, which is the age for statutory rape in most states. I just think it's subsidizing and encouraging behavior that's probably not healthy for kids that age," Leary said.
New York City's schools already offer regular birth control pills and condoms, just as many other schools around the country do. But emergency contraception is especially controversial.
Many scientists say Plan B works by blocking ovulation or fertilization. But Plan B's label says it may also prevent a fertilized egg from implanting in the uterus, and conservative activists who believe life begins at conception contend it amounts to an abortion pill.
The American Academy of Pediatrics says Plan B does not cause abortion or encourage risky sex, and it has called for the sale of the morning-after pill over the counter to help prevent teen pregnancies.
Last year, however, the Obama administration blocked plans to put the pills on drugstore shelves, keeping them behind the pharmacy counter. The contraceptive requires a prescription for those under 17 but is available to older women without a prescription if they show pharmacists proof of age.
Opposition to making Plan B available over the counter came mostly from conservatives and religious groups who said such a step would promote underage sex.
At least one high school in a Los Angeles neighborhood with a high teen pregnancy rate also offers emergency contraception in a partnership with Planned Parenthood.
Teen pregnancies have declined in recent years nationwide, a trend attributed partly to increased use of birth control.
The most recent government figures show the rate was about 70 pregnancies per 1,000 girls ages 15 through 19 in 2008. New York City's rate was 82 per 1,000 girls that year, and dropped to 73 per 1,000 in 2010. Nationwide, about 43 percent of girls ages 15 to 19 have had sex.
Some students on their way Tuesday to New York's Fashion Industries High School said they knew emergency contraception was available there, while others did not.
Glenesha Fernandez, a ninth-grader, said her mother opted out. "I said 'OK, I don't care,'" Glenesha said.
Yerenia Aybar, another ninth-grader, said girls her age shouldn't get the pill. "It might make students think it's OK to have sex," she said.