Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 3, 1991 TAG: 9102030313
SECTION: HORIZON PAGE: F-1 EDITION: METRO
SOURCE: By DEBORAH MESCE ASSOCIATED PRESS
DATELINE: LENGTH: Long
It could be an important new option for teen-agers notoriously negligent about contraception, for women who shouldn't take birth control pills because they're over 35 and smoke, for women finished with childbearing but still fertile, for child-abusing women who keep having children . . .
Whoa!
It's easy to see where the uses and what some would call abuses of Norplant could lead, especially because its 99 percent effectiveness rate makes it the most reliable method of birth control after sterilization.
Should drug abusers be forced to use it? How about child abusers, the mentally ill, prostitutes, women on welfare?
"The very properties that make it useful and attractive as a birth control option also make it tempting for judges and other authorities to coerce behavior that falls into the area of basic human rights," said Arthur Caplan, an ethicist at the University of Minnesota.
"We've seen sterilization abused and I'm fearful people might go down that road again," he said.
Norplant barely had been approved when the issue heated with an editorial in The Philadelphia Inquirer suggesting that women on welfare be encouraged to use it.
The newspaper later published an apology, saying its original opinion was "misguided and wrong-headed" for leaving the impression that poverty could be cured by reducing the number of black people. The paper said birth control should be a matter of choice.
Judges have previously ordered defendants to use birth control as part of their sentences. And observers predicted long ago that once Norplant was approved, a judge somewhere would sentence a defendant to use it.
Earlier this month, a California judge became the first to do that, setting off alarms among medical, legal and social policy experts.
"People have reproductive liberties in this country and we don't take that away from them," said Dr. Michael Grodin, a professor in Boston University's law, medicine and ethics program. "We just don't do that in this country."
The Food and Drug Administration approved Norplant on Dec. 10. Sixteen other countries already had approved it. Wyeth-Ayerst Laboratories, the manufacturer, said the implant was to be on the U.S. market this month.
When inserted on the underside of a woman's upper arm, the six silicone, matchstick-size rods slowly release a synthetic hormone that prevents pregnancy for up to five years. Its major side effect is irregular menstrual bleeding, which is disruptive enough that some women have the implant removed. When removed, fertility is restored, usually within days.
In the California case, a Tulare County Superior Court judge sentenced a convicted child-abuser, 27-year-old Darlene Johnson, to one year in jail and then three years on probation with the birth control implant.
Johnson, seven months pregnant with her fifth child, was convicted of beating her daughters, ages 4 and 6, with a belt, belt buckle and extension cord. Judge Howard Broadman said his sentence was appropriate because "this is a woman who beat the tar out of her children."
The group that developed Norplant, the New York-based Population Council, takes the position that Norplant should not be considered any differently from other birth control methods.
"Adoption of contraception should always be voluntary informed choice with the decision made by the client whether to use contraception, which method to use, when to use it and when to stop or try another," said George Zeidenstein, council president.
But, in fact, some do see Norplant as different from the other methods: it's long-acting; its use does not depend on a woman's behavior; it can't be forgotten, misplaced or used incorrectly. And unlike sterilization, which has a stormy legal history, Norplant is reversible.
"This is tricky stuff," said Doug Besharov, an American Enterprise Institute scholar, who can see benefits as well as liabilities when Norplant is used as a tool of the judicial system.
"One way to look at this is that Norplant will give women yet another option for birth control," he said. "So, too, will it give another option to women who are in trouble with the law. It might be a lot better than spending time in jail. It might be more humane. As long as you give the defendant a choice, it doesn't seem that bad."
But in the mind of Rachael Pine, staff counsel for the American Civil Liberties Union's Reproductive Freedom Project, a woman standing before a judge is in a coercive situation.
"I don't see any role for court-ordered medical decisions," even if the woman agrees to a Norplant sentence in a plea bargain, she said.
"It's a violation of someone's right to bodily integrity," she said. If that is allowed, she said, "then why not brain implants?"
She recalled times when poor women seeking abortions were coerced into sterilization by doctors who refused to do only the abortion since it wasn't covered by Medicaid and sterilization was.
Once exposed, coerced sterilization became less frequent and the procedure itself became more heavily regulated, she said, but "people are drawing from that history in looking ahead to Norplant."
Norplant may not be that far from sterilization, Caplan said. "A one-year implant today could become a lifetime implant later," depending on the whim of a judge.
"We at least ought to have some legislative and public discussion on what the options, alternatives and significance is of allowing the state to take away reproductive capacity as a form of punishment," he said.
by CNB