An Anne Arundel medical team is training doctors and nurses from across the state to properly administer the new Norplant birth control device at public health clinics.
Dr. Leland Spencer and Sandra Reinhard, who run the county Health Department's family planning services, are teaching public health workers and some private physicians about the contraceptive method, which was approved just six months ago.
State health officials, who want to make the birth control optionwidely available, chose the county as a training site in part because Spencer was one of the first physicians to learn how to insert the Norplant device. The other training center is in Baltimore.
The birth control method involves injecting six flexible, toothpick-shaped capsules under the skin of the woman's upper arm. The capsules continually release a contraceptive hormone into the bloodstream for five years.
Twenty-two women have had the devices inserted since Anne Arundel County began its weekly training sessions in April. All the recipients have been over age 20, and most already had at least one child, Spencer said.
"A lot of them had trouble with other birth control methods," he said. "They wanted to space out their children over acouple of years and were looking for a longer-term method."
Womenfrom as far away as the Eastern Shore have driven to Annapolis to get Norplant because only a few public health clinics are offering the devices so far. Anne Arundel's 11 family planning centers eventually will provide the contraceptive, but now refer women interested in Norplant to the Health Department's headquarters on Riva Road.
Spencer and Reinhard run weekly sessions there to teach nurses and doctors the pros and cons of Norplant, along with the 10-minute insertion procedure. The biggest benefit of the device is that it lasts five years, but fertility can be restored within 24 hours after the capsules are withdrawn. The worst side effect is irregular menstrual cycles.
For many women, the biggest drawback has been the stiff price. The kit alone costs $350. With counseling, a gynecological exam and follow-up visits, the device runs $595 at Planned Parenthood and up to $800 at some private doctor's offices.
Two months ago, state officials announced they would use a $93,000 grant from the Abell Foundation tohelp cover the cost for women who don't qualify for Medicaid but whocannot afford to pay for the Norplant devices.
Public health centers will offer the contraceptive for free, either through Medicaid orthe grant, but will charge related fees -- for such services as office visits and counseling -- based on ability to pay.
While Baltimore officials have suggested giving the devices to teen-age women who often don't use birth control, Anne Arundel doctors stressed that Norplant is only one option.
"When you come in, you get the whole gamut of choices," Reinhard said. "The patient and clinician go over them and then decide together. Norplant is just one of six birth-controlmethods that might be appropriate."
Teen-agers will be counseled about different birth-control op
tions and can then choose Norplant. Parental consent is not needed under Maryland law.
Some public health workers have said the device would be ideal for young, sexually active women who forget to regularly take birth control pills. The Governor's Council on Adolescent Pregnancy plans to issue a statementon Norplant in July, spokeswoman Erlene Wilson said.