Nearly a year after the Food and Drug Administration approved Norplant, the contraceptive that works for as long as five years after it is implanted in a woman's upper arm, public health officials and family-planning clinics say the device works well and is on its way to wide usage.
State public health officials say the demand for Norplant at subsidized family-planning clinics is so large that it is impossible to keep up with.
"We've done 1,200 insertions, and we have waiting lists all over for the next 800 we ordered," said Carla Schmidt of the Florida Family Health Service.
In every state except California and Massachusetts, Medicaid now covers the cost of the device for poor women. And some health experts predict that Norplant will become immensely popular as more women become aware of it.
"I think it's going to skyrocket," said Alexander Sanger, president of Planned Parenthood of New York City.
Many private gynecologists, however, seem less certain that the use of Norplant will be widespread. The price is a real obstacle for many women, they say, since many insurance policies do not cover contraceptives.
Birth-control pills cost $15 to $30 a month. It costs $350 for the hTC Norplant device, plus $150 to $650 to the person who insertsit.
Another shadow is clouding the early optimism about Norplant.
Some public health groups and women's advocates worry that the contraceptive could easily become an instrument of social control, forced on poor women and others whose fertility is seen as more of a threat to society than a blessing.
"I feel more of these coercive laws coming, because they have a lot of appeal to some legislators," said Julie Mertus, a lawyer with the American Civil Liberties Union's Reproductive Freedom Project.
About 100,000 American women have received Norplant, less than 1 percent of the number who take daily birth-control pills.
Many women who use Norplant say the insertion was surprisingly easy, and the method surprisingly liberating.
". . . For about a month, I worried about bumping it, but now I forget about it. It's great not to have to take the pill. Two of my friends have gotten Norplant after seeing how good it's been," said Eileen Kotecki, 27, a Baltimore woman who switched from oral contraceptives to Norplant last spring.