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.
About 100,000 American women have received Norplant, less than 1 percent of the number who take daily birth-control pills. But more than 25,000 doctors and nurses have been trained to perform the 10-minute insertion procedure, in which six matchstick-size capsules are placed under the skin through a small incision.
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. "It has the potential to be the method of choice, because you don't have to remember to take a pill, and it's easily reversible."
Norplant is attractive to many women not only because it has a lower failure rate than any other form of contraception, but also because it avoids the safety concerns that accompany most new forms of contraception.
Both the drug and the capsule material used in Norplant have been on the market for years. The drug, progestin, is available in oral contraceptives and the capsule material is in surgical use. But there are two shadows clouding the early optimism about Norplant. One is the specter that the device could all too easily become an instrument of coercion whose use is forced on poor women, criminals or women with AIDS. The other is the high initial cost: $350 for the device, plus $150 to $650 to the person who inserts it.
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. "This is a good method, it's making women very happy, and I think it's going to be very popular.
Wyeth-Ayerst Laboratories, the American Home Products Corp. division that manufactures and distributes Norplant, will not release its market projections but says that sales are running ahead of expectations.
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.
"I was really disappointed to find that my insurance won't pay for Norplant, since they would have to pay my maternity costs if I did get pregnant," said Zobeida Franco, a Bronx woman who is planning to get Norplant. "I'm going to try to find a way to pay for it anyway. I have a busy schedule and three kids and sometimes I forget about the pill, so I want something I don't have to worry about."
Many women who use Norplant say the insertion was surprisingly easy, and the method surprisingly liberating.
"I was very nervous, because I hate needles, but the whole procedure took nine minutes, and it was fine," said Eileen Kotecki, a 27-year-old Baltimore woman who switched from oral contraceptives to Norplant last spring.
"They use what looks like a big ball point pen to shoot the capsules in, and my arm was about as sore the next day as if I had worked out too much. 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."
Ms. Kotecki said that another of her initial fears, that the Norplant would be visible, had also proved unfounded. "I didn't like the idea that I'd be sailing or something, and people would see it and say, 'Check her out, she's got Norplant,' " Ms. Kotecki said. "But you can't see it at all unless I squeeze my arm."
Because Norplant lasts so long, and requires nothing from the user after it is inserted, it was widely hailed as a breakthrough in contraception when it was approved by the Food and Drug Administration on Dec. 10, 1990.
But the same qualities that make Norplant a boon to women may be a two-edged sword: 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.
For unlike other contraceptive methods, the presence of Norplant could easily be monitored by a parole officer or welfare official, anxious to prevent further pregnancies.
The Philadelphia Inquirer, in an editorial last December, suggested that welfare mothers be offered incentives to use Norplant, but it apologized for the editorial and its racist overtones after protests from people inside and outside the paper.