New Choices for Women

November 07, 1992

"Pro choice" has been the great rallying cry for abortion rights, but in reality American women have had relatively few choices when it comes to reproductive freedom. In recent years, at least one promising new form of birth control has gotten tangled up in the abortion debate -- RU-486, the French pill that prevents a fertilized egg from implanting in the womb. But the greater dampening effect on the development and marketing of new contraceptives came after women won multimillion-dollar judgments for damages suffered from Dalkon Shields, a defective brand of IUD, or intra-uterine device. As a result, birth control choices that have long been available in other countries are only now gaining approval for the U.S. market.

The most recent of these is Depo Provera, an injectable drug that gives three months of birth control with each shot. Depo Provera has been used as a contraceptive for as long as 25 years in 90 other countries, but the Food and Drug Administration withheld approval until last month.

Depo Provera may not become the most popular method of birth control in this country, since it won't be the cheapest or the one with the fewest side-effects. But hundreds of thousands of U.S. women will use the drug, perhaps as many as the half-million now using Norplant, a contraceptive approved by the FDA in 1990. Norplant was the first new birth control method available to U.S. women in 30 years. It consists of six tubes the size of match-sticks implanted under the skin of the upper arm, providing contraceptive protection for five years. (By comparison, about 10 million U.S. women use the Pill, an oral contraceptive.)

No contraceptive is perfect; most represent trade-offs between effectiveness, convenience and side-effects such as weight gain or menstrual irregularity. That's why choice is important. With less than 1 percent failure rate, Depo Provera and Norplant are about as effective as contraceptives get.

But neither drug will suit every woman's needs. Norplant may be a good choice for a woman who does not want to get pregnant for five years and who can afford the cost -- between $400 and $700. That covers five years, but it's a heavy sum to pay all at once. For other women, a three-month shot of Depo Provera may be much more appropriate, and more affordable as well. And for millions of others, neither drug is desirable.

The point is simple: the more choices -- safe choices -- the better. That's what freedom is all about.

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