Reality check on Norplant

February 08, 1993

When a well-meaning governor raises the possibility of "requiring" welfare recipients to use the contraceptive implant Norplant or when City Council members raise fears that Norplant is a tool of "social engineering," it's time for a reality check.

Norplant is a convenient and effective contraceptive that has been used by almost 2 million women in 51 countries. Tomorrow, the City Council holds an informational hearing on Norplant. That's good, because the implant seems to be a lightning rod for controversy.

Like every contraceptive, Norplant is a choice, and should remain so. But because the cost in this country -- $365, plus an insertion fee -- is prohibitive for many women, it could easily be a choice only for affluent women.

The latest outcry stems from concern about the city health department's efforts to make Norplant available in the city's eight school-based health clinics. As yet, only one school -- Laurence Paquin School for girls who are pregnant or have given birth -- has Norplant available on site. Other clinics can refer girls elsewhere for Norplant. But counselors report that many adolescents are wary of some of Norplant's side effects, like unpredictable bleeding or weight gains. Most girls who choose contraceptives prefer the more familiar Pill (which, like Norplant, provides no protection against AIDS or other sexually transmitted diseases).

There are plenty of problems with suggesting that contraceptives be required of anyone. But the biggest one is that such schemes simply don't work. When people want to produce babies, they usually do it despite efforts to discourage fertility.

Fears of "social engineering" are unfounded. Baltimore's school-based health clinics provide girls and boys with health care they might not otherwise get. "Family planning" accounts for only 14 percent of the clinics' visits -- and that includes both boys and girls.

Every clinic stresses the advantages of sexual abstinence. That is an idea no one would seriously criticize. But in addition to health concerns, it reflects a societal value also evident in the governor's misguided suggestion -- that people should be encouraged not to produce children until they are able to fulfill their responsibilities as parents. That is as true for a 14-year-old as for a 24-year-old.

In any discussion of birth control, the most important word is choice. It is ironic that any effort to expand options for poor women and girls would be misinterpreted as an effort to coerce or to engineer choices. Sure, adolescents can be led astray. But they are also capable of exercising rational self-interest. That is exactly what clinic counselors try to help them do.

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