Much ado about Norplant

February 23, 1993

Two weeks ago, after the Baltimore City Council held a raucous hearing on the Health Department's plan to offer the contraceptive Norplant in school-based clinics, the department braced itself for an avalanche of outrage. There was none. The department got about 20 calls. Most came from women, both African-American and white, and all but one caller registered support for the plan. The lone dissenter, a male, was as concerned about contraceptives in general as about Norplant.

The lesson? An issue that brought politicians national attention when they raised concerns about "social engineering" and the spread of AIDS is simply not a big deal to the people of Baltimore. Maybe the people affected by the policy know more about Norplant -- and about the school-based health clinics -- than City Council members do.

More than other contraceptives, Norplant seems to stir deep-seated passions and fears. In one case -- the concern that, unlike a condom, Norplant provides no protection against AIDS or other sexually transmitted diseases -- the fear is based on fact. But the fact needs to be placed in context. In Baltimore's school-based health clinics, most girls who want a contraceptive choose the pill -- which also provides no protection against AIDS.

Less understandable is the charge that Norplant can be a tool of social engineering to discourage poor girls and women from having children. Norplant is easily removed -- and the Health Department has a policy of offering removal to any woman who is dissatisfied with the implant regardless of where she had it inserted.

Moreover, the implant releases such low dosages of hormones that once it is removed fertility returns within a week -- much faster than is the case with oral contraceptives. The implant has been used safely and effectively by millions of females of child-bearing age around the world. In Baltimore, it will be available only in high school clinics, not in middle schools.

Concerns about the school-based clinics offering Norplant without parental permission are groundless: No student can visit a school-based clinic, for any reason, without parental consent. True, once there, they can obtain contraceptives. But with advisory boards and parental involvement in setting clinic policy, the Health Department has taken care to see that the policies of these clinics don't take parents or community leaders by surprise.

Maybe Norplant's real problems are that it is new, it's convenient and it lasts five years. Certainly it is not ideal for everybody, but neither is any contraceptive. That's why it's important to offer choices -- informed choices that are not clouded by politics.

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