5 more city schools may offer Norplant Health chief proposes expansion

August 27, 1993|By Sandy Banisky | Sandy Banisky,Staff Writer

Baltimore's first-in-the-nation program offering the contraceptive Norplant in schools -- an idea that drew international attention and some local controversy -- should be expanded to five other high schools this fall, the city health commissioner says.

After reviewing the cases of the nine students who received Norplant at the Laurence Paquin School clinic from January through April, Dr. Peter Beilenson is asking Mayor Kurt L. Schmoke to expand the program to the other high schools that have clinics: Southern, Walbrook, Patterson, Dunbar and Southwestern.

There, Norplant, the five-year contraceptive, would be one in an array of products already available to students who come to the clinic for birth-control counseling.

High schools without full clinics and middle schools would not offer the contraceptive.

Mr. Schmoke, mindful of the fact that Baltimore has one of the country's highest adolescent pregnancy rates, supported the introduction of Norplant into the Paquin clinic last year. The mayor is on vacation and was not available for comment.

Dr. Beilenson says that city health classes will continue to stress abstinence. But sexually active teen-agers are urged to avoid unwanted pregnancies and disease by using birth control and condoms.

Teen-agers already can go to private doctors and public health clinics to ask for Norplant, six match-stick-sized capsules inserted under the skin of the arm to slowly release a contraceptive hormone over five years. But last fall, Dr. Beilenson decided to add Norplant to the contraceptives available at one public school -- Paquin, a school for students who are pregnant or have recently given birth.

The move apparently made Baltimore the first city in the nation to put Norplant in schools. That drew international attention -- and challenges from some local critics.

Most of the protesters contended that Norplant, used for nearly 30 years around the world but only for the past two in the United States, had not been adequately tested on African-American girls.

A group of East Baltimore ministers protested that the plan to offer Norplant appeared "genocidal," as most city school students are black.

Last night, the Rev. Melvin Tuggle, representing Clergy United for the Renewal of East Baltimore, said his group still objects to the use of Norplant and will appeal to the mayor and City Council members to block its availability in other schools.

"You already have Norplant in city health clinics," the minister said. "I do not object to a parent bringing a daughter to a city health clinic. But putting it in schools makes it too available. It sends the wrong message."

Second District Councilman Carl Stokes, one of the sternest critics of the plan when it was proposed last year, yesterday said of Dr. Beilenson's recommendation, "I'm not for it or against it. I think there's a lot of conversation with the community that needs go on before this is expanded."

But Dr. Beilenson said that a study of the students who have received Norplant in school so far should allay the concerns of critics.

The fact that only nine students who came to the clinic to ask for birth control chose Norplant "shows we weren't promoting it," Dr. Beilenson said. "It's just one of the options."

Paquin Principal Rosetta Stith agreed that "Norplant wasn't pushed here. It was just added to the menu."

Most students who asked for contraception still chose birth-control pills, and health counselors still stress abstinence as the perfect way to avoid pregnancy and disease, Dr. Beilenson and Dr. Stith said.

No students received Norplant without at least two counseling sessions, and all who receive it have monthly follow-up examinations, Dr. Beilenson added.

He said Norplant has been used by more than 3 million adolescents in other countries over the past three decades without any side effects different from those found in adult women. The most common side effect is irregular bleeding, which Norplant users are counseled to expect.

Though some of the students reported irregular bleeding, none reported any serious health problem and none asked to have Norplant removed, Dr. Beilenson said.

He added that health counselors also found the girls apparently are heeding warnings to require condom use to prevent disease.

Of the nine, two girls said they require condom use about as often as they did before Norplant, and seven said they now are more careful to require condoms. Dr. Beilenson said those reports from the patients might not be considered entirely reliable -- but they are substantiated by the fact that none of the Norplant users has contracted a sexually transmitted disease.

The students also had a parent, sibling or boyfriend with them when Norplant was inserted, he said. Counselors say that they urge students to tell a parent and that most girls follow the advice.

"My girls did not have a problem because it was school-based," Dr. Stith said. "Our girls didn't suffer anything. We have the records of these young women. We have their histories."

Dr. Beilenson said he will discuss the Norplant issue with parent-teacher groups, in school assemblies and with the health department's Community Health Advisory Group, a 30-member panel of city residents formed last spring to advise officials on neighborhood health problems.

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