Rebel Girl: Who's in Control Here?

Catherine Sameh

LAST DECEMBER 10, the medical and feminist communities were abuzz with the arrival of “-awaited news. The newest contraceptive to hit the United States in thirty years had finally been approved by the Food and Drug Administration after twenty years of testing.

The device is called Norplant and consists of six matchstick-size capsules filled with the female hormone progestin. In a fifteen-minute procedure under local anesthesia, the capsules are implanted beneath the skin of the woman’s upper arm.

The device continually releases small doses of progestin into the woman’s bloodstream, protecting her against pregnancy. Once in place, Norplant can be removed only surgically and must come out after five years. It is estimated that by the end of this year its use throughout the United States will be commonplace. The cost $350-500.

Norplant has been hailed as the ‘dream method’ of birth control because it is procedurally easy and effective for so long, and because women (weighing less than 130 pounds) using it have no more than 3-5% chance of conceiving over the five-year period.

Like all “advances” in contraceptive technology, Norplant warrants careful scrutiny before we embrace it as a step forward for women. There are two questions we must ask. What are the dangers that Norplant will be used to coerce or abuse women—especially poor women and women of color? How safe is Norplant?

Norplant was developed by the Population Council, which has been providing it to Third World governments and family planning organizations at a low price since 198t In fact half a million women in seventeen countries already use Norplant It’s been promoted as wildly successful by population control programs because it is so easy: Norplant requires no ongoing healthcare, education or follow-up.

Two days after Norplant was approved, the Philadelphia Inquirer ran an editorial titled “Poverty and Norplant–Can Contraception Reduce the Underclass?” advocating that Black welfare mothers be offered incentives to take Norplant Demonstrators picketed the newspaper’s office and within two weeks the paper ran a refraction, admitting that cash benefits for certain kinds of reproductive procedures “is tantamount to coercion.”

In early January a county judge in California ordered that Darlene Johnson receive the implant for three years as a condition of probation. Johnson, a twenty-seven-year-old mother of four, had pleaded guilty to beating two of her children with a belt buckle. Instead of helping a woman who has admitted to abusing her children gain greater control over her life, the judge imposed an arbitrary ruling that has little to do with the charge against her. But the judge has set a precedent other women prisoners may soon face: bargain an early release by agreeing to an implant.

Given the history of how Native American, Latin American and African American, and Puerto Rican women have been subjected to sterilization, given low-income women’s reduced access to abortion, and given the rise of criminal prosecutions against pregnant women who are addicted to drugs or alcohol, Norplant can easily become yet another way women’s reproductive lives are regulated by the state.

Norplant is the only contraceptive that is externally visible all the time, especially in thin women. Once inserted the capsules look like little lumps in the shape of a fan. For those in the health, judicial and social work fields who would like to make sure that poor, young, drug addicted or developmentally disabled women won’t reproduce themselves, they need only look at or feel a woman’s arm to know what the next step should be. Already state agencies are implementing new rules that provide the up-front money for the procedure.

The most alarming aspect of Norplant use is that because of its five-year efficacy, yearly gynecological checkups are not required. Some promoters of Nor-plant are using this fact as a selling point.

Health Hazards

At a time when female reproductive cancers and pre-cancerous conditions are on the rise, this is quite disturbing. Furthermore, Norplant can cause irregular bleeding, also a symptom of cervical or endometrial cancer. Without yearly follow-up, the cause of such symptoms will go unanswered. Yet in testing, 15% of the women who fried Norplant had it removed because of bleeding problems.

In fact, Norplant is not a good option for women with liver disease, previous blood clots in their legs or abnormal bleeding, and is “best” for non-smokers and women with no personal or family history of heart disease or breast, uterine or ovarian cancer. Women with diabetes, high-blood pressure or anemia should be carefully monitored while on Norplant.

Although Norplant has been billed as “user-friendly,” i.e. easy to use, it actually robs the user of any control and could roll back the steps made by health workers, providers and educators to encourage condom use as protection against HIV and other sexually transmitted diseases and pregnancy.

The too-easiness of Norplant will likely also discourage young women from learning essential things about their bodies that other contraceptive measures encourage, and inhibit the healthy kind of dialogue about sexuality that they and their partners should have. In fact, Norplant is primarily aimed at women who are in a “mutually monogamous” relationship (meaning that each partner is sure there are no others).

Clearly all contraceptive options should be accessible to all women. Norplant included. But until the knowledge of their effects and control over their use, distribution and cost are in the hands of the women who use them, advances in contraceptive technology will have a double edge.

May-Jun 1991, ATC 32