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The Use and Abuse of Norplant

By Allen C. Soong

Last summer, environmentalists discovered that beavers were proliferating out of control. According to Wildlife 2000, a Colorado environmental group, the beaver population may have reached 12 million, owing to the declining popularity of hunting and fur coats.

What would you guess they proposed? Allowing hunters to kill off some of their numbers? Encouraging furriers to use more beaver pelt? Of course not.

They decided to start fitting female beavers with the contraceptive Norplant, in the hopes that the beaver population would stabilize and then return to normal levels. It's already been tried successfully on skunks, and veterinarians in Montana are optimistic about the chances for similar results with the beavers.

Norplant, approved in December of 1990, has quickly become a popular form of birth control among humans as well. Only 100,000 women had the surgically implanted contraceptive inserted last year, but today the Norplant users total over 500,000--not including beavers and skunks. Norplant is highly effective, cheap, and easy; insertion of the device takes less than 10 minutes. In fact, Medicaid covers it in every state.

Norplant consists of six matchstick-sized capsules that, when inserted under the skin of a woman's arm between her armpit and her elbow, begin releasing small amounts of progestin, a hormone that blocks ovulation. The implant is effective within 24 hours of insertion for a period of five years with a success rate of 99.8%. Norplant is also cheap at about $500 for the capsules, insertion, and removal. By comparison, purchasing birth control pills over the same period would cost $900. Once Norplant is removed, fertility is restored. Not even stitches are necessary.

The cost-effectiveness and almost fool-proof nature of Norplant has attracted the attention of public officials, who are interested in lowering the pregnancy rate of individuals who rely heavily on public assistance or are likely to be unfit parents. Children born to criminal or drug-dependent parents are statistically at high risk of becoming costly burdens to society as well.

In Baltimore, public health officials, faced with one of the highest teenage pregnancy rates in the nation, decided in December to add Norplant to the existing contraception program in the school health clinics. Female students there welcomed the introduction of Norplant into school clinics, since it will boost their chances of finishing school with out worrying about getting pregnant. According to the latest statistics, 1 in 10 Baltimore girls 15-17 gave birth in 1990.

But the most controversial application of Norplant is its introduction into the welfare system. Last month Maryland Governor William D. Schaefer announced that his administration is exploring ways of employing Norplant to reduce the number of children being born into poverty in that state. He even went so far as to say that his staff would look at requiring a woman to get Norplant if she is on welfare and already has a number of illegitimate children.

The ends stated by Schaefer and other concerned officials are indisputably desirable; a smaller underclass, which means less suffering in general and less burden to the state. But using Norplant as a means of social control is at the least questionable and at most conjures up a nightmarish Orwellian scenario.

Government-sponsored voluntary use of Norplant by welfare mothers does not deviate from current policy and is opposed only by the most fundamentally pro-life. It is government- sponsored required use, however, that could be a violation of reproductive rights. Such a policy might also be considered racist as it might have also be considered racist as it might have a disproportionate effect on Black Americans. Nearly half of the Black children in America are living in poverty and would thus be the indirect target of Norplant population control.

Norplant, then, presents us with a chance to finally break the vicious cycle of poverty, but at the cost of perhaps infringing upon fundamental rights and raising the issue of eugenics. It is paternalism at its most extreme.

Polls have shown that public support is greater for offering cash incentives to these women than for actually making a Norplant a condition for receiving benefits. In 1991 Louisiana state representative David Duke proposed paying welfare mothers to take advantage of state-subsidized Norplant.

But just what kind of a choice is that? When women are desperate for money to help raise their children, the carrot of increased benefits for using Norplant becomes a stick, and choice becomes coercion, even extortion.

Legally speaking, court-ordered use of Norplant violates a person's right to refuse medical treatment and to reproduce, and in criminal cases may violate the Eighth Amendment prohibition on cruel and unusual punishment. The Supreme Court has long ruled that a state may infringe upon individual rights to serve a "compelling interest," but to require use of Norplant might constitute discrimination. Intent is irrelevant. If there is an adverse "prima facie" statistical effect on minorities the policy in question could be considered discriminatory, as has been upheld in court with some hiring policies.

On the other hand, efforts to improve the quality of life for welfare children, who are often stuck with drug-addicted and abusive parents, have been only marginally effective. Many welfare mothers fail to take advantage of free contraceptive programs. Above all, welfare mothers with more than one child are almost sure to remain on some form of public assistance for the remainder of their lives.

The apparent impotence of current programs in the face of the face of the problems of the underclass is what makes Norplant's use-- required or with incentives--so tempting. No one who seriously cares about the plight of the poor can assail the short-term logic of resorting to Norplant. But it is based on a false premise: merely reducing the number of children born into poverty or other adverse living conditions does not in itself remove the condition and is thus an overly simplistic method of dealing with the current crisis.

If, however, we look at Norplant as providing a fresh start for welfare women overwhelmed by the burdens of mother-hood, the positive benefits might outweigh the authoritarian aura that surrounds the government-sponsored use of Norplant. If we could assist mothers by packaging the insertion of Norplant with a program of education, counseling, and periodic medical checkups, if we could convince them to accept Norplant voluntarily, we just might be able to help them turn their lives around. This should be done, not with cash incentives that would increase their dependency on welfare, but with non-financial aid that would help them and future aid that would help them and future generations get off the welfare rolls.

But these are big ifs. This would require a dramatic shift in the orientation that we apply to most welfare programs, which attack the symptoms and not the virus. We cannot dismiss out of hand the opportunity Norplant presents, but neither can we ignore the challenge. The consequences could be ruinous if we do not prove up to it.

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