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What's left? Pill use dropped by nearly half in the decade since 1973, when the National Center for Health Statistics reported that 36.1% of married women between the ages of 15 and 44 preferred that method. This month the New England Journal of Medicine reported that the Pill does not increase the chance of breast cancer, even in many high-risk groups. The Journal concluded that the dangers are so small that "the vast majority of users will experience only the benefits." But many women are wary. The most popular birth control is now sterilization. One-third of sexually active women are either sterilized or have partners who are. Another choice is the sperm barrier, especially the condom. Its sales have increased dramatically, mainly because of the fear of sexually transmitted diseases, particularly AIDS and herpes. No longer hidden behind drugstore counters, condoms are openly displayed on self-service racks. The customers have changed too. Today women buy at least a third of all condoms, and they are not shy about asking their partners to use them. Says Deborah Agre of the Coalition for the Medical Rights of Women: "Women feel they can more legitimately ask, if not demand, that men take responsibility." Manufacturers of this vintage prophylactic have been quick to take note of shifting attitudes. Trojans has downplayed its helmet logo to emphasize mood scenes featuring romantic couples. Mentor and Lady Protex are new brands packaged specifically for women and sold next to tampons, sanitary pads and douches.
Birth-control specialists applaud the condom's effectiveness. Still, "it's like the horse and carriage," notes Dr. Harrith Hasson of the Society for the Advancement of Contraception. "It's a fine means of transportation, but if we had been satisfied to stop there, we would never have invented the car and the airplane." Unfortunately, research faces difficulties. Many companies have pulled back because of the cost of testing and the risk of suits. Federally funded research is down as well. Clinical tests of an NIH-developed implant system called Capronor stalled for more than a year because the company designated to study the device could not get insurance. Says Hasson: "We are rapidly becoming an underdeveloped nation in terms of contraception."
Indeed, several birth-control methods are available abroad but not in the U.S. Depo-Provera, an injectable contraceptive that prevents pregnancy for three months, is used in 86 countries. Ironically, it was created by the U.S.'s Upjohn Co., but it has repeatedly failed to win the approval of the Food and Drug Administration because of concern about side effects. Norplant, which releases a hormone for five years, is available in five nations. The implant was developed by scientists of the New York City-based Population Council and will be submitted to the FDA next year. But even if Norplant gains acceptance, it is unlikely that any American corporation will market it domestically because of the liability problems. If the U.S. wants newer, better contraceptives, consumers will have to change their attitudes, says Guttmacher's Lincoln. "The expectations in this country for perfection are unrealistic. There has never been a contraceptive device made that didn't have some risk."