Contraception: Freedom from Fear

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regularly: "We have some women who've been on the pills for eight years straight, and we can't get 'em off them—not even to take part in our study of a once-a-month injection."

National preferences and practices in birth control vary astonishingly, without regard to education or socioeconomic levels. The highly sophisticated Swedes are educated in contraception early, and get frequent reminders in slick magazine ads. In affluent, literate West Germany, the pills and lUDs are little used; abortions equal live births—every year, 1,000,000 of each. France forbids the importation of birth-control materials; only a few women in elite private clubs pour le planning familial enjoy their benefits; again, abortion is rampant, as it is in Italy and an endless list of other, supposedly civilized nations. In most Iron Curtain countries, abortion is discouraged but permitted, and performed quickly and safely with a Soviet-invented vacuum suction device. Dr. Guttmacher calls abortion "the most severe pandemic disease in the world today."

Latin America counts 2,000,000 pill users, a remarkably large number considering its Roman Catholic heritage and low income levels. But that is still less than 5% of the fertile women. Among the masses, baby follows baby with such deadly rapidity that Colombian women crouch on the ground to abort themselves with sharp sticks. In Chile, the victims of bungled abortions occupy 20% of the beds in maternity wards, use up 27% of the transfusion blood. The situation became so serious that four years ago, with a high death rate among women who left five to ten orphans behind, the Catholic hierarchy tacitly agreed to look the other way while the government backed family planning. About one-sixth of Chile's fertile women now have lUDs or take the pills. Next week, partly in recognition of this progress, Chile will be host to the eighth world conference of the International Planned Parenthood Federation.

At the conference, talk will turn from what present contraceptives are achieving to new methods still in the experimental stage, which it is hoped will eventually surpass the pill in simplicity and effectiveness. Among them:

∙ THE MINIPILL. In what Manhattan's Dr. Elizabeth B. Connell calls "Harlem and other underdeveloped areas," carelessness in counting 20 days on and eight days off is as common as it is serious. Dr. Connell is experimenting with a one-every-day "minipill." It consists of chlormadinone acetate, a synthetic that resembles progesterone and works in much the same way, but in doses only a quarter or half as big as those in even the smallest of the usual pills. Menstrual periods arrive regularly after a few months. The unwanted pregnancy rate is less than 2%, and a woman, knowing that she has to take the pill every day of the year, can forget about counting days.

∙ INJECTIONS. A progesterone derivative, the Upjohn Co.'s Depo-Provera, has had FDA approval for six years as a treatment for disorders of the lining of the uterus. Its use as a contraceptive is still limited in the U.S. to experimentation by researchers. The dose, injected into a muscle and slowly released into the system, can be adjusted so that women might need an injection only once a month, or every three or six months.

∙ IMPLANTS. A year's supply, or 20

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