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Norplant's biggest advantage over other contraceptives is that it requires only one birth-control decision every five years. The method will be useful to young women who want to delay their first pregnancy and to older women who want a reversible alternative to sterilization, which is now the most common method of contraception in the U.S.
But the same advantages that recommend Norplant to many women also raise the specter of abuse. Some health experts fear that legislators and judges will try to use the method as a way of restricting the reproductive freedom of teenagers, drug users, convicted child abusers or even the mentally ill. Economist Isabel Sawhill at the Urban Institute, a Washington-based research organization, recently published a paper in which she suggested that all teenagers be encouraged to use Norplant at puberty. "The decision to have a child would become a conscious choice -- decoupled from the dictates of biology, hormones and peer pressure," she wrote.
Sawhill is not recommending the use of force, but some experts believe that coercion is an inevitable next step. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, points to a handful of cases in the past five years in which judges have tried to require women to take oral contraceptives or to force men to take drugs that lessen their sexual drive. "There are judges out there who will try to use Norplant," says Caplan. Others worry that some developing countries will force the contraceptive on women without their full consent in a misguided attempt to keep population growth down.
The controversy over Norplant highlights a general dissatisfaction with the state of contraception research in the U.S. Numerous other methods are being studied around the world, including a hormone-releasing IUD, a hormonal badge that is taped to the arm and releases a contraceptive through the skin, a female condom and a hormone-emitting vaginal ring, which a woman can insert and remove at will. The French abortion pill, RU-486, is being actively considered for approval in several other European countries but has not been approved in the U.S. Thanks in part to political skittishness about funding contraception in the U.S., American women still have a paltry array of birth- control choices. Many experts see this contraceptive gap as the chief reason why 3.5 million unwanted pregnancies still occur each year in the U.S. Policymakers are a long way from stopping that national tragedy, but the approval of Norplant may be a start.