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The DILEMMA of DESIRE

September 26, 1993|LYNN SMITH and NINA J. EASTON | Times staff writer Lynn Smith's last piece for this magazine was "Oh, Grow Up!"; magazine staff writer Nina J. Easton last wrote "L.A. and Other Fictions."

The first young woman smiles into the camera. "I love my Norplant," she says. "You don't have to worry about having a child for five years," the next says shyly. A third volunteers: "For me, I think Norplant is the ideal method."

Their inviting testimonials are part of a widely used educational video, made by the Emory University Summer Program in Family Planning and Human Sexuality, for women considering Norplant. The upbeat 18-minute presentation, distributed to sales representatives, doctors and family-planning clinics, notes accurately that Norplant is the most effective reversible contraceptive available and that it is brand new. A doctor explains some of the common side effects, but they're quickly counterbalanced by the young women, who say that the irregular bleeding and the weight gain didn't really bother them. The young women display their upper arms, where the six slim, inch-long rods containing synthetic hormones were implanted, and testify that the pain of the operation, if any, was easily diminished with Tylenol. They say their fathers and their boyfriends approve.

More girls come forward with the same cheerful message. "It doesn't hurt, there's nothing to worry about with it. It's simple, and it works real good," says a happy young woman. "A lot of teen-agers needed Norplant. I'm about the only girl in my neighborhood who doesn't have kids. . . . They need to get some (Norplant) so they can have fun and enjoy life while they be young. You got all your life to have kids."

As the tape is concluding, a white-haired doctor in a white coat pats the shoulder of a young African-American girl looking up at him from a chair. "So, what might you tell a young teen-age girl?" he asks her. "Get it!" she replies. He smiles to bystanders off camera.

The promise of Norplant as a foolproof, long-lasting contraceptive that requires little thought and works for almost everyone is so seductive, so longed-for, that the message has spread with amazing speed among young women and policy-makers since the Food and Drug Administration approved it for public use in December, 1990.

In less than two years, 13 state legislatures had proposed Norplant measures, nine of them requiring or inducing mothers on welfare or who abused drugs to be surgically implanted with the rods. Norplant's upfront costs are high--the distributor charges clinics and private physicians $365 to buy it, and paying patients can be charged more than $500. But within two years, despite the distributor's insistence that public agencies pay the same price as private physicians, despite a list of known and suspected health risks similar to those of birth-control pills and amid explosive charges of racism, all 50 states and the District of Columbia had approved Norplant as a birth-control method covered by Medicaid. In California, state officials say they plan to save more than $5 million in health and welfare costs by offering $5 million in Norplant subsidies to about 10,000 eligible women. Nationally, the independent, nonprofit Norplant Foundation has committed $2.8 million in 1994 (equal amounts were allotted in '92 and '93) to provide implants for low-income women not covered by Medicaid.

Now an estimated 780,000 women in the United States are assured they will not conceive because tubes continually pump synthetic hormones into their bodies, altering rhythms as ancient as the tides.

But along with the obvious relief expressed by many women, the new technology has brought complex and worrisome issues. Will the poorest of the poor feel forced or pressured into using a birth-control method they cannot then control? Is an implant appropriate for teen-agers? Will it make women less likely to protect themselves from sexually transmitted diseases? Is birth control an acceptable way for society to solve its seemingly intractable social problems?

*

SONDRA, A SECOND-GENERATION INNER-CITY WELFARE MOTHER, HAD her first baby at 15, her second a year later. Like her friends in the drug-ridden northeast Washington, D.C., neighborhood where she grew up, Sondra, now 17, can't really say why she didn't use birth control before. Now she sees how it is: Her boyfriend has departed, and she and her children are forced to live in an aging brick townhouse with her grandparents, two aunts and their four children. She cannot live with her own mother, who abuses both drugs and children.

"I don't want to be on welfare," she says. "I want to give my kids things. That's why kids go out and sell drugs. Because their parents can't afford to give them things."

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