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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."

Haunted by the memory of mass compulsory sterilizations in this country at the beginning of the century, some minority leaders suspect that attempts to promote long-acting contraceptives are really eugenics in disguise. One African-American minister in Baltimore has said that promoting Norplant to inner-city teen-agers is a form of genocide. The Tennessee legislator who sponsored Norplant incentive bills says a colleague compared him to Hitler.

"In minority neighborhoods," says Linda Gordon, professor of history at the University of Wisconsin at Madison and author of "Woman's Body, Woman's Right: Birth Control in America," "we're dealing with people who have good historical reason to be suspicious."

From the 1890s until the Holocaust of World War II, it was fashionable in the United States to believe that society needed to control population among "inferior" groups. "People assumed many qualities were hereditary which we now know not to be hereditary, such as criminality and insanity," Gordon says. "In the first third of this century, 27 states passed laws involving forcible sterilization of people labeled feeble-minded or criminally insane." Using these laws against minorities, immigrants and culturally deprived people as well, health providers sterilized more than 12,000 people.

Even in the 1970s, when attitudes had changed, several disturbing cases came to light of poor or minority women sterilized without their knowledge or consent. Gordon says it was common practice to threaten to take away a woman's welfare payments or to ask women on welfare to sign a sterilization consent form when they were in labor.

In 1978, federal guidelines were passed prohibiting consent during childbirth or an abortion and requiring informed consent, extensive counseling, a 30-day waiting period between consent and procedure and a ban on sterilization for those under 21.

Some health professionals argue that guidelines are needed to prevent abuse of Norplant. In California, the state Office of Family Planning has sent a sample Norplant consent form to all its clinics. While such guidelines do not prevent legislative and judicial actions, they help decrease the possibility of coercion if coupled with effective training of health-care personnel.

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WHETHER NORPLANT WILL remain popular is unclear, but it is certain that Norplant is only the beginning of a new era in reproductive control. The FDA has already approved a second long-acting contraceptive, Depo Provera, a progestin injection that lasts three to six months. It may be more popular than Norplant because of its lower upfront costs, but it has a serious drawback: No matter what side effects occur, it cannot be reversed; it must wear off.

A two-rod version of Norplant is also on the drawing board, as are biodegradable implants and vaginal rings (the latter already available in other countries), also with time-release hormones. Several morning-after methods are also being developed. One already available is Ovral; two tablets of high-dose estrogens are taken within 72 hours after sex, then again 12 hours later. The controversial French product, RU-486, which sloughs off eggs from the lining of the uterus, has been approved in China, France and Germany but is unlikely to be available in the United States soon because some consider it an abortifacient.

Further down the road, a non-hormonal anti-fertility vaccine will likely become available. And at least four new methods are being developed for men, including ultrasound treatment to prevent the growth of sperm and polymer injections that slow sperm motility for more than a year.

With widening choices, perhaps young women--and men--of the '90s will start to hear the "drums of prevention," says Rosetta Stith, principal of Laurence Paquin School for expectant or parenting adolescents in Baltimore. She believes that if we teach morality and self-esteem to toddlers, giving children character-building experiences, when they reach puberty they will understand the importance of delayed childbearing and the value of abstinence.

"A lot of young people don't have anything in their lives," says Julia Scott of the National Black Women's Health Project. "They need places to go for emotional support. They need a place to feel safe. In very depressed areas like the projects, they feel frightened every moment. They're trying to find some place to feel protected and loved--even if it's in a moment of sexual intimacy.

"There's not a pill or an implant that's going to solve the teen-age pregnancy problem," Rosetta Stith says. "That's going to come when this country decides to be committed to children."

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