Norplant: A New Contraceptive with the Potential for Abuse

Norplant is a new contraceptive that became commercially available in the United States in February, 1991, after its approval by the Food and Drug Administration. Norplant consists of six matchstick-size silicone capsules that are inserted in a woman's upper arm. The capsules release small amounts of progestin over five years and must be inserted and removed by a trained medical professional. Norplant is an extremely effective contraceptive. Women using the drug have an annual pregnancy rate of less than 1% over a five-year period.

A majority of women using Norplant experience some side effects, such as irregular bleeding and other menstrual changes, headaches, weight changes, and acne. Norplant poses particular health risks for women who are overweight, who smoke, or who have diabetes or heart or circulation problems. 

What Is Norplant's Effect On Reproductive Freedom?

The development of new methods of contraception enhances the reproductive freedom of women and men. Because not every contraceptive will suit a given individual's particular health needs or life circumstances, it is important to have available a range of safe and effective contraceptive options. 

But this new method of birth control has also been a vehicle for infringing on the reproductive autonomy of women. Almost immediately after the FDA approved Norplant at the end of 1990, judges and legislators attempted to mandate its use by certain individual women or groups of women. Because it works automatically, is easily monitored, and cannot be removed without medical assistance, Norplant can be used more readily than other contraceptives to control women's reproduction. 

How Has The Government Attempted To Use Norplant Coercively?

In several states, judges have given women convicted of child abuse or drug use during pregnancy a "choice" between using Norplant or serving time in jail. In 1991, 1992, and 1993, legislators in more than a dozen states introduced measures that, had they passed, would have coerced women to use Norplant. Some of these bills would have offered financial incentives to women on welfare to induce them to use Norplant. Other legislation would have required women receiving public assistance either to use Norplant or lose their benefits. Some bills would have forced women convicted of child abuse or drug use during pregnancy to have Norplant implanted.

What Is Wrong With Using Norplant As A Condition Of Sentencing Or Welfare Benefits?

Offering a "choice" between prison and forced contraception is unconstitutional. Such a choice violates the fundamental constitutional right to reproductive autonomy and bodily integrity by interfering with the intimate decision of whether and when to bear a child and by imposing an intrusive medical procedure on individuals who are not in a position to reject it. 

Attempts to require or encourage women on welfare to use Norplant also violate the constitutional right to reproductive and bodily autonomy. The incentive plans, while not couched as requirements, are nonetheless coercive. Particularly for low-income women, the offer of money to feed, clothe, and house their families--even if it is in exchange for giving up their constitutional rights--may be difficult to refuse.

In both the judicial and legislative schemes to manipulate women into using Norplant, some women would be forced or induced to take Norplant even when it posed a danger to their health. Moreover, allowing judges and legislators to control the reproduction of some women would legitimize the role of government as an overseer of women's childbearing capacity in general.

What Attitudes Underlie Norplant's Proposed Use As A Condition Of Government Benefits Or Sentencing?

Mandating or proposing the use of long-term contraception as a "cure" for poverty is premised on and reinforces misperceptions about women in poverty. Such policies are motivated by erroneous notions that women on welfare have children indiscriminately and remain on welfare indefinitely. In fact, the average number of children in a family on welfare is 1.9 (a figure no larger than that for the general population), and in 1990 the median period for receipt of Aid to Families with Dependent Children was 23 months. 

Nor does mandated Norplant use really address the problems of drug use or child abuse. A woman's use of Norplant prevents conception; it does not stop her from taking drugs or abusing her children. The solution to these problems is not forced contraception but adequate drug treatment and social services to prevent and address family violence. 

Have The Coerced Uses Of Norplant Been Discriminatory?

The recent Norplant sentencing requirements and legislative proposals single out women as those responsible for birth control and pregnancy. Men are not punished for child abuse or substance dependency with vasectomies or mandatory birth control. Nor are vasectomies often proposed as a condition of eligibility for initial or increased public assistance for men. 

The attempts to coerce the use of Norplant also discriminate against low-income women and women of color. The incentive plans target women on welfare, and the sentencing tactics have been disproportionately aimed at low-income women of color. These policies are reminiscent of the eugenics movement earlier this century which targeted low-income, non-English speaking women and women of color for forced sterilization. A mere two days after Norplant's approval by the FDA, the Philadelphia Inquirer ran an editorial headlined, "Poverty and Norplant--Can Contraception Reduce the Underclass?," which endorsed incentive plans. This country has a deplorable history of sterilization abuse of people of color and people with mental illnesses or disabilities. Laws have been developed in the last two decades to prevent such abuses. The recent attempts to coerce women to use Norplant represent a reversion to an era of overt racism and eugenics.

What Do Experts In Medicine And Law Advise Concerning Norplant?

The American Medical Association condemns the coerced use of Norplant in judicial sentencing or welfare programs. According to the AMA, such actions raise "serious questions about a person's fundamental right to refuse medical treatment, to be free of cruel and unusual punishment, and to procreate. . . . Society must be careful about taking shortcuts to save resources when constitutional rights are involved." 

The American Bar Association opposes "any state, federal, or territorial legislation or judicial action that requires a woman to use any method of contraception or sterilization, or to otherwise refrain from bearing children" as a penalty for conduct, a condition of probation or parole, or a condition for receiving public benefits. The ABA also opposes incentive plans.

Dr. Sheldon Segal, the originator of Norplant, has stated: "I am totally and unalterably opposed to the use of Norplant for any coercive or involuntary purpose. It was developed to improve reproductive freedom, not to restrict it. My colleagues and I worked on this innovation for decades because we respect human dignity and believe that women should be able to have the number of children they want, when they want to have them. Not just educated and well-to-do women, but all women."