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The Norplant Contraceptive System: Uses, Abuses, and Welfare Payments
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10652 |
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Section : |
MODERN THOUGHT
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Date : |
7 / 1993 |
3,295 Words |
| Author
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Stephen G. Post
Stephen G. Post is assistant professor of medical humanities
at the Center for Biomedical Ethics, Case Western Reserve
University School of Medicine, Cleveland, Ohio. |
In 1990 the Food and Drug Administration approved the Norplant Contraceptive System for long-term use by women. Norplant consists of six thin, oblong capsules, each about an inch long. The capsules are surgically implanted under the skin of the inside upper arm in a fanlike pattern that is slightly visible to the eye in less than 20 percent of recipients. The procedure takes about fifteen minutes. Local anesthetic is sufficient to control pain. Levonorgestrel, a progestin that suppresses ovulation, is released into the bloodstream, providing a 99-percent effective contraceptive active within twenty-four hours and lasting for five years unless removed. Norplant-2 consists of two capsules and is effective for three years. Norplant is contraindicated for diabetics and those with acute liver dysfunction, heart disease, or hypertension. It is reversible: One week after removal, levonorgestrel is almost undetectable in the bloodstream and the woman regains full fertility.
It is certain that other long-acting contraceptives will be introduced in the future, some of them for use in men. Thus, the issue of how society might properly use these contraceptives will become more pointed in the future. Norplant is at the cutting edge of what promises to be a protracted social and ethical debate.
THE SOCIAL ISSUE
Norplant catches the attention of policymakers and judges because its effectiveness does not depend on the skill or attention of the user. Immediately after its approval, the Philadelphia Inquirer published an editorial heralding Norplant as a method of choice for reducing the size of the underclass through controlling the procreation of women on welfare ("Poverty and Norplant: Can Contraception Reduce the Underclass?" December 12, 1990). Critics claimed that the article was racially tainted; the newspaper issued a public apology. A Kansas legislator introduced a bill that would have allowed the state to pay women on welfare $500 to use Norplant and an additional $50 per year so long as they remain on it. Is it ethical to make basic welfare payments or special additional payments conditional on the recipient's use of a long-acting contraceptive that poses no serious health risk? Is it wrong to restrict the reproductive freedoms of those who are unable to provide for their children and who turn to welfare programs for support, thereby burdening society? Is it wrong to wave $500 bills as an elective inducement for women on welfare to not have children? Is this sort of inducement best thought of as coercive or as rehabilitative, allowing women the opportunity to reorganize their lives and escape poverty? If incentives are focused
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