How Others Interpret The Uses Of Norplant


New York. Dr. Sheldon Segal expected Norplant to generate a controversy sooner or later. It was the "sooner" that took him by surprise.

On the very morning the FDA approved the long-lasting contraceptive implant, Dr. Segal found himself in a taxi between television studios listening to someone on a radio talk show loudly proclaim that every girl should have it stuck in her arm at puberty. The cab driver uttered his full-throated agreement and the man who developed this new birth-control method shrank down into his seat: "That was Day One," Dr. Segal says.

On Day Two, the Philadelphia Inquirer published an editorial about Norplant saying that readers should "think about" Norplant as a tool in the fight against black poverty. The message, spiked with a volatile mix of race, class and contraception, kicked up a storm.

Dr. Segal sent off his own outraged letter-to-the-editor. But before it was published, the story struck again. A California judge ordered a convicted child-abuser to use Norplant as part of her sentence.

The contraceptive wasn't even on the market yet.

Sitting in his office at the Rockefeller Foundation, he shakes his head at all this. "We created a method to enhance reproductive freedom and people keep finding ways to use it for the opposite purpose."

It took 24 years to develop, test and approve an implantable device that can prevent pregnancy for as long as five years. It took less than two weeks for Norplant to be billed as a new method of coercion.

Yes, the team that worked on Norplant had been concerned that a government would misuse the device to enforce birth control. But frankly, they were worrying about China, not California.

Now the story has moved to Kansas. Last week, the legislature held hearings on a bill that would pay welfare mothers $500 to get the implant. It would also pay for the Norplant, plus an annual checkup and a $50 check a year.

Under the bill, the state would offer an incentive to one class of women -- poor, single mothers on welfare -- for one kind of birth control -- Norplant.

The man who came up with this idea, Kerry Patrick, a Kansas state representative, describes himself as "a pro-life Republican Presbyterian." He defends this bill as a way "to encourage people to engage in a certain type of behavior."

At the same time, he figures to save the state the $205,000 it costs for each child on welfare from birth to adulthood.

An incentive plan is not as coercive as a sentencing plan. We use incentives all the time. As Dr. Segal says, "It's the way we get people to join the army, buy a Chevrolet, give to charity."

Other governments attempt to influence the decisions families make about fertility all the time. In France, they give bonuses for each baby. In India, they offer "expense money" to citizens who get sterilized.

The Kansas offer of $500 plus free birth control may sound like a good deal for a poor woman who wants Norplant. But "the line between incentive and coercion gets very fuzzy," says Dr. Segal.

The $500 bonus can be a heavy government hand on the scales of choice for the poor. Dr. Segal worries that "when you single out a welfare mother, wave a $500 bill in front of her face and say that the government is going to induce you not to have children, you've gotten into a risky area, ethically and morally."

There is another uncomfortable message emanating from that "risky area." More than 1 million women in the world from Thailand to Sweden already use Norplant. The simple, effective device offers women, especially those in Third World countries, the liberating possibility of planning their families, often for the first time. But in America the first reactions are not about expanding possibilities.

Norplant has been most publicly and ardently taken up by those who want to cap social problems by getting a lock on the womb. It is tempting policy makers, from California to Kansas, who distrust women -- especially poor mothers. They prefer an old fix in a new form: controlling women.

There is a profound gap between the promise of birth control and the threat of woman control. It's more than a $500 difference.

Ellen Goodman is a national syndicated columnist.

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