Baltimore officials, facing an adolescent pregnancy rate among the country's highest, are organizing doctors and foundation officials to promote Norplant, the contraceptive that lasts five years.
Baltimore Health Commissioner Peter Beilenson has organized the Baltimore City Norplant Consortium and wants to target teen-agers, who use birth control erratically or not at all. The consortium is considering an advertising campaign and wants Norplant discussed in family-life classes in city schools.
Norplant, Dr. Beilenson said, is "virtually complete protection. It will cover them during their school years, which is what you want. We're hoping to change teens' attitudes -- without being coercive."
Norplant, Dr. Beilenson added, won't cause a quick drop in the number of unintended pregnancies among teen-agers. "I don't think it's a panacea," he said.
But if Norplant is used by 5 per cent to 10 percent of women who haven't been using birth control regularly, the impact will be significant.
Statewide, in 1990, about 35 of every 1,000 girls aged 15 to 17 gave birth.
In Baltimore, the rate was almost three times higher: about 97 of every 1,000 girls aged 15 to 17 gave birth. Many of those young mothers drop out of school and end up struggling in poverty.
Dr. Beilenson said the consortium of hospitals, private doctors and foundation officials was proceeding carefully, aware that it risks charges that it is trying to force Norplant on poor teen-agers.
That's a concern of the Abell Foundation, which has put about $400,000 this year into family-planning programs -- with about half that amount directed to buying Norplant for women who do not have medical insurance.
"The risk is that this has been seen as something aimed at low-income people," said Robert C. Embry Jr., the Abell Foundation president.
"This program is meant to give them the same options as everyone else has. But I don't think it should be seen as something to manipulate them," Mr. Embry said.
"Abell is very, very involved," Dr. Beilenson said. "They've funded almost everything in town having to do with Norplant."
The Abell Foundation is investing $20,000 in an 11-minute educational videotape that features Maryland women and men talking about Norplant and how it has affected their lives.
Deirdre Smith, an Abell Foundation consultant, said the tape will be available in clinic waiting rooms to help answer questions about Norplant for patients.
Wyeth-Ayerst Laboratories, Norplant's American marketer, provides an educational videotape. But Ms. Smith said that clinic officials felt "there was a need for a video for a wider audience. The women in the Wyeth video are stereotypically middle-class."
Available in the United States only since February 1991, Norplant has been gaining steadily in popularity, though it still trails the pill and other forms of contraception.
In Baltimore, an estimated 4,000 to 5,000 women are using Norplant. Nationally, the figure is about 500,000, according to Audrey Ashby, a Wyeth-Ayerst spokeswoman. Seventy-one percent are under 30 years old. About half are married. Forty-eight percent consulted a private doctor. The rest went to clinics, health-maintenance organizations and hospitals.
"It's on its way to becoming a mainstream contraceptive," Ms. Ashby said.
Norplant is contained in six matchstick-sized capsules that are inserted under the skin of a patient's arm, a procedure that takes 5 to 15 minutes. Over five years, the capsules steadily release a contraceptive. A patient who wants to become pregnant can have Norplant removed.
Considered safe and effective, Norplant is expensive, however. The capsules cost $350.
Doctors usually charge another fee for the insertion, and some doctors also require a physical or medical history -- which means another charge.
Some insurance companies and all Medicaid programs cover the cost. In Baltimore, the Abell Foundation's $200,000 is paying for Norplant for "gray-area women," who are not poor enough to qualify for state medical assistance but aren't wealthy enough to buy insurance.
Dr. Arista Garnes, Baltimore Health Department's director of reproductive health, said teen-agers are beginning to come into city clinics asking for Norplant. But, she said, she expects more will arrive once ads begin running in women's magazines.
In younger patients, she said, doctors worry about whether the girl really wants this contraceptive and is willing to put up with such possible side effects as irregular bleeding. "We've had several parents who have brought their young person in and said, 'I know she's going to be sexually active and I want you to put Norplant in.' And we refuse to do it, because we want there to be informed consent, not coercion."
At the Johns Hopkins Hospital, Dr. J. Courtland Robinson said teen-agers adjust well to Norplant, but it's unclear whether it will significantly lower the number of unplanned pregnancies.
Norplant may attract teen-agers who already are responsible enough to use other contraceptives; the question facing the consortium is whether teen-agers who have never used birth control can be interested in Norplant.
"Part of that group is a hard-core crowd" that doesn't even concern itself with contraception, Dr. Robinson said. "How we're going to impact that crowd is hard to say."
The consortium's effort is grounded in the reality that Baltimore has had a chronically high teen-age birth rate and that many adolescents ignore warnings about pregnancy.
Dr. Beilenson said the Norplant consortium should not be viewed as promoting sex for adolescents.
"This is only for the sexually active," he said.