TOPICS FOR OUR TIMES : NORPLANT COERCION : AN OVERSTATED THREAT

The identification of the contraceptive implant Norplant as an agent of coercion has been unfortunate. While legislators in 13 states have proposed bills which would require Norplant acceptance as a condition of receiving welfare payments or would provide financial incentives to women on welfare for accepting the contraceptive none has been enacted into law. In addition early attempts by the judicial system to force use of Norplant (for example as a condition of probation) have abated and have been met with disapprobation. The public efforts to use Norplant in a coercive fashion caused concern about whether health care providers were exerting pressure upon women to accept the method. A study involving a sample of over 2000 low-income women in three large urban areas of the US who were choosing a contraceptive method (with an oversampling of those who choose Norplant) revealed that health care providers are not pressuring women to accept the method. Only three of the 45% who accepted Norplant felt any pressure. One choose sterilization and the other two reported that they had to return to the clinic a number of times before insertion. Women indicated that they choose Norplant because of convenience effectiveness and duration. Norplant acceptors had to make more clinic visits than oral contraceptive (OC) acceptors and received an average of 22 minutes more counseling than OC acceptors. Fears about coercion haunt all long-acting methods and have overshadowed the desires of many women who welcome such methods. A balance must be struck between prevention of coercion and guarantee of access.