The Norplant Option

articles
Aug. 29 1996 3:30 AM

The Norplant Option

A sensible, humane alternative that wasn't even considered during the welfare-reform debate.

(Continued from Page 1)

Why Norplant? Because it requires no ongoing effort or supervision to be effective, and it can be discontinued only after some (rather small) effort. As such, Norplant is the only contraceptive the government could pay people to use with any hope of affecting those who aren't strongly motivated to either become pregnant or avoid pregnancy.

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How much good the Norplant option would do is debatable. But the arguments that it would do harm seem unpersuasive. Here's a quick review of possible objections, left and right:

Bribing poor women and girls to implant Norplant would coerce them into not having children, thus violating their rights to reproductive choice, like the one-child-per-family policy and coerced abortions in China.

To the contrary, a government offer of money is not coercion--and not even remotely comparable to what goes on in China. Existing benefits would not be reduced for anyone declining Norplant. This means that nobody who really wanted a child would be prevented from having one. To be sure, the government would be trying to influence reproductive choices. But the same is true of existing policies promoting free contraception, and of laws like the Hyde Amendment, which denies Medicaid funding for abortions--not to mention the still extant statutes making it a crime to commit statutory rape (sex with a consenting minor), fornication (premarital sex), and adultery.

In its groveling 1990 editorial apology, the Inquirer said: "Our critics countered that to dangle cash or some other benefit in front of a desperately poor woman is tantamount to coercion. They're right." No, they were wrong, and the Inquirer was right in its initial Norplant editorial, when it noted that women would be free to "change their minds at any point and become fertile again."

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"Many people," David Boldt, then-editor of the Inquirer's editorial page, noted in a subsequent commentary, "saw the editorial as part of an ongoing white conspiracy to carry out genocide of blacks in America."

This is pernicious nonsense, no matter how many people say it. The original Inquirer editorial unwittingly invited such smears by linking its Norplant proposal to race--specifically, to a report that nearly half the nation's black children are living in poverty. But nobody is proposing that race be a factor in any program promoting Norplant to welfare recipients, most of whom are white. Nobody is proposing to sterilize women or forbid them from having children. And while a disproportionate percentage of welfare mothers and children are black, black America, like white America, can only benefit from any program that rewards people for avoiding pregnancy unless and until they are old enough and self-supporting enough to provide decently for children.

Girls and women on Norplant may be at greater risk of contracting and spreading AIDS, because they will be less likely to demand that their sex partners use condoms.

A 1994 study reported in The New England Journal of Medicine found that Norplant had no effect on recipients' decisions whether to use condoms or visit doctors--and was 19 times as effective as the pill in preventing pregnancy. Any Norplant incentive program should include vigorous counseling about the need to use condoms against disease. But even now, how many women and girls are so much more afraid of pregnancy than of death that they use condoms solely to avoid the former, and would stop once on Norplant? Not many, I suspect.

Norplant itself may be unhealthy.

The possibility of serious long-term health damage from any relatively new contraceptive like Norplant must be taken seriously, and the risks should, of course, be fully disclosed to women considering using it. But no contraceptive is risk-free. And the available evidence indicates that the risks inherent in pregnancy and childbirth--and in abortion--are at least as great as the risks inherent in Norplant.

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