TIME: Almanac 1993/TIME Almanac 1993.iso/time/022690/0226131.000

Text File | 1992-08-28 | 6.1 KB | 139 lines

                                                                                HEALTH, Page 44

A Bitter Pill to Swallow


Birth control in the U.S. is out of date -- and getting more so


    The dirty little secret about the birth-control "revolution"
is this: three decades after the introduction of the Pill, many
of the more than 57 million American women of childbearing age
are still unable to control their reproduction. The proof: about
six million unwanted pregnancies occur in the U.S. each year.
Not only are all the available methods of contraception
inconvenient, only partially effective or potentially risky, but
the array of devices to choose from is also getting smaller, not
larger. Some women must visit several doctors and spend hundreds
of dollars before finding the contraceptive that is best for
them. Others, especially teenagers, just avoid the hassle and
go unprotected. The situation is forcing men and women to make
painful choices -- to have abortions or be sterilized at an
early age.

    The dismal state of birth control in the U.S. was
highlighted last week in a study issued by the National Academy
of Sciences (NAS). The report states that American contraceptive
research has come to a virtual halt, causing the U.S. to fall
far behind other countries in developing new techniques. Methods
available overseas but not in the U.S. include an injection that
provides two months of protection and a skin implant that can
release a contraceptive hormone into the bloodstream for up to
five years.

    In Europe, which is years ahead of the U.S., pharmaceutical
companies are aggressively pursuing male birth-control pills,
reversible vasectomies and long-lasting vaccines. Even women in
many Third World nations have more choices than their American
counterparts. Observes Carl Djerassi, a Stanford chemist who
helped develop the first Pill: "The U.S. is the only country
other than Iran in which the birth-control clock has been set
backward."

    Part of the reason lies with the U.S. Food and Drug
Administration, which has been extraordinarily slow and cautious
in deciding whether new drugs are safe or not. It can take up
to $50 million and as long as 15 years to move a contraceptive
from the laboratory to approval for use in the U.S. What really
frightens pharmaceutical companies, however, is the threat of
liability suits, like the legal barrage that drove A.H. Robins
into bankruptcy after its Dalkon Shield intrauterine device was
found to have damaging side effects. No wonder that of the nine
major U.S. firms that were conducting contraceptive research 20
years ago, only one is still doing so.

    Efforts to boost federal support for birth control have run
up against conservative opposition. Right-to-lifers are
particularly determined to block the U.S. introduction of
RU-486, a French-made drug that can induce menstruation after
fertilization takes place. Opponents call RU-486 the abortion
pill. "Contraception," says Judie Brown, president of the
American Life Lobby, "means better killing through chemistry."

    And yet the failure to develop any new kinds of
contraception has helped lead to 1.5 million abortions a year
in the U.S. By some estimates, up to half of them could be
prevented if women had more birth-control options. Jennifer, a
20-year-old college student in Maine, has already had two
abortions, following unsuccessful attempts to use the Pill and
a diaphragm. "At this point I'm afraid to have sex," she says.
"I don't know what to use."

    Amy, a 24-year-old Manhattan film producer, has also
searched unsuccessfully for a contraceptive she can trust. First
she was fitted with a diaphragm, but felt it was too obtrusive
and unreliable. She switched to an over-the-counter spermicidal
sponge, but it did not work. She got pregnant and had an
abortion. Four months ago, she began taking an oral
contraceptive. Her moods became unpredictable, as if she were
riding an emotional roller coaster. Lately she has felt better,
but she is still terrified about the Pill's long-term health
effects. "Something has to be done so a woman doesn't worry so
much," she says. "It infuriates me."

    The plight of women like Jennifer and Amy will not improve
until there is an overhaul of federal policy on birth control.
The NAS report calls on the FDA to streamline its stringent
rules for the approval of new contraceptives. The authors also
recommend that pharmaceutical companies be given federal
protection from liability suits so that they will be encouraged
to get back into the contraceptive business. Unless something
is done quickly, the situation for U.S. women may be no better
in the 21st century than it is today.


By Philip Elmer-DeWitt. Reported by Georgia Harbison/New York
and Dick Thompson/Washington.


____________________________________________________________
METHODS USED IN THE U.S. [Showing percentage of women who favor
them.]


    STERILIZATION - 38%. Once a woman has her Fallopian tubes
"tied," it is difficult to reverse the procedure.

    ORAL CONTRACEPTIVES - 32%. The Pill is 95% to 97% effective,
but questions about its safety persist.

    BARRIER METHODS - 24%. Condoms, diaphragms and cervical caps
have failure rates of 12% or more.

    INTRAUTERINE DEVICES - 3%. Most manufacturers have stopped
making IUDs for fear of costly lawsuits. This method fails in
6% of women.

    SPERMICIDES - 3%. Foams, creams and jellies are sold over
the counter, but failure rates are about 26%.

_________________________________________________________________
METHODS USED ABROAD [But not available in the U.S.]


    NORISTERAT. This two-month injectable contraceptive has a
2% failure rate and is approved for use in more than 40
countries.

    NORPLANT. Placed under the skin on the inside of the upper
arm, this progestin-releasing implant can provide 99% protection
for up to five years.

    RU-486. This pill can induce menstruation in a woman whose
period is up to six weeks late.

    FILSHIE CLIP. This titanium-and-silicone clip can block the
Fallopian tubes without cutting or cauterizing, making it easier
for a woman to change her mind.