TIME: Almanac 1993/TIME Almanac 1993.iso/time/081291/0812130.000

Text File | 1992-08-28 | 8.5 KB | 177 lines

                                                                                HEALTH, Page 52

Why Isn't Our Birth Control Better?


Policies, politics and prudery are making it harder for Americans
to control their own reproduction -- especially compared with
Europeans

By PHILIP ELMER-DEWITT -- Reported by Ann Blackman/Washington,
Tom Curry/Chicago and Edwin M. Reingold/Los Angeles


    A portrait in American fecundity: every day hundreds of
young women, their bodies roundly pregnant, descend on the
University of Southern California Women's Hospital. They
overflow the available chairs and sprawl awkwardly on the floor.
They come for prenatal checkups, gynecological care and,
finally, to deliver their young. Last year more than 18,000
babies were born in this building, roughly 1 out of every 200
babies born in the U.S. "Sometimes they are lined up in the
hallways and stacked up for C-sections like planes at LAX, six
or seven deep," says obstetrician-gynecologist David Grimes.

    But this busiest of U.S. obstetrics units also symbolizes
an American failure: the extent to which the birth control
revolution has not fulfilled its promise in the country where
it began. Three decades after the Pill was introduced in the
U.S., a shocking number of the 58 million American women of
childbearing age still find it difficult to control their own
reproduction, especially compared with women in other countries.
Teenage pregnancy in the U.S. is more than double that of
European countries, and the nation's abortion rate -- 1.6
million a year -- is one of the highest in the developed world.
All told, more than half of all American pregnancies -- 3.4
million out of 6 million each year -- are accidents, the result
of misusing contraceptives, using unreliable contraceptives or
using no contraceptives at all.

    The sorry state of birth control in America is underscored
in a report prepared by the Population Crisis Committee, a
nonprofit research group based in Washington. The committee
found not only that Americans have fewer contraceptive options
than their counterparts in most developed countries, but also
that contraceptive devices are more expensive and more difficult
to obtain in the U.S. than in some parts of the Third World.

    While scientists around the globe are making rapid
progress deciphering the dance of hormones that makes pregnancy
possible -- work that raises new strategies for blocking
conception -- the major American pharmaceutical companies have
all but abandoned the field. Of the nine doing research in
contraceptives 20 years ago, only one (Ortho Pharmaceutical) is
still active. The others have been scared off by the fear of
costly lawsuits like the one that drove the maker of the Dalkon
Shield, an intra uterine device, into bankruptcy, and by public
controversy such as that surrounding RU-486, the French
"abortion pill."

    Most of the world's governments encourage family planning
and even subsidize the use of birth control devices. The U.S.
stands out as the only major industrialized country that is
moving in the opposite direction. Over the past decade,
Washington has halted federal research on new reproductive
technologies and declined to approve some of the most promising
new methods of birth control.

    There have been some improvements in U.S. contraceptive
options, but they have been incremental rather than
revolutionary. Manufacturers of the Pill have developed low-dose
versions that avoid most of the side effects associated with
earlier varieties. IUDs have improved greatly in the past decade
and are now about as safe and effective as the Pill. And owing
largely to the fear of AIDS, the condom, which dates back to the
age of the Pharaohs, has come out from behind the pharmacists'
counters and is now prominently displayed at stores across the
U.S. in various colors, shapes and sizes.

    Even the Food and Drug Administration-sanctioned Norplant
-- the long-lasting hormone implant hailed as the first new
contraceptive device approved for use in the U.S. in three
decades -- is really a repackaging of the same chemical used in
the Pill. Norplant is housed in matchstick-size tubes and
inserted under the skin of a woman's arm. Its main advantage is
that it does not depend on someone's remembering to take it
every day. But it can cause irregular bleeding, and its cost (up
to $1,000) puts it out of the price range of many who need it.

    In Europe sexually active couples can choose from a wide
selection of contraceptive approaches that includes more than
two dozen different kinds of pills, monthly and bimonthly
contraceptive injections, and an IUD that boosts its
effectiveness with the slow release of hormones. The big news
this summer is Britain's decision to become the second country
-- after France -- to approve the sale of RU-486, the
controversial postcoital contraceptive.

    Carl Djerassi, the Stanford chemist who helped develop the
original Pill in the early 1950s, calls RU-486 "the single most
important new development in contraception of the past two
decades." Reason: it gives women, for the first time, a
relatively safe way to avoid pregnancy after they have had
unprotected intercourse -- thus fully removing the decision to
exercise birth control from the decision to have sex. Basically,
RU-486 is a menses inducer. Used in conjunction with a
prostaglandin, it brings on a woman's period whether or not she
is pregnant. Although there has been one death associated with
its use (triggered by an allergic reaction to the
prostaglandin), it is considered fairly safe. Several states,
including conservative New Hampshire, are lining up to become
test sites to speed its adoption in the U.S.

    That is not likely to happen soon. Right-to-life groups
have made opposition to the "French death pill" a rallying cry
and have vowed to boycott not just it but all products made by
any drug company that dares distribute it in the U.S. They
argue that the notion of postcoital birth control is just
abortion by another name; in addition, they are not enamored of
the idea of separating sex from its consequences. "The problem
is not that contraceptives are not available; the problem is
that many people are not behaving responsibly," says Allan
Carlson, president of the traditionalist Rockford Institute.

    That attitude, which has come to dominate federal policy,
indicates that the real dispute in America is not so much about
abortion or contraception as it is about sex and values.
American culture is a strange blend of prurience and prudery
that tends to lead to the worst of both worlds: movies and
magazines that exploit sex and teach kids that it's glamorous
and free of consequences, combined with a skittish denial of the
facts of life that makes it hard to teach those kids how not to
get pregnant.

    "Many American women are grossly misinformed," says
U.S.C.'s Grimes. For instance, 31% of American women in a 1985
Gallup poll indicated their belief that birth control pills
cause cancer, when in fact the evidence shows that for
nonsmokers the Pill actually reduces the risk of ovarian and
endometrial cancer. Europeans are much better at putting sex --
and birth control -- in its place. Despite their Roman Catholic
heritage, the French schools conscientiously provide sex
education during which birth control and abortion are frankly
discussed.

    It would be a mistake, however, to blame the paucity of
new contraceptive devices in the U.S. just on puritanical
attitudes and conservatism. One group that would have been
expected to be contraception's natural constituency, feminists,
has been more vocal in pointing out the dangers of various
devices than in promoting their use. The positive result was the
development of the new low-dose pills. The negative effect was
that thousands of women abandoned the Pill altogether.

    The National Academy of Sciences last year called for an
infusion of federal dollars into contraceptive research, better
sex-education programs and protection from liability suits for
manufacturers who want to get back into the birth control
business. But under the current Administration such actions are
unlikely. Meanwhile, sexually active Americans are often left
with an inadequate range of options: make the best of the
contraceptives they have, choose to be sterilized, or turn to
abortion when all else fails. With the last option under
increasing legal challenge, the choices at the turn of the
century are likely to be narrower than they are today.