Finally, we should remember that a Norplant subsidizing policy is not bad in itself. Determining the morality of this program rests particularly on observing its implementation. If the contraceptive method is administered by a coercive family planning clinic, then women’s rights for contraceptive alternatives and to informed consent are likely to be violated. However, this is not a fault of the Norplant for Consenting Teens policy. How counseling occurs and the impartial behavior of family planning clinics is a procedural issue that faces family planning policies.

The Policy’s Fatal Flaw

While the Norplant for Consenting Teens policy may work, there is deep problem with the policy. The policy is a overly drastic solution to the problem. Teenagers need more information about reproduction and contraception. They currently do not know where to go for more information. Unfortunately the society is not open to discuss important reproductive and contraceptive topics with teenagers. As a result, one in three female teenagers will not use a form of contraception the first time they have intercourse and, one in five teenagers do not use any form of contraception.

Over half the teens polled incorrectly thought that they needed parental permission to buy over the counter contraceptive devices. Teenagers have cornered the market in contraception failure, e.g., their average failure rate for an oral contraceptive is 11% compared to the average for women over 20 is about 5%. Likewise, sexually active teenagers wait between thirteen to fourteen months after they started having intercourse to come to a family planning clinic. Sadly, in 1981 the most common reason for teenagers making their first clinic visit was their fear of being pregnant.

Sexual education offers hard-to-get information to teenagers. As a consequence, teenagers participating in sexual education programs are more likely to use a contraceptive when having intercourse and will use contraceptives more effectively. They will also abstain from sexual intercourse for longer periods of time. Since 80% of sexually active teenage males indicated that they believe they first had intercourse at too young an age, this phenomenon seems to be in the interests of teenagers.

Unfortunately the sexual education in the United States is inadequate. Over half of all teens do not take a sexual education course until after they have become sexually active. On average secondary schools only offer six and a half hours a year on all sexual education topics, and less than two of those hours covers contraception and STD prevention.

The eugenics objection to the Norplant for Consenting Teens program argues that the program has some hidden eugenic agenda. For example, former Ku Klux Klan leader David Duke proposed a Norplant incentive bill that referred to young black women by employing code words, such as ‘welfare recipients in need of birth control education’. Because black women have a higher pregnancy rate and are more likely to be poor, they are particularly subject to most all the proposed Norplant policies. This fact, however, allows others to use the guise of impartiality to cloak an agenda to stop ‘undesirables’, e.g., low income families or particular minority groups, from breeding. This discriminatory behavior has a history of abuse with sterilizations, so we should not consider opening another avenue for this behavior to flourish.

Deterring teenage pregnancies generally improves the socioeconomic situation of the teens, regardless of race, religion, or economic situation. Several discriminatory policies that employ Norplant may exist. However, the Norplant for Consenting Teens policy is not such a policy. The Norplant for Consenting Teens policy affects all teenagers, unlike policies such as the one proposed in Kansas, that only affects women on welfare. Since the pregnancy rate among black teenagers is much higher than other ethnic groups, the policy helps the black community more. By improving education and the economic situation of black teenagers, the policy will offer them better socio-economic opportunities by helping reduce the rate of unwanted or unexpected pregnancies, just like giving out free birth control helps everyone. Why would this supposed discriminatory agenda specify bettering the education and the over all standard of living of those whom it intends to ‘victimize’? This policy hardly fulfills a true eugenicist program because it is more likely for the targeted group to prosper under these conditions.

Second, having more children does not entail having a healthier community or ensures the survival of that community. To presume that women of a community should breed, regardless of the adverse consequences these women and their children must face, does not seriously demonstrate concern for members of that community. Having a healthy society, or a fit population, requires that the offspring have enough resources available to thrive. Coincidentally, by allowing young members of a community to avoid situations that will inhibit their ability to acquire resources and to avoid perpetuating this disadvantage, the Norplant for Consenting Teens program promotes healthier communities. This is true for any community, regardless of race.

For the Norplant for Consenting Teens policy to succeed, it needs to develop the sexual education programs in the United States. There are two faults with this.

First, the need for sexual education programs hides many of the costs of the Norplant birth control for Consenting Teens policy by shifting them to the education programs. Thus the savings the Norplant birth control for Consenting Teens program would generate would not necessarily be as great as it first appears.

The second fault with the Norplant birth control for Consenting Teens policy requiring better sexual education is more insidious. Since parents place a prodigious amount of pressure on schools to avoid or limit sexual education, sex has become a taboo topic among public schools. If the general attitudes in the United States changed, schools would be more likely to implement a sexual education curriculum. Consequently, since teenage pregnancy rates go down proportionately with a country’s openness to talk about sex related issues, the teenage pregnancy rate will already be on the decline as the sexual education courses increase. The increase of sexual education programs will also decrease the number of teenage pregnancies. Norplant Birth Control is no longer available in the United States, as of 2002. Therefore, once Norplant birth control for Consenting Teens is established, the sexual education and the greater openness in society may have already dropped the teenage pregnancy rate to an acceptable level. Ironically, one of the key successes to Sweden’s low teenage pregnancy rate is not necessarily their sexual education programs, but that the society does not try to deter teenagers from sexual behavior and that the citizens are relatively open to discuss sexual topics.

Since we do not live in a perfect world, the likelihood of increasing the access, frequency, and quality of sexual education in the United States in the immediate future is very low. A Norplant birth control for Consenting Teens program could do some good in family planning clinics that counsel teenagers. The program would be more effective than current programs to reduce teenage pregnancy. However, in order for the program to succeed, it needs to increase its accessibility for teenagers. This requires comprehensive sexual education programs in public schools, for offering Norplant birth control as an option without providing sex education would limit teenagers’ knowledge of the contraception and of its availability. This has deterred the usage of the contraceptive in the past. Ironically, once the environment in this country allows for the education required for the Norplant for Consenting Teens program to succeed, teenage pregnancies will probably not be the dire issue that it is today.

A more sophisticated objection to the policy for subsidizing Norplant, or any other single form of contraception, argues that such a policy interferes with a woman’s right to make her own contraceptive choices. Instead of offering true choice among alternative methods, governmental contraceptive incentive policies effectively force low income women into making a single contraceptive choice. Thus the policy is interfering with their right to choose a contraceptive method by reducing her feasible options to only one form of birth control. Further, by promoting only one form of contraception, the government can mislead women about their contraceptive options, such as the safety of one particular contraceptive method. For example, in Bangladesh it is not clear to the extent women were informed about their contraception options prior to being introduced to Norplant. This bias towards a particular contraceptive method can serve the interest of the government, and not necessarily the interests of the women the policy effects. For these reasons, any public policy that deals with contraception should guarantee women a choice of all the different contraceptive methods.

It is important to recognize the Norplant for Consenting Teens policy does not specify that it is the only contraceptive method available to teenagers. As mentioned earlier, provided their costs are affordable, other effective methods could be used, e.g., Depo-Provera. The policy never suggested that no other contraceptive methods should be available to teenagers. Since synthetic hormone birth control methods do not protect against STDs and AIDS, the government should not solely promote this form of contraception. Programs to encourage condom use exist for this purpose.

While it would be optimal that all synthetic hormone contraception birth control methods cost the same, contraceptive costs will probably always affect women. It may be a governmental obligation to supply women with affordable contraception, but this does not entail that the government should supply women with every possible form regardless of cost or effectiveness. This is just not practical considering real world costs. However, subsidizing long term synthetic hormone contraception may help broaden the contraceptive choices for teenage women. Presently, oral contraception is the most common teenage contraceptive choice. When cost was not a factor, 48% of the teenagers chose Norplant instead. This high rate suggests that the excessive cost of Norplant is denying some teenage women access to their first choice of synthetic hormone contraception.

The morality objection disapproves of sexual education programs. These programs, it claims, teach teenagers about all types of sexual behavior, even though some of these acts are immoral. Because of their age and inquisitiveness, teenagers will be intrigued by what they have learned. They will then want to practice these immoral behaviors.

Thus, sexual education programs encourage teenagers to practice immoral sexual behavior that they have learned from these programs. Since the Norplant for Consenting Teenagers program requires sexual education and counseling, it is subject to this objection.

Underlying the morality objection is the assumption that sexual education programs introduce students to various sexual behaviors and this encourages students to become sexually active. There is no evidence for this assumption. In fact, there is evidence that sexual education programs encourage students to abstain from sex. A study in Atlanta revealed that students enrolled in a sex education program are significantly more likely to postpone sexual intercourse through to the end of ninth grade than non-program students.  Likewise, a study of over a thousand students showed that males who participated in a sexual education program are less likely to have sexual intercourse than non-participating students. If parents want their children to abstain from sexual activity, they should be promoting sex education instead of protesting it.

Ideally it would best if parents would teach their children the health and moral issues involved with sexual behavior. The problem with letting parents have total responsibility of their child’s sexual education is that parents are not doing it. Only 18% of males and 32% of females in the United States first learn about sex from their parents. Further, research suggests that there is a great difference between what information parents think they have conveyed about sex-related topics and what the teenagers think they heard from their parents. Sexual education programs teaching about what type of birth control to use offer reliable sources for teenagers to learn about sexual issues and these programs act as safety nets to guarantee that teenagers have access to important sex-related information so that they can act more responsibly.

A solution to both of the problems facing the Norplant for Consenting Teens policy would be to center the program in the schools.

Schools offer a place where most all of the teenagers will be and because of its pedagogical function, it is ideal for sexual education. By incorporating sexual education into the curriculum of public schools, teenagers will have a regulated and reliable source of information in an environment that they are more comfortable in. Comprehensive sexual education programs are very successful at increasing teenager’s knowledge of reproduction and contraception. If the government implements a comprehensive sex education program and subsidizes Norplant for teenagers within public schools, the policy could have educated teenagers consenting to have inexpensive Norplant birth control systems. Furthermore, since the public schools traffic a large proportion of the teenagers in the United States, the program would probably either give teenagers a better standard of living for the same cost that we are spending on teenage pregnancies or save the government in social service costs.

Objections
There are four common objections to the public policies similar to the proposed ‘Norplant for Consenting Teens’ policy. The first two objections, the message objection and the morality objection, argue against any governmental subsidized contraception and sexual education, respectively. The other two objections, the eugenics objection and the reproductive choice argument, object to the particular use of Norplant in a public policy.

The message objection states that the government is sending the wrong message to teenagers with this program. By subsidizing Norplant birth control, teenagers are simply ‘equipped for sex’ and the policy complacently ignores important moral issues about sexuality. This policy effectively encourages teenagers to become sexually active and implies that they are not responsible for their actions. The government should not send such messages because it directly attacks the moral fiber of the country.

The message objection is correct in that the policy may project a message to teenagers. What that message states is hard to interpret. With education about contraception and the health consequences of unprotected sexual behavior, the message may be that the government is concerned about the health of teenagers. Furthermore, the message states that the government is aware that some teenagers will act sexually and that it wants to help protect their health and welfare too. Reducing the cost of birth control methods shows that the government is willing to help sexual teenagers act more responsibly. Finally, with public icons making books that promote unsafe sexual practices, it is hard to believe that any message that the policy gives is worse than the media messages that bombard teenagers every day.

The second class of ‘Norplant for Teens’ policy supplies Norplant systems to consenting teenagers. The government would offer these consenting teenagers Norplant systems for free or for a very low price. For example, the government could charge the reasonable fee of ten dollars, if it wanted to generate revenues and still make Norplant extremely affordable for teenagers. This price could help pay for the program, e.g., the suggested fee could generate about $50 million dollars. It is important though to make sure that the Norplant systems are affordable so that the teenagers have an incentive to choose it. This type of program would be more effective because the Norplant systems will be generally going to sexually active teenagers — the economic argument applies to the policy.

One problem with the proposed policy is difficulty in getting informed consent from a teenager. We have no assurance that the teenager knows all the options she has, like IUD birth control, or that she understands what the drug actually does. Somehow we need a comprehensive method for making certain that teenagers know about their bodies, different forms of contraception, and the implication of each one’s use.  For example, we cannot assume that all teenagers understand that Norplant does not protect against sexually transmitted diseases (STDs). A responsible Norplant for Teens program must offer detailed sexual education and counseling.

The second problem with a consent driven Norplant for Teens program is that the sexual education and the Norplant services must be accessible for teenagers. If the program is not accessible to the majority of teenagers, then it will not benefit them no matter how good the program is. There is good evidence that placing such a program in traditional clinics would not target the majority of teenagers. Studies have shown that in both the United States and England, many teenagers believe that the clinics are not meant for them. Both male and female teenagers have reported that they feel uncomfortable in these clinics. Likewise, 38.7% of boys polled incorrectly thought that parental permission was needed to go to the clinic. In order for a Norplant for Consenting Teens program to work, it must occur in an environment that has access to most all teenagers and makes them feel comfortable.

There are two classes of policies we could adopt to implement a ‘Norplant for Teens’ policy. The first would make Norplant implants mandatory for all female teenagers. This blanket policy would be the most effective, for no teenager could fall through the cracks. The number of teenage pregnancies would be directly related to the failure rate of Norplant systems, i.e., 0.5%. This can reduce the number of accidental pregnancies by over a factor of one hundred.

A critical problem with a mandatory ‘Norplant for Teens’ public policy is that it infringes on several recognized constitutional rights. First, since some religions object to birth control, a mandatory Norplant policy would violate those citizens’ right to religious freedom. Second, the Supreme Court recognizes that the Constitution implies rights that “promise that a certain private sphere of individual liberty will be kept largely beyond the reach of the government”. These rights protect the ability to make particular decisions that are considered fundamental for preserving ‘autonomy’ and ‘individual dignity’.

Decisions about procreation, contraception, and marriage have all been recognized as protected by these rights. A mandatory Norplant policy directly conflicts with these rights. Finally, for over two hundred years, any medical treatment performed without consent, unless in emergency cases, has been considered battery by Anglo-American law. As mentioned earlier, Norplant is a drug and its insertion is a medical procedure. To not allow individuals to refuse this ‘treatment’ would violate the long recognized and protected right to self-determination. This right protects individuals from “severe” intrusions of their “personal Privacy and bodily integrity”.

Second, because the government would have to supply Norplant systems to every female teenager, the policy would not be cost-effective. There are just too many teenagers and Norplant is too costly for the economic argument to apply. Putting costs aside, making Norplant mandatory for teenagers completely disregards that Norplant is a drug — levonorgestrel. It has particular health risks and is not safe for everyone. In the previous section I reviewed a considerable amount of side effects that individuals may not want. Furthermore, evidence determining whether or not synthetic hormone contraception causes or increases chances of breast cancer is still inconclusive. This is particularly true of Norplant, since it is a relatively recent drug. Likewise, few comprehensive studies exist that investigates the effect Norplant has on teenagers. Forcing female teenagers nationwide to get Norplant systems may be invoking serious health risks. The only way to avoid violating all the aforementioned rights and to remain cost-effective is by offering, not mandating, Norplant to consenting teenagers.

A purely economic argument for distributing Norplant systems to teenagers makes the policy very compelling. I will presume that the government can purchase a large quantity of Norplant systems, implement them, and maintain them for five years for about $700 per unit. If we sent a buyer to Sweden and purchased them from Leiras instead of Wyeth-Ayerst Laboratories, the cost would go down to about $200 per unit. There are ten million sexually active teenagers in the United States. Presuming that each successive year, five million different teenagers become sexually active, the total of sexually active teens over five years would be 30 million. If we supplied every one with Norplant birth control, the cost would be $21 billion in the poor scenario and $6 billion in the relatively good scenario.

Each year, babies born to teenage mothers will cost the government six billion dollars in social services over the next twenty years. That the cost is spread out over the years actually makes the situation worse, considering the figure does not account for inflation. Meanwhile, the taxpayers’ cost caused by teenage pregnancies over five years will well exceed $30 billion.

This is still $9 billion more than in a very poor Norplant scenario. Furthermore, the difference between the costs will grow further apart with time. The difference in cost is even more alarming when you remember that both female and male teenagers are sexually active. The number of sexually active females should be much lower than accounted for. To keep the scenario very poor, however, this high number could assume that many non-active females will also opt to get a Norplant birth control system.

A common concern about a Norplant birth control subsidy program, or just the drug itself, is that it will encourage teenagers to avoid using condoms and visit attending health clinics less regularly. Presently no information confirms this hypothesis. However, evidence suggests that condom birth control use does not significantly differ from teenage Norplant users and their oral contraceptive using peers. Norplant use does not seem to affect the teenage attendance of health clinics either. Neither the number of follow-up clinic visits, the rate of duration of the follow-up, nor the rate of return significantly varied between observed Norplant using teenagers and their oral contraceptive using counterparts. This evidence suggests that the increase in the use of Norplant in teenagers would not likely affect their condom use or their regular attendance of clinics.

Long term birth control methods offer ideal contraception for teenagers. For one, they are the most effective contraception device to date. Secondly, teenagers are notoriously poor contraceptive users. Teenage women are more likely than older women to have an accidental pregnancy while using any given method of contraception. Because of the very little amount of effort required by a Depo Shot or Norplant, either an injection every three months or an hour of implantation procedures every five years, they are virtually teen-proof.

Women who use Norplant for over a year report that they like it for its effectiveness, convenience, and lack of serious side effects. This convenience is also appreciated among teenage users. Over seven out of ten (71%) teenagers using Norplant stated that they chose the contraceptive method because they would not have to remember to take pills daily, and 48% also referred to the contraceptive methods’ ease of use. Likewise from 74% to 86% of Norplant using teenagers reported being satisfied with the contraceptive method. This contrasts with the 39% reported satisfaction rate of oral contraceptive using teenagers. The ease of use and effectiveness probably accounts for the high level of satisfaction among long term synthetic hormone contraceptive users, adolescent or otherwise.

The cost over five years makes long term synthetic hormone contraception the most economical form of birth control.  For example, the average cost of oral contraceptives and doctor’s visits over five years is about $1,400. Currently Depo-Provera ( or “Depo shot“) costs $1,000 for five years of effectiveness and Norplant generally costs about between $500 to $700. However, the cost of Norplant in other countries is significantly less — always under $120, and the cost should have been substantially lowered in 1995. The actual cost to make and market the device is sixteen dollars. Because of the difference in potential cost and that most teens do not care about the convenience in reversing contraceptive methods, Norplant presently is more desirable than Depo-Provera (commonly called “Depo Shot“)for a cost-effective teenage pregnancy deterring policy.

There is an obvious argument for supplying teenagers with subsidized Norplant systems. This policy will protecting the health, welfare, and future of the teenagers. Most teens do not intend to become pregnant. Becoming pregnant subjects the mother to many health risks. Likewise, since teenage parenting generally subjects mothers to a higher risk of socioeconomic disadvantage throughout their lives, most teenagers do not want to become pregnant. Supplying teenagers with Norplant systems is a win — win situation. The state will drastically reduce the number of teenage pregnancies and consequently the costs spent on them. Teenagers will have fewer health risks, better educational opportunities, and better career options, than if they did not have access to contraception and become teenage parents.