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.

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.

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.

Long term synthetic hormone contraception offers the most efficient reversible birth control available today. There are presently two types of these birth control methods; synthetic hormones that are injectable and synthetic hormones that are released by implanted capsules. Both types are extremely effective at preventing pregnancy. The advantages of these type of birth control methods, apart from their effectiveness, are that they are long acting and require very little effort to maintain. This section will review how these birth control methods function and the health risks associated with each.
Depo-Provera (sterile medroxyprogesterone acetate suspension) and Noristerat (norethisterone enanthate) are the most popular injectable synthetic hormone contraception techniques. Both consist of a progestin, a synthetic hormone that acts like progesterone. A shot of Depo-Provera must be injected every three months to remain an affective pregnancy deterrent. Noristerat must be renewed every two months. Cyclofem and Mesigya are two new monthly injectable contraceptives that combine a progestin and estrogen. Because Depo-Provera is the only injectable contraception that is FDA approved, I will concentrate on this injectable birth control method.

Depo-Provera is produced in the form of crystals suspended in a water-based solution. The progestin prevents pregnancy primarily by suppressing ovulation. It increases the viscosity of cervical mucus, creating a sticky barrier that blocks spermatozoa. Depo-Provera also appears to make the endometrium less suitable for implantation. This contraceptive has tested 99.9% effective in a World Health Organization (WHO) study. Women using Depo-Provera will notice changes in their menses. Most women stop having periods after one year of use. Similarly, these women usually require nine to twelve months to become pregnant once they have stopped the injections. Currently, each injection of Depo-Provera cost about fifty dollars.

Depo-Provera was suspected of causing breast cancer when a study showed that large doses caused increased breast nodules in beagles. The study is dubious though because the mammary structure of beagles is dissimilar to human mammary structure. Research has been inconclusive in the past thirty years since Upjohn company introduced Depo-Provera. Nevertheless, breast cancer rates slightly increase in women under the age of thirty-five during the first four years of using the contraceptive. Studies have likewise found that Depo-Provera protects against the risk of endometrial cancer.
Common reported side effects of Depo-Provera are: irregular menstrual bleeding, amenorrhea, weight gain, headache, nervousness, stomach pain or cramps, weakness or fatigue, and decreased sex drive. All of these symptoms usually decrease over time. Other reported complaints with the drug are: acne, leg cramps, breast swelling, excessive hair loss, no hair growth, depression, insomnia, rash, and hot flashes. At present, it is suspected that Depo-Provera may cause osteoporosis.