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.

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.

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.

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.

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.

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.

Bonnie Steinbock for offering helpful comments on an earlier draft. Will, G. F. (1993). ‘Teenagers and Norplant,’ in The Washington Post, March 18, A-27, col 1.
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The FDA first did not approve Depo-Provera, despite two favorable recommendations by its advisory panel of medical experts. The tense environment has discouraged Schering AG, the makers of Noristerate, to apply for FDA approval. See, Population Crisis Committee (1993).
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Upjohn raised the price from $30 to $50 in 1993 to supposedly cover the developmental costs of the Depo-Provera. This reason for the cost hike appears to be bogus because of the long international history and marketing success of the drug. See “Sticker Shock” (1993) Time Magazine, Jan 25, p. 56.
Levine, C. (1979).
Population Crisis Committee (1993).
Association of Reproductive Health Professionals (1992) and, Population Crisis Committee (1993).
Upjohn Company (1993). See also, Association of Reproductive Health Professionals (1992).
Population Crisis Committee (1993). See also, Upjohn Company (1993).
Stehlin, D. (1993) ‘Depo-Provera – the Quarterly Contraceptive,’ Consumer Magazine, July. See also, Association of Reproductive Health Professionals (1992).
Sheldon, S. (1987). ‘A New Delivery System for Contraceptive Steroids,’ American Journal of Obstetrics and Gynecology. 157: 1090-1092.
Sheldon, S. (1987).
Board of Trustees Report (1992). ‘Requirement or Incentives by Government for the Case of Long Acting Contraceptives’ JAMA. Apr 1, 267 (13), 1818-1821.
Norplant should cost much less and Wyeth-Ayerst promised the US government that it will cost less in the future, see Hilts, P. (1993) ‘Contraceptive Maker to Cut Price for Clinics,’ The New York Times, Nov 11, B-13.
Runner, J. (1992). ‘If You’re Asked About Norplant,’ RN. 55: 44-47.
Frank, M.L., Poindexter III, A.N., Cornin, L.M., Cox, C.A., & L. Bateman. (1993). ‘One Year Experience with Subdermal Contraceptive Implants in the United States,’Contraception. 48, 229-243.
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Sarma, S.P. & R. A. Hatcher (1994).
Hatcher, R. A. & J. Trussell (1994). The Norplant II, an implant with only two rods, is currently seeking FDA-approval.
Wyeth-Ayerst Laboratories (1991) and Upjohn Company (1993) for respective drugs.
Levine, C. (1979) for Depo-Provera and Sheldon, S. (1987) for Norplant.
Levine, C. (1979) for Depo-Provera and Sheldon, S. (1987) for Norplant, and private conversation with Dr. Scott T Riebel.
Jones, E. F., J. D. Forrest, et al (1985) ‘Teenage Pregnacy in Developed Countries: Determinants and
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Charo, Alta (1992). ‘Medicine and the Law,’ Lancet. 339, May 2, 1104 -1105.
Moskowitz, E., B. Jennings, & D. Callahan (1995). ‘Long-Acting Contraceptives: Ethical Guidance for Policy Makers and Health Care Providers,’ Hasting Center Report, Jan-Feb, Special Supplement
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the 1982 National Survey of Family Growth,’ Family Planning Perspectives. 21 (3).
Darney, P.D., E. Atkinson, S. Tanner, S. MacPherson, S. Hellerstein, & A. Alvarado (1990).
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Polanczky, M., G. Slap, C. Forke, A. Rappaport, & S. Sondheimer (1994). ‘The Use of Levenorgestrel Implants (Norplant) for Contraception in Adolescent Mothers’ New England Journal of Medicine.
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Both are costs from several HMOs in New York state. It appears to be the national average.
Wyeth-Ayerst promised the government that it would reduce the cost of Norplant by this date, see Hilts, P. (1993). The company has not fulfilled this promise.
Hilts, P. (1993).
Depo-Provera is more desirable for women who are considering having a child within the next two years or less. Since most all teen pregnancies are accidental, very few teenagers intend to have a child. While older teens, ages 17 to 19, may consider having children within the next two years more than fourteen year olds, the difference is minimal considering the number of accidental pregnancies. Ironically, when given the choice between free oral contraception or free Norplant implants, the older teenagers showed a preference for Norplant (see Polanczky, M., et. al. (1994)).
If Depo-Provera was to decrease its cost, there seems no reason to not include it as an option. Generally, Depo-Provera and Norplant offer no serious differences except in the ease of reversing the contraceptive effect.
National Research Council (1987).
The difference is taken from the varience from the cost of a Norplant unit in Sweden, $23, see Hilts, P. (1993).
This number is unrealistically high considering the number of multiple partners several female teenagers have reported (see Besharov, D. & K Gardiner, 1993). I have assumed this number to keep a very poor schenario.
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Kantrowitz, B. & P. Wingert (1993). ‘The NORPLANT Debate,’ Newsweek. Feb 15, 37-41. Also see,
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Hatcher, R. A. & J. Trussell (1994). Sadly, their condom use is consistently very low. This is not a feature associated with Norplant. Instead, we need to remove the focus on condoms as a contraceptive method and emphasize that condoms are for protection against STD’s and AIDS.
Polanczky, M., et al (1994).
Thornburgh v American College of Obstetricians and Gynecologists, 476 US 747, 772, (1986).
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Skinner v Oklahoma, 316 US 527, 541-542 (1942). See also Carey v Population Services International,
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Eisenstadt v Baird, 405 US 438, 453 – 454 (1972).
Loving v Virginia, 338 US 1 (1967).
Slater & Baker v Stapleton, 95 Eng. Rep. 860 (KB 1767).
Union Pacific Ry. Co. v Botsford, 141 US 230, 251 (1891) “No right is held more sacred… than the right of every individual to the possession and control of his own person.”
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8:20.
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This class of policies contains a number of policies that could contain other defining parameters. For example, parental permission may be required before a minor could consent to the implantation of a Norplant system.
That is, of course, if you do not think that pregnancy is a sexually transmitted disease.
One should note that this will increase the cost of the program.
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This assumption dehumanizes the women of the community and treats them like incubators.
For example, having more children so that they deplete all food resources adversely affects the population and may drive it into extinction. A parallel can also be made with this example to economic resources and opportunity.
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Most teenagers find it very difficult to spend $700 for contraception.
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The cost of Norplant over five years is still less than A Dollar-A-Day for the same time, the failure rate is less, and the Norplant policy can effect teens before they give birth. For more on the Dollar-A-Day program see Dolgan J. & S. Goodman (1992) Dollar-A-Day: Teenage Pregnancy Prevention Program. Sponsored by Planned Parenthood of the Rocky Mountians. c/o Margo Daly.
Holmes, S. (1994). ‘Norplant is Getting Few Takers at School: Low Usage of Contraceptive Implant
by Teenage Women at Laurence Paquin School at Baltimore,’ The New York Times, June 6, A-8.