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.

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.

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.

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.

Imagine that you are an administrator responsible for the education and development of the teenage population of a city. Currently 10% of all girls in the city, ages 15 to 17, give birth. Most of these teenage mothers do not continue to get their high school diploma and consequently will have difficulty gaining employment. Because of their poor employment options, most mothers most rely on welfare. Finally, in the inner city environment, the pregnant teens do not have the same pressures to go to college or
marry as teens in sub-urban environments. The teenage mothers seek support in matriarchies, consisting of relatives and friends who probably all were teen mothers. Thus teenage parenting continues its self – perpetuating cycle, with tremendous social costs. This is the situation the Lawrence Paquin School in Baltimore faced and what inspired many to support the school’s policy that supplies its students with Norplant birth control systems.

This paper will investigate the implications of a public policy that distributes long term synthetic hormone birth control methods to minors. For the program to be acceptable, it must fulfill three criteria. The program must be cost effective. Second, the policy must successfully deter teenage pregnancies. Third, any public program should be morally permissible. We should not embrace a policy that cuts costs if it entails violating individuals’ rights. A program that meets the above criteria will be proposed and examined. Then I shall discuss the common objections to such a project and evaluate the overall success of the proposed policy. I will first review both the social costs of teenage pregnancies, and information about the currently
available long term synthetic hormone contraception.

† I would like to thank …

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 Company (1993). ‘Depo-Provera? Contraception Injection,’ an information pamplet distributed by Upjohn Company. See also, Population Crisis Committee (1993).
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.
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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).
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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.
Wyeth-Ayerst Laboratories (1991). ‘Norplant? System: Questions and Answers,’ an information pamplet distributed by Wyeth-Ayerst Laboratories.
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Journal of Medicine. 33 (18), 1229-1230.
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
Policy Implications,’ Family Plannning Perspectives. 17 (2).
Charo, Alta (1992). ‘Medicine and the Law,’ Lancet. 339, May 2, 1104 -1105.
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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).
‘Acceptance and Perceptions of Norplant Among Users in San Francisco, USA,’ Study of Family
Planning. 21 (3), 152-160.
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.
331, 1201-1206.
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Berenson, A. B. & C. M. Wiemann(1993). ‘Patient Satisfaction and Side Effects with Levonorgestrel
Implant (Norplant) use in Adolescents 18 Years of Age or Younger,’ Pediatrics. 92, 257-260.
Polanczky, M., et al (1994).
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.
Center for Population Options (1990).
Kantrowitz, B. & P. Wingert (1993). ‘The NORPLANT Debate,’ Newsweek. Feb 15, 37-41. Also see,
Dewitt, K. (1992). ‘Teenage Girls Split on Birth Control Plan,’ The New York Times. Dec 15, A7.
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).
Thornburgh v American College of Obstetricians and Gynecologists, 476 US 747, 777,(1986).
Skinner v Oklahoma, 316 US 527, 541-542 (1942). See also Carey v Population Services International,
431 US 678 (1977).
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.”
Winston v Lee, 470 US 753, 763 – 766 (1985).
American Medical Association (1990). Drug Evaluations, Chicago: American Medical Association.
8:20.
Allen, C. (1991). ‘Norplant – Birth Control or Coercion?’ The Wall Street Journal, Sep 13, A-10.
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.
Howard, M. (1990). ‘Helping Teenagers Postpone Sexual Involvement,’ Family Planning Perspectives.
22 (1).
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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.
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by Teenage Women at Laurence Paquin School at Baltimore,’ The New York Times, June 6, A-8.

Appraising Long Term Contraception Distribution Policies for Minors

Abstract: Teenage pregnancy is costing the United States billions of dollars in social programs. These
costs are rising and so is the rate of teenage pregnancies. Unfortunately, teenage parents are driven into poverty and have a very little chance of escaping. Similarly, their children face poor care, higher health risks, and are more likely to be teenage parents. In light of this situation, some have proposed giving teenagers Norplant contraceptive implants.

This paper will investigate the economic, social, and moral issues involved with a public policy that distributes long term synthetic hormone contraceptive to teenagers. It will show that such a policy could save the United States billions of dollars, improve the contraceptive options for teenage women, and does not necessitate a coercive public policy that represses women’s rights. The problems facing implementing this public policy include radically restructuring our public schools and establishing a better governmental sexual education curriculum. This goal, however, will probably accomplish much of what the controversial policy was intended to do.