- The Washington Times - Tuesday, August 22, 2000

The future looks barren for long-lasting birth-control methods Norplant and Depo-Provera, which have been "spurned" by most American women, according to a recent study.

Few women use them or plan to use them, which raises "questions about the promise of the future for these methods," wrote Koray Tanfer, lead author of a study in the July-August issue of Family Planning Perspectives, published by the Alan Guttmacher Institute. He said American women have "spurned these two contraceptives."

But the makers of Depo-Provera and Norplant said they aren't giving up on these drugs, which were introduced in the United States nearly a decade ago and have near-perfect records in birth control.

Depo-Provera is a birth-control shot that women can get every three years. It is 99.7 percent effective in preventing pregnancy.

"The rate of new prescriptions for this year is up 24 percent over last year," said Christopher Bilkey, vice president for women's health for Pharmacia Corp., which makes the drug. "So that's fairly good evidence of continued and growing acceptance of Depo-Provera."

Norplant "is a viable option … and we're going to keep educating doctors about this as a contraceptive alternative," said Doug Petkus, spokesman for Wyeth-Ayerst Laboratories, Norplant's manufacturer.

Norplant is the birth-control method that comes in six slender capsules that are surgically implanted in a woman's arm. It releases birth-control drugs slowly for up to five years and is 99.9 percent effective.

For several years, Norplant was the subject of lawsuits based on women's complaints about the drug's side effects. Last year, Wyeth-Ayerst agreed to pay $1,500 each to some 36,000 women who had filed lawsuits against Norplant. It admitted no wrongdoing.

Last week, the Milwaukee Journal Sentinel reported that Norplant's manufacturer mailed letters to 9,100 Norplant providers and wholesalers saying there may be problems with the product's shelf life. Wyeth-Ayerst asked doctors not to use implants shipped since October and urged women with implants to use backup contraceptive methods.

Elsewhere in the nation, groups like Children Requiring A Caring Kommunity (CRACK) have made headlines for encouraging and even paying poor or drug-addicted mothers to use long-lasting birth-control like Norplant or Depo-Provera.

The group's founder, Barbara Harris, says giving $200 to drug-addicted mothers to take long-lasting birth control is the best way to reduce the incidence of drug-addicted babies. Others call such tactics coercive and discriminatory.

Both Norplant and Depo-Provera also have received public kudos.

Federal and private researchers frequently credit Norplant and Depo-Provera with playing a significant role in bringing down the teen pregnancy, birth and abortion rates.

One study indicated that as many as 8 percent of sexually active teens choose either Norplant or Depo-Provera, while another found that 19 percent of black teens, ages 15 to 19, liked "the shot."

But contraceptives always raise a question of "acceptability" with women, said Mr. Tanfer, a researcher at Battelle Memorial Institute's Centers for Public Health Research and Evaluation in Seattle.

Both Norplant and Depo-Provera have been used successfully in dozens of other countries, he said. But American women "seem to not be so tolerant" of their side effects, such as weight gain, he said.

Ten years ago, Mr. Tanfer wrote, the U.S. market seemed to be ripe for birth-control drugs like Norplant and Depo-Provera.

Roughly half of all U.S. pregnancies were "unintended," which meant many women should be interested in reliable contraception, the study said.

Diaphragm use was half of what it was in 1960, the intrauterine device (IUD) was no longer being made in the United States, and birth-control pills were falling into disfavor because of links to cardiovascular disease and breast cancer.

Condoms were the third most popular form of birth control, after sterilization and the pill, but they were disliked by most men and had a failure rate of 12 percent to 15 percent.

All of these developments suggested that there should be demand for long-lasting, convenient and reversible birth control, wrote Mr. Tanfer and his colleagues.

Norplant and Depo-Provera entered the U.S. market in 1991 and 1993 respectively with "well-documented" safety records and proven acceptance in other countries, they said.

But according to the National Surveys of Women, which involved women in their 20s and 30s, use of Norplant and Depo-Provera was surprisingly low.

In 1993, for instance, 1.2 percent of these women used Norplant. By 1995, this figure fell to 0.9 percent of women.

The 1995 survey included Depo-Provera use and found it low as well, with 1.2 percent of women saying they used it.

When asked why they didn't use these methods, women said they preferred other contraceptive methods, didn't know much about Norplant or Depo-Provera, or feared the side effects of the drugs, the Tanfer study said.

The NSW also asked women about their intention to use these long-lasting birth-control methods.

Their answers boded ill for Norplant: Only 5 percent of women said they intended to use it in 1995, down from 8 percent in 1993.

The news was better for Depo-Provera, with 10 percent of women saying they might try it in 1995, compared with 5 percent in 1993.

Mr. Tanfer and his colleagues found that "both methods seem to appeal to certain subgroups" of women.

With "proper interventions and social marketing" of Norplant and Depo-Provera, they said, more young, single women who want to delay childbearing may be "more willing to try them."

Both drugs are likely to remain controversial: Web sites have sprouted up to collect complaints from women about their experiences with Norplant and Depo-Provera. Many of the complaints concern weight gain, mood swings and unwanted changes in menstrual periods.

"We believe that the range of contraceptive options should be as broad as possible, but the choice should be a matter for the woman and her health care provider. So we support the concept of better education about the choices," said Mr. Bilkey of Pharmacia. "No one contraceptive suits all women, and indeed, no one contraception method suits a single woman for the entirety of her reproductive life."

Meanwhile, there's talk of new contraceptives that are highly effective and with reduced side effects. These include a flexible ring that is inserted once a month into the vagina, where it slowly releases birth-control drugs; a birth-control "patch" that can be worn for several days at a time; and a birth-control shot that women would get each month.

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