Birth Control

Appraising Long Term Contraception Distribution Policies for Minors


David F Wolf II
Dept. of Philosophy
University at Albany
Albany, NY 12222
United States of America

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.


Appraising Long Term Contraception Distribution Policies for Minors

Introduction†


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.
Besharov, D. & K Gardiner (1993). ‘Teen Sex,’ American Enterprise. 4 (1).
Forrest, J. & S. Singh (1990). ‘The Sexual and Reproductive Behavior of American Women, 1982 -
1988,’ Family Planning Perspectives, 22 (5).
Besharov, D. & K. Gardiner (1993).
Sonenstein, F, J. Pleck, & L. Ku (1989). ‘Sexual Activity, Condom Use, and AIDS Awareness Among
Adolescent Males,’ Family Planning Perspectives, 21 (4).
Sonenstein, F, J. Pleck, & L.C. Ku (1989).
Forrest, J. & S. Singh (1990).
Zelnik, M. & F.K. Shaw (1983). ‘First Intercourse Among Young Americans,’ Family Planning
Perspectives, 15 (2).
Clark, S.D., L. S. Zabin, & J. B. Hardy (1984). ‘Sex, Contraception, and Parenthood: Experience and
Attitudes Among Urban Black Men,’ Family Planning Perspectives. 16 (2).
National Center for Health Statistics (1984) ‘Advanced Report of Final Natality Statistics,’ Monthly
Vital Statistics Report. 33 (6) Supplement.
Jones, E. (1986). Teenage Pregnancy in Industrial Countries. New Haven: Yale University Press.
Besharov, D. & K. Gardiner (1993) and Forrest, J. & S. Singh (1990).
Jones, E. (1986).
Besharov, D & K. Gardiner (1993) and Henshaw, S. (in Press). Family Planning Perspectives.
National Research Council. (1989). Teenage Pregnancy in the United States: The Scope of the Problem
and State Responses. New York: AGI.
Forrest, J. & S. Singh (1990).
National Research Council. (1989).
Forrest, J. & S. Singh (1990).
Besharov, D. (1993). ‘A Moral Choice: Would Norplant Simply Stop Teenage Pregnancies or Would
Increase Teen Sex?’ National Review, 45 (15), 50-52 .
Besharov, D. (1993).
U.S. Public Health Service, Centers for Disease Control. (1990) Monthly Vital Statistics Report.
Advanced Report of Final Natality Statistics, 1988, 39 (4) Supplement, Aug 15.
The Alan Guttmacher Institute (1981). Teenage Pregnancy: The Problem that Hasn’t Gone Away,
New York: AGI.
U.S. Public Health Service, Centers for Disease Control. (1990).
The Alan Guttmacher Institute. (1989a) Prenatal Care in the United States: A State and Country
Inventory. New York: AGI.
National Research Council (1987). Risking the Future: Adolescent Sexuality, Pregnancy, and
Childbearing. Cheryl D. Hayes, ed. Washington DC: National Academy Press.
U.S. Public Health Service, Centers for Disease Control. (1990).
The Alan Guttmacher Institute (1989b). Sex Education and AIDS Education in Schools: A Survey of
State Policies, Curricula, and Program Activities. New York: AGI.
Hardy, J., et al (1989). ‘Fathers of Children Born to Young Urban Mothers,’ Family Planning
Perspectives. 21 (4).
Hardy, J., et al (1989).
National Research Council (1987).
National Research Council (1987).
The Alan Guttmacher Institute (1987). The Financing of Maternity Care in the U.S. New York: AGI.
Congressional Budget Office (1990). ‘Sources of Support for Adolescent Mothers,’ Government
Printing Office, Washington DC.
Besharov, D. (1993).
The Center of Population Options (1990). Teenage Pregnancy and Too-Early Childbearing: Public
Costs, Personal Consequences. Washington DC: CPO.
The Center of Population Options (1990).
Furstenberg, F.F., J. A. Levine, & J. Brooks-Gunn, ‘The Children of Teenage Mothers: Patterns of
Early Childbearing in Two Generations’ Family Planning Perspectives. 22 (2).
Dryfoos, J.G. (1988). Putting the Boys in the Picture. Santa Cruz, CA: Network Publications.
This is considering the effectiveness of the contraceptive form. I am not including abstinence as a serious contraceptive method under scrutiny.
Population Crisis Committee (1993). ‘Injectable Contraceptives: Safe, Effective but Neglected,’
Washington DC.
Population Crisis Committee (1993).
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).
Levine, C. (1979). ‘Depo-Provera and Contraceptive Risk: A Case Study of Values in Conflict,’
Hastings Center Report. 9 (4).
Population Crisis Committee (1993).
Association of Reproductive Health Professionals (1992) ‘About Birth Control Shots,’ ARHP.
Washington DC.
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.
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.
Sheldon, S. (1987). ‘A New Delivery System for Contraceptive Steroids,’ American Journal of
Obstetrics and Gynecology. 157: 1090-1092.
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.
Burns, E. (1992). ‘Norplant Insertion and Removal (contraception device),’ Patient Care, 26 (5).
Sarma, S.P. & R. A. Hatcher (1994). ‘The Emory Method: a Modified Approach to Norplant Implants
Removal,’ Contraception. 49, 551-556.
Frank, M.L., Poindexter III, A.N., Cornin, L.M., Cox, C.A., & L. Bateman. (1993).
Hatcher, R. A. & J. Trussell (1994). ‘Contraceptive Implants and Teenage Pregnancy,’ New England
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.
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
Wolf, D. (1995). ‘Mona Charen Misleading About Welfare,’ The Daily Gazette. [Schenectady, NY]
Mar 31, B-15.
Board of Trustees (1992).
Jones, E.F. & J. D. Forrest (1989) ‘Contraception Failure in the United States: Revising Estimates from
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.
Polanczky, M., et al (1994).
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).
Allen, I. (1991). Family Planning and Pregnancy Counselling Projects for Young People. London:
PSI.
For males see Dryfoos, J. (1988) for females see Allen, I. (1991).
Clark, S., L.S. Zabin, & J. B. Hardy (1984).
Marsiglio, W. & F. Mott (1986). ‘The Impact of Sex Education on Sexual Activity, Contraceptive Use
and Premarital Pregnancy Among American Teenagers,’ Family Planning Perspectives. 18 (4).
Neuhaus, R. (1993). Commentary, National Review, 45 (15), 52-53.
Helms, J. (1984) ‘Testimony before the U.S. Senate Committee on Labor and Human Resources,
Sub-Committee on Family and Human Services,’ April 4.
Madonna’s book, Sex, contained several sexually explicit pictures. None of the photos displayed any safe sexual behavior.
Neuhaus, R. (1993).
Schawtz, M. & J. Ford. (1982). ‘Family Planning Clinics: Cure or Cause of Teenage Pregnancy?’
Linacre Quarterly. 49:143.
Zabin, L., M. Hirsh, et al (1986). ‘Evaluation of a Pregnancy Prevention Program for Urban Teenagers,’ Family Planning Perspectives. 18 (3).
Howard, M. (1990).
Eisen, M., G.L. Zellerman, & A. McAlister. (1990). ‘Evaluating the Impact of a Theory-Based
Sexuality and Contraceptive Program,’ Family Planning Perspectives. 22 (6).
Harris, L. & Associates, (1985). Public Attitudes About Sex Education, Family Planning, and Abortion
in the United States a poll conducted for Planned Parenthood Federation of America.
Newcomer, S. & J. Udry. (1985). ‘Parent - Child Communication and Adolescent Sexual
Behavior,’Family Planning Perspectives. 17 (2).
Redman, R. (1991). ‘Duke’s Bills Shelved,’ Baton Rouge Morning Advocate, July 1, 1B
Denmark, S. (1991). ‘Birth Control Tyranny,’ The New York Times, Oct 19, p. 23.
Shapiro, T. (1985). Population Control Politics: Women, Sterilization, and Reproductive Choice. New
York: Routledge.
Denmark, S. (1991).
National Research Council (1987).
Will, G. F. (1993).
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.
Mertus, J. & S. Heller (1992). ‘Norplant Meets the New Eugenicist: the Impermissibility of Coerced
Contraception,’ Saint Louis University Public Law Review, 11.
UBING. (1988). ‘The Norplant Trial: an Investigative Study on the Methodology and Ethical Issues,’
Hygiea. 3 (1 & 2).
In the case in Bangladesh, the agenda was to test Norplant in large trail cases.
Hatcher, R. A., J. Trussell, F. Stewart, et. al. (1994). Contraceptive Technology. 16th rev. ed. New York: Irvington.
Polanczky, M., et. al. (1994).
Most teenagers find it very difficult to spend $700 for contraception.
Schrater, A. F. (1992). ‘Norplant: Conflicting Veiws on its Safety and Acceptability,’ in Issues in
Reproductive Technology I: an Anthology, H. B. Holmes (ed), New York: Garland Publishing Inc.
Editorial Board (1994). ‘Expanding the Meaning of Choice,’ The New York Times. Jan 17, A-16.
Forrest, J. & S. Singh (1990).
Clark, S, L. Zabin, & J. Hardy (1984).
Jones, E. & J. Forrest (1989).
Kisker, E. (1984). ‘The Effectiveness of Family Planning Clinics in Serving Adolescents,’ Family
Planning Perspectives. 16 (3).
Zabin, L. & S. Clark. (1981). ‘Why They Delay: A Study of Teenage Family Planning Clinic
Patients,’ Family Planning Perspectives. 13 (3).
Eisen, M., G. Zellman & A. McAlister (1990).
Howard, M. (1990).
Clark, S, L. Zabin, & J. Hardy (1984).
Editorial Staff (1992). ‘Sex Education and Sex Related Behavior,’ Family Planning Perspectives.
18 (4).
Forrest, J. & J. Silverman (1989) ‘What Public School Teachers Teach About Preventing Pregnancy,
AIDS, and Sexually Transmitted Diseases’ Family Planning Perspectives. 21 (2).
Jones, E. (1986).
Gress-Wright, J. (1993). ‘The Contraception Paradox,’ The Public Interest. Fall 113.
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.

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