More than a dozen states have introduced Bills that encourage using Norplant as social policy and to cut welfare bills. This includes financial incentives for mothers on benefit to use Norplant, or requiring them to use it if they want to continue receiving money. In Maryland, extra funding has been allocated to make it available to more than 2,000 poor women.
A school in Los Angeles and another in Baltimore have added Norplant to the range of contraceptives on offer, and others are expected to follow. In addition, several court cases have resulted in rulings that women who have injured their children should use the implant. A judge in the Californian Superior Court ordered a mother of four, found guilty of abuse, to use Norplant or face a stiffer sentence. So far only one woman in Illinois, who murdered one of her children, has been fitted with Norplant.
Sandra Waldman, of the Population Council, a non-profit research organisation based in New York which developed the implant, said yesterday: 'People are using Norplant as a way of solving difficult (social) problems . . . that should be tackled in another way.' The state legislative action is aimed at women on welfare, while court action so far has dealt with women who have killed a child, she said.
The Norplant issue has been simmering away since the implant was approved by the US Food and Drug Administration in December 1990. Shortly afterwards, the Philadelphia Inquirer newspaper ran an article entitled 'Poverty and Norplant: can contraception reduce the underclass?' Journalists on the paper forced a retraction. But the controversy really took hold late last year when city council officials in Baltimore announced proposals to make Norplant available to teenagers through the school system in 1994. The city has one of the highest schoolgirl pregnancy rates in the country, with one in 10 girls between the ages of 15 and 17 getting pregnant in 1990. Black girls are particularly high-risk. Norplant, which does not rely on a teenager remembering to take the Pill, was seen as a solution. Others saw it as a 'tool of black population control'.
Ms Waldman points out that the controversy focuses on a minority of women, and it is not known how many states are actually putting legislation on contraceptive use into practice. She is concerned that 'politicisation' is detracting from the benefits of what is the most reliable long-acting and easily reversible contraceptive known.
'No woman should be forced to use a contraceptive and no woman should be denied one. The important thing is making an informed choice,' she said.
A spokeswoman for the Family Planning Association, which is compiling an information leaflet about Norplant, said that a similar controversy surrounded the contraceptive injection Depo-Provera, which is effective for three months. There have been reports of doctors using it in teenagers and women from ethnic minorities who do not use the Pill without their consent.