Contraceptive implants. Ooh, yuk. You don't want one of those. They put it in your arm and the next thing you know it's migrated to your brain! A kneejerk reaction? Absolutely. But one many women had, following the public discrediting of the Norplant implant, the first to be made available in this country in 1993. The supply of Norplant was discontinued in Britain earlier this year.
Next month, a new contraceptive implant for women, Implanon, will become available in the UK. But where Norplant came in with a fanfare when launched six years ago, Implanon's debut will be far more low-key. The manufacturer, Cambridge-based company Organon, are actively discouraging publicity. "There won't be an official launch," says a spokesman. "We are hoping for a slow build-up of awareness." This is not because it doesn't have faith in Implanon. But given the impact of what the Family Planning Association calls Norplant's "trial by media", they are keen to keep a low profile.
So have contraceptive implants been unfairly vilified? On the face of it, they seem an excellent option. Inserted under the skin of the upper arm under local anaesthetic they release a long-acting low dose of the hormone progestogen. Once in place they remain active for three to five years during which the woman need take no further action; no pills to remember, no devices or tubes of gloop to fiddle with. Once the device is removed, fertility returns to normal almost immediately. Norplant consisted of six small thin flexible rods; Implanon is a single piece of plastic smaller than a matchstick. "The principle of fit-and-forget contraception provides very good protection against pregnancy. The fact it doesn't have to be remembered or applied is fantastic," says Ann Furedi of the British Pregnancy Advisory Service (BPAS).
Norplant's problems stemmed from a number of complaints by women, including claims that their implants had migrated and couldn't be found for removal. These were seized on by journalists. At one stage, as many as 250 women were reportedly thinking of taking their cases to court. Since then, all actions against the manufacturer of Norplant have been dropped. But the damage had been done, and supplying the product became commercially unviable in Britain. "Without a shadow of doubt they had a rough ride," says Furedi. "First of all there was the bad press, though all attempts at compensation action collapsed." There was also, she says, wrangling behind the scenes. "GPs were reluctant to give it to women because, for bureaucratic reasons, there was a dispute about how much they would be paid for fitting it." It is, she says, "a tragedy that a good contraceptive was killed off by bad publicity and bureaucratic wrangles."
Problems with fitting weren't only of a bureaucratic nature, adds Toni Belfield of the Family Planning Association (FPA). "A few doctors felt they didn't need to be trained in fitting the implants. If an implant is put in badly, there will be problems. In clinical trials, put in by well-trained doctors, there were no failures." She points out that 55,000 women were using Norplant at one stage. "Demand was unrivalled. Our phone line was taking thousands of extra calls. For the first time, we could have a long-term reversible method of contraception. But any method is only as good as the user - or, in this case, the provider." The media, she says bluntly, "took Norplant to the cleaners" at the first sign of problems.
Hannah Grey was one of the 55,000 satisfied users of Norplant. She had hers fitted in 1994, aged 30. "It didn't hurt and just took a few minutes. My doctor did it at the local surgery. Once it was in place, you could feel it under the skin if you knew it was there, but it wasn't a bother at all. I had been on the Pill for ages and didn't want to use it anymore. I hated the diaphragm and my husband wasn't keen on condoms. We thought we'd try an implant but have it removed immediately if I didn't get on with it. I kept it for about four years and would recommend a similar method." Hannah had her Norplant removed with no problems in 1998. "I wanted to start a family, so I had the bits of plastic slipped out, the doctor used forceps. I was pregnant three months afterwards."
Whether the ignominy of Norplant has an adverse effect on Implanon remains to be seen. "Hopefully, women's concerns will be assuaged by the fact Implanon is a single rod and should be more straightforward to use," says Furedi. Implanon may be easier to insert and remove than Norplant, but women considering the device should make sure their GP has been trained in fitting it, she advises.
Whatever the success of Implanon, says Belfield, Norplant's legacy will linger. "This scare ultimately means a reduction in choice of contraception for women. Their confidence in hormonal methods of contraception is at rock bottom."
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