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Birth control forces tough choices

Chris was careful. Every day, at the same hour, she took a birth control pill. She also took pills to prevent seizures. That medicine, her doctor said, would make her oral contraceptive slightly less reliable but still 95 percent effective, which sounded to her like good odds. Until she got pregnant.

Single, 22, and looking for a new job, Chris decided she wanted children someday, but not now. So, last week she went with her mother to the St. Petersburg Woman's Health Center and had her first abortion.

"It's important to realize that people who are trying to be responsible, it can happen to them, too," she said afterward. "I wish there was something that was 100 percent effective."

Similar stories are told every day in cities throughout the United States. On an average day, more than 6,000 abortions are performed on American women and girls who say they were taking contraceptives. In the White House, our last two presidents have called for a constitutional amendment that would require women who get pregnant to become mothers.

Yet the federal government spends little to encourage the search for more effective contraceptives, and private research is almost at a standstill. By now, the United States has fallen decades behind Europe in developing new contraceptives.

In this field, "the United States has gone from being a world leader to being in the backwaters," said Dr. David A. Grimes, a contraceptive research specialist at the University of Southern California.

And because little research is being done now on contraceptive products that will need extensive testing before they can be sold, "we're condemned to another decade or decade and a half of nothing new," he said.

In the meantime, millions of American women who rely on today's methods of birth control will someday be forced to choose between having an abortion or an unwanted child. Rather than face that choice, many others will pay a surgeon to render them sterile.

More than 3-million unplanned pregnancies a year occur in the United States, 43 percent because contraceptives failed or were used incorrectly, according to the Alan Guttmacher Institute, a private research organization. Half the unplanned pregnancies end in abortion.

The reasons why so little is being done to reduce that risk are spelled out in an important little book released on Valentine's Day. A project of the National Academy of Sciences' research council, it details the findings of a national committee of experts and bears the prosaic title, Developing New Contraceptives: Obstacles and Opportunities.

The committee found a host of obstacles. Its members blamed the lack of contraceptive research in America on legal, regulatory, social and financial barriers.

Much of the legal trouble can be blamed on a single intrauterine device (IUD). The side effects of the Dalkon Shield, a product introduced in 1968 without federal safety tests, included accidental pregnancies, spontaneous abortions and pelvic infections. About 320,000 liability claims later, its maker went bankrupt.

The pharmaceutical industry, stung by huge judgments against the Dalkon Shield and other contraceptive products, lost interest in looking for new ones. Once, nine major U.S. drug companies were involved in contraceptive research. Now there is one.

The Food and Drug Administration (FDA), fearing another Dalkon Shield will reach the market, has chosen to reject contraceptives that dozens of other countries have approved.

The anti-abortion movement, arguing that life begins at conception, is fighting the development of any contraceptive device that can destroy a fertilized egg.

And the politicians have stayed on the sidelines. In the last 15 years, the federal money spent to develop better contraceptives wouldn't buy one Stealth bomber today. Moreover, annual federal spending has been erratic enough to dissuade young scientists from starting a career in contraceptive research.

For all those reasons, "we have not paid enough attention to contraceptive development," said William A. Campbell, a law professor who served on the academy's committee of experts.

"We have let an area of research and development that is extremely important to the health of women slide. We have, I think, labored under the the assumption that existing methods were okay. We had the pill, we had condoms, a few IUDs, what do you need?"

Too few choices

In about 90 countries, women can take an injectable contraceptive that lasts up to three months instead of a daily pill. Since the early 1980s, women in Finland and Sweden have used a contraceptive implanted under the skin of the upper arm that provides protection against pregnancy for up to five years. In the Netherlands, which supplies minors with contraceptives, the teen pregnancy rate is one-seventh that of the United States.

On the frontiers of contraceptive research, scientists are studying chemical contraceptives for males, vaginal rings that suppress ovulation by continuously releasing steroids, pills that induce menstrual periods, ovulation timers and anti-pregnancy vaccines.

In the United States, oral contraceptives were introduced in 1960. IUDs followed four years later. Since then, rocket scientists have put astronauts on the moon and congressmen in space shuttles. Medical science has entered the age of organ transplants, developed laser beams that vaporize tumors and introduced a robot arm that assists in brain surgery. The science of birth control remains pretty much the same.

Oral contraceptives are sold in smaller doses today. The Dalkon Shield is gone, but so are most other IUDs. Diaphragms have joined condoms on the list of physical barriers that work most of the time, and there is a new sponge that may protect a woman from some sexually transmitted diseases but is not especially effective at preventing pregnancy.

"There just hasn't been a lot of change," said Susan Tew of the Alan Guttmacher Institute.

Collectively, the available contraceptives aren't being used very successfully. More than half the pregnancies in the United States are unplanned.

Worldwide, the most serious consequence of inadequate contraceptives is the death of the mother. Yearly, about half a million women die from causes related to pregnancy. In the United States, a contraceptive failure is more likely to interrupt a career, cause dependence on the social welfare system or bring another client to an abortion clinic.

On a typical Saturday, about 20 pregnant women come to a health clinic in Tallahassee for abortions. Often they are greeted by protesters waving signs that accuse them of murdering babies. Inevitably, some were taking contraceptives they thought would prevent pregnancy.

Typically, "as many as four of those women are pill-takers," said Lynn Rosenthal, the clinic director, and the most common culprit is a prescription drug that counteracts the chemistry of oral contraceptives. The effectiveness of birth control pills can be lost when a woman forgets to take one, vomits or suffers diarrhea, or takes one of several prescribed drugs, including the common antibiotic tetracycline.

Yet pills are among the most reliable methods of contraception. Other methods have fewer side effects and a higher risk of pregnancy. The safety and effectiveness of a diaphragm depend greatly on the user's ability to follow instructions carefully, and broken or spilled condoms probably result in "over 500,000 accidental pregnancies in the United States each year," the National Academy of Sciences report estimates.

"You tried birth control pills, and you got migraine headaches. You tried a diaphragm, and it gave you bladder infections. Your boyfriend hates condoms, and the spermicides make you itch. Now you tell me, what are you going to do?" Rosenthal asked.

In growing numbers, American women and men are turning to a reliable but often irreversible alternative. They get sterilized.

Today, an estimated 40-million American couples practice some type of contraception. One-third rely on surgical sterilization of the female or male. Sterilization is now believed to be the most common method of human birth control in America, followed closely by oral contraceptives.

Many later regret being sterilized.

Dr. Edward Zbella, a Pinellas County surgeon, averages one call a day from women who want their sterilization operations reversed. He warns them that the fee is substantial, and the results uncertain.

Catherine, a 32-year-old St. Petersburg woman, decided to take the risk. Impregnated as a teen-ager, she gave birth to a severely retarded daughter. She was sterilized in 1982. The absence of a safe, reliable contraceptive was "a big factor" in that decision, she said.

In her case, the reversal operation worked. "I'm pregnant now," she said.

When it doesn't, the patient loses the chance for parenthood and up to $10,000, minus whatever an insurance company will pay.

The need is there

Norplant, the implantable contraceptive, may be approved for use in the United States this year. Depo-Provera, an injectable contraceptive, is now being used in Europe, Asia and Canada, but was rejected in the United States by the FDA, which cited a study showing a high incidence of mammary tumors in beagles injected with the drug.

Human tests on male contraceptives are just beginning, and researchers doubt any will reach the market this century. RU-486, a pill that induces early abortions, has been approved for use in France and China and is being tested on a limited number of American women by Dr. Grimes at the University of Southern California. "There is an intense national interest" in the drug, he said, but "we'll see it all over Europe and the world before it comes to the United States."

The authors of Developing New Contraceptives did not endorse specific products. Instead, they pointed to the growing number of surgical sterilizations, the high abortion rate and "the very high rate of teen-age pregnancy" as evidence of the need for better contraceptives.

They call for increased federal support of contraceptive research, greater regulatory recognition of the potential health benefits of contraceptives and a change in product liability laws that would allow drug companies to use FDA approval of contraceptives as a partial defense.

Family planning groups welcomed the report; anti-abortion groups did not.

The report asks many Americans to accept trade-offs. If the anti-abortion movement really wants to reduce the abortion rate in America, it may have to draw a moral distinction between the destruction of a 5-month-old fetus and a fertilized egg. If couples want better contraceptives, they may have to limit their right to file $5-million lawsuits against the manufacturers. If parents don't want to see their daughters pregnant, they may have to consider how inadequate and inaccessible today's contraceptives are to teen-agers who decide to try sex.

David Olinger is a staff writer for the St. Petersburg Times.

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