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The Impact of Norplant on Minority Women

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The Impact of Norplant on Minority Women
Annotated Bibliography

Eric Ludwig

2nd Year Law Student
The University of Dayton School of Law
Fall 1998


This annotated bibliography provides an overview of the use of the Norplant contraception system. The primary focus of this bibliography is the effects of Norplant on minority communities. The development of Norplant has given the judiciary and legislature the ability to control the reproductive choice of poor minority women. Several judicial decisions have given convicted child abusers lighter sentences if they volunteer for Norplant implant or other sterilization techniques. State legislatures are also exercising control over some individuals reproductive choices by offering higher welfare benefits to recipients that voluntarily accept Norplant. One must ask, how voluntary are these choices? Is the government using coercive pressure to force poor minority women to accept Norplant.

This bibliography also covers recent developments in tort litigation of Norplant. I have included articles and case law to help the reader gauge the future of Norplant. Many Norplant patients complain of side effects from headaches to minor strokes, and surgeons are having a difficult time removing the implants. Wyeth-Ayerst Laboratories, the maker of Norplant is now involved in 650 lawsuits with 13,000 plaintiffs. However, the FDA continues to support Norplant as a safe and effective contraceptive. Only time will tell how this civil litigation will effect the viability of Norplant and the development of other contraceptive methods.

On December 10, 1990, the Food and Drug Administration approved the distribution and use of Norplant in the United States. This approval came nearly a decade after approval in Europe. This approval was heralded as the first significant advancement in contraceptive in thirty years. The Norplant contraceptive system requires a one time implantation of six match-sized plastic capsules. The capsules are surgically placed in a woman’s upper arm. Once inserted the capsules provide a continuous source of Levonorgestrel, which is a synthetic hormone that prevents pregnancy. The implantation procedure takes about fifteen minutes and only requires a local anesthetic. The capsule last for approximately five years.

Since Norplant is fairly inexpensive it’s popularity was immediate. Norplant is maintenance free, unlike other forms of birth control. Therefore, a woman does not need to remember to take a pill every day. Norplant is virtually as reliable as sterilization; however the process is reversible through the removal of the implants.

The very characteristics that make Norplant an exciting choice for women also provide the government with an opportunity to control a woman’s reproduction system. Shortly after Norplant’s introduction courts and legislatures began to consider it as a way to control the reproductive choices of poor minority women. 

The first example of judicial use of Norplant was the California case of People v. Johnson. In this case a superior court judge ordered a mother who pled guilty to child abuse to either accept Norplant as a condition of probation or receive a seven year prison sentence. There was never a written opinion filed in this case, so I will briefly describe the facts. At the time of this case, Darlene Johnson was a welfare recipient with four children and pregnant with another child. Her stepfather-in law reported her to the police for child abuse. Apparently she had beaten her children with a belt buckle and an electric cord. On December 3, 1990 (a week before Norplant was approved in the United States) she pled guilty to the charges.

A month later at sentencing, Judge Broadman offered Johnson the option of serving one year in prison and having Norplant surgically implanted in her arm for the duration of her probation. Otherwise the judge was going to sentence a seven year prison term. The judge then briefly described the Norplant implants. Ms. Johnson agreed to the reduced sentence and Norplant procedure as a condition of probation. Five days later Johnson filed a motion to reconsider, claiming she was not adequately informed about the Norplant procedure. She argued that her acceptance was not knowing and voluntary. Johnson also argued she suffered from medical conditions that made Norplant inappropriate. The judge rejected both arguments, he held the sentence was statutorily appropriate and Johnson’s acceptance was knowingly and voluntarily made. The judge also rejected Johnson arguments that she was medically unsuitable.

Darlene Johnson then appealed this decision. While awaiting her appellate hearing, Johnson violated her probation conditions by using cocaine. The court then revoked her probation and sentenced her to five years of prison. Therefore, the appeal became moot and the California Court of Appeals did not have the opportunity to issue a written opinion on the case. The Johnson case is mentioned in the majority of the following articles. The article, Judicial Control of Reproductive Freedom: The Use of Norplant as a Condition of Probation by Kristyn Walker provides an excellent description of the Johnson case and was the basis for most of this summary.

The second way the government can influence a woman’s reproductive decision is through legislative enticements. This bibliography presents some statutes that provide incentive for women to use Norplant. The majority of the incentives are directed at encouraging women on welfare to consent to Norplant implants. The state offers the women increased benefits if they voluntarily agree to Norplant.

The problem with judicial and legislative enticement of Norplant implants is the decision is not voluntary. As was seen in the Johnson case, the defendant had the option of seven years in prison or one year in prison and Norplant implants. This is not much of an option. Likewise when the state offers increased welfare benefits for Norplant use, the recipient does not have much of an option. Many of the recipients need the extra money to provide for themselves and their family. The choice to "voluntarily" submit to Norplant is their only other option beside starving. For these reasons a woman’s choice is coerced into accepting Norplant. Thus the state is effectively sterilizing these women. Most of the following annotations provide insight on how this coercion effects poor African American women.

On its face, these judicial and legislative decisions appear to affect all races equally. The unavoidable reality is that African American women are more likely to be reported for child abuse because they have substantially more contacts with government agencies. This because African American women are five times more likely to be welfare recipients and three times more likely to be unemployed than white women. This racial disparity leads to African American women face a greater chance to be coerced into accepting Norplant implants. 

Many of the annotations challenge the constitutionality of using Norplant in this manner. An individual in this country has a fundamental right to personal autonomy and privacy. Under this penumbra of constitutional rights, an individual has the right to bear children. Some of the annotations argue the use of Norplant in criminal sentencing is a violation of the Eighth Amendment which protect defendant from cruel and unusual punishment. In order to ultimately decide this question the court system must balance the interest of the state against the rights of individuals.

Many of the following annotations consider the moral and ethical problems facing the use of Norplant in criminal sentencing and welfare benefits enticement. The state’s interest in reducing the incidences of child abuse is a legitimate purpose. Likewise, the state’s interest in reducing the number of individuals on welfare is a legitimate interest. However, the use of Norplant to achieve these goals pose moral and ethical problems. The state is often taking the easy way out. Instead the government should develop programs that break the viscous chain of child abuse. The state needs to inform and counsel child abusers on proper parenting techniques. The state also needs to provide welfare mothers with the proper education, encouragement and opportunity to enable themselves. These solutions will provide the results the state wants, not attempting to extinguish the reproductivity of the poor.

Many of the annotations describe the Norplant medical procedure. Since its approval Norplant has faced a barrage of tort class action suits. Many patients complain of unbearable side effects. The women complain of headaches, vaginal bleeding, nausea, dizziness, moodiness, weight gain and nervousness. Despite these problems, Norplant is considered the most effective contraception system in reducing pregnancy. Another problem that arises with the Norplant implants is difficulty in the removal procedure. Many doctors improperly inserted the implant, thus problems have occurred in the removal process. 

The following bibliography contains twenty-three annotations dealing with the Norplant system. The annotations come from law review articles, state statutes, case law, and medical and sociological studies. I hope they provide the reader with a greater understanding of the Norplant system and its effects. 

The following articles are included in this bibliography:

Janice Castro, A Judge Whose Ideas Nearly Got Him Killed

Meredith Blake, Welfare and Coerced Contraception: Morality Implications of State Sponsored Reproductive Control 

Tenn. Code Ann. §71-5-133 

Barbara Bernier, Class. Race and Poverty: Medical Technologies and Sociopolitical Choices

Douglas Breman, The Rights and Wrongs of Norplant Offers

Joan Callahan, Contraception or Incarceration: What’s Wrong With This Picture?

Melissa Burke, The Constitutionality of the Use of the Norplant Contraceptive Device as a Condition of Probation

Rebecca Dresser, Long-term Contraceptives in the Criminal Justice System

Rachel Stephanie Arnow, The Implantation of Rights: An Argument for Unconditionally Funded Norplant Removal

S.C. Code §43-5-24 

Scott J. Jebson, Conditioning a Woman’s Probation on Her Using Norplant: New Weapon Against Child Abuse Backfires

Smith v. Superior Court of Arizona

Cal. Welf. & Inst. Code §11450.04 

Wash. Rev. Code §74.09.800

Kristyn M. Walker, Judicial Control of Reproductive Freedom: The Use of Norplant as a Condition of Probation

Darci Elaine Burrell, The Norplant Solution: Norplant and the Control of African American Motherhood

People v. Pointer

Rita Rubin, Stopping This Birth Control Can Hurt. Removing Norplant Capsules Takes Skill

Catherine Stevens-Simon & Lisa Kelly, Correlates and Consequences of Early Removal of Levonorgestrel Implants Among Teenage Mothers. (Norplant Contraceptive Implants)

Kathryn Ericson, FDA Says Norplant Is Safe, Approves New Package Insert

Linda M. Dinerman, Michele D. Wilson, Anne K. Duggan & Alain Joffe Outcomes of Adolescents Using Levonorgestrel Implants vs. Oral Contraceptives or Other Contraceptive Methods

Avondet v. Blankstien

Rita Rubin, Birth Control Failure Americans -- and Their Doctors--Ignore Some Effective Options

The University of Dayton School of Law

Eric Ludwig is a second year student at the University of Dayton School of Law in Dayton, Ohio. He graduated in 1997 from the University of Kentucky in Lexington, Kentucky, with a B.S. degree in Economics and Business Management.

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Janice Castro, A Judge Whose Ideas Nearly Got Him Killed, Time, Mar. 9, 1992.

This article is an interview of the Judge Howard Broadman. He is the judge that gave Darlene Johnson the option to use Norplant as a condition of probation. I used this article because the holding of People v. Johnson is not a matter of public record. I want to give the judge's reasoning for the sentence.

In the interview the judge states that he felt providing Ms. Johnson with the Norplant option was a compassionate decision. He felt that sterilization system would create less stress in the defendant’s life, thus helping her become a better parent. When asked if he violated Ms. Johnson rights to privacy, the judge answered that courts balance one right against another. He felt he was balancing her rights against the rights of others.

In an interesting side note someone tried to assassinate the judge, as a result to the decision to include Norplant in probation sentencing.

Meredith Blake, Welfare and Coerced Contraception: Morality Implications of State Sponsored Reproductive Control, 34 U. Louisville J. Fam. L.311 (1995-1996).

This article discusses the recent trends of state legislators to condition the receipt of welfare benefits upon submitting to the Norplant contraceptive. The primary focus is on the moral issues which these proposals raise. The author begins by providing a brief overview of historic and the modern movement toward coercive contraception use by women on welfare. Legislators and politicians in Arizona, Connecticut, District of Columbia, Florida, Kansas, Louisiana, Maryland, Mississippi, South Carolina, Tennessee, and Washington have proposed creating incentives for AFDC mothers to begin use of Norplant [1].

The most interesting section of this article deals with the coercion welfare mothers endure under these new welfare "reforms." Many women select Norplant without being completely informed about the risks associated with the procedure. Next the author poses the question of whether there is a real informed and voluntary choice between accepting the Norplant system or discontinued receipt of state aid. The welfare programs intice women by offering them extra welfare benefits. For these women the extra money may be the opportunity provide food and shelter for the woman’s family.

In conclusion, the author suggest politicians should develop alternative to address the welfare problem. The government should provide alternative contraceptive programs for poor women. However, the author does not explore or identify any particular alternative.

Tenn. Code Ann. §71-5-133 (1996)

This Tennessee statute is an example of a the state placing increased emphasis on providing welfare mother with information about Norplant.

The statute states, "the department of human services shall provide written information concerning the availability through the medical program of the Norplant contraceptive implant." The statute also state, "such information shall be supplied to other women of child bearing age whose income is below the federal poverty level and are receiving any other state or federal government subsidies, including, but not limited to food assistance."

Douglas Breman, The Rights and Wrongs of Norplant Offers, 3 S. Cal. Rev. L.& Women’s Stud. 1 (1993).

This article outlines some of the proposed legislative initiatives to pay women to utilize Norplant. The author condemns these proposed initiatives because he believes they are racist and sexist. The proposed Norplant offers are racist because they focus on influencing the procreation decisions of women on welfare. The author states the disproportionate percentage of women receiving welfare are in fact minorities. Therefore the Norplant proposals have a racist eugenic undertone.

The article also describes the inherent sexism of Norplant proposals. Norplant system only sterilizes women. However, women do not become pregnant by themselves, but there are no proposals for male contraception systems.

The value of this article is its proposed alternatives to using state mandated Norplant sterilization. The author proposes a basic plan of offering financial incentives (through tax deductions) for people attening classes discussing responsible parenting. The purpose of these classes is to facilitate reproductive autonomy, not to encourage or dissuade use of contraception. These classes would be open to all people across the socio-economical spectrum, which alleviates any racist or sexist biases. 

Joan Callahan, Contraception or Incarceration: What’s Wrong With This Picture?, 7 Stan. L. & Pol’y Rev. 67 (1995-96).

This article take a very unique perspective on the use of Norplant in criminal sentencing. The author argues the use of Norplant as a condition of probation is both legally and morally acceptable when incarceration is the only other alternative. The author argues that making Norplant a condition of probation is simply an option given to the female defendant. The court system is not directly forcing the woman to receive the Norplant system, instead the defendant’s sentence is suspended on the condition she accepts Norplant. In other words, the defendant has a choice of probation with Norplant or incarceration. The choice is between a bad option of Norplant and a worse alternative of prison.

Many other commentators assert the use of Norplant in probation sentencing is coerced. These commentator state acceptance of Norplant is not voluntary when only other alternative is the threat of prison. [2]. The author attacks this reasoning by the analogy that "refusing to allow Norplant as a condition of probation because women are or would be ‘compelled’ to accept it as an alternative to incarceration is like preventing a mugging victim from handing over her cash on the grounds that her choice to do so is not free, thereby forcing her to accept the other alternative." [3].

The author conclude that the use of Norplant should only be an alternative to incarceration. The problem with both of these options is that neither the interest of women or children are served.

Melissa Burke, The Constitutionality of the Use of the Norplant Contraceptive Device as a Condition of Probation, 20 Hastings Const. L.Q. 207 (1992).

This article proposes that the criminal justice system should never order the use of Norplant as a condition of probation for mothers convicted of their first child-abuse offense. The article evaluates the constitutional issues of similar probation orders.

The author uses the California case of People v. Johnson to develop an analytical framework for determining when a state has a constitutionally compelling interest to justify the infringement of an individuals fundamental rights. This article provides a good overview of the Johnson case, which was the first time a judge used Norplant as a condition of probation for a child abuse conviction. The article then applies the facts to the three part compelling interest test. The three part compelling interest test is used to determine whether a condition of probation is constitutional. First, the condition must reasonably relate to the intended purpose; second, the value to the public must vastly outweigh ant resulting impairment of probationer’s rights; finally, other alternative must not be less subversive of constitutional rights. [4].

The author concludes that court ordered Norplant use may survive the compelling interest test. However, the justice system should only use Norplant in situations where the defendant is a repeat offender and the defendant volunteers to use Norplant. 

Rebecca Dresser, Long-term Contraceptives in the Criminal Justice System, Medicine and Health News, Jan. 1995.

This article analyzes the sentencing of Norplant in criminal cases. The author evaluates whether the Norplant is justified under the four goals of punishment: retribution, deterrence, incapacitation, and rehabilitation. These goals support the fundamental principle that the state is morally authorized and required to deprive convicted offenders of substantial freedom.

Norplant sentencing has its greatest justification in the goal of rehabilitation. In the Johnson case the judge’s rehabilitative claim was that by preventing future births the defendants stress level would decrease. The author implies the use of Norplant will have a disproportionate effect on minorities, but never develops this idea.

The author concludes that when judges offer Norplant as a probation condition, then the judge should offer at least one additional nonincarcerative option. This would alleviate some of the coercive problems with sentencing Norplant.

Rachel StephanieArnow, The Implantation of Rights: An Argument for Unconditionally Funded Norplant Removal, 11 Berkley Women’s L.J. 19 (1996)

This article addresses the problems with state Medicaid policies that provide unconditional funding for insertion of the Norplant contraceptive but restrict the funding for removal. These policies can effectively sterilize indigent recipients who want the Norplant strips removed. In almost every state, Medicaid coverage will fund both the cost of insertion and removal of Norplant. However, the states of South Dakota, Oklahoma, and South Carolina limit the funding for removal. South Carolina expressly exclude removal funding to relieve medical side effects. Oklahoma and South Dakota exclude funding removal for the purpose of conceiving children.

The author asserts the restrictions on Norplant removal is an direct violation of section 1396 of the federal Medicaid act. [5]. This section allocates federal money for furnishing "medical assistance on behalf of families...whose income and resources are insufficient to meet the costs of necessary medical services." [6]. The author then concludes these statutes violate fundamental rights of the Constitution. In Cruzan v. Missouri Dept of Health, the rights to withdraw medical treatment was established. [7]. In Grizsold v. Connecticut, the Court established the right to procreative freedom. [8].

S.C. Code §43-5-24 (1997)

When an individual applies for assistance through the Aid to Families with Dependent Children Program, the Department of Social Services must provide the applicant with information on methods of contraception and family planing, excluding abortion counseling.

Barbara Bernier, Class. Race and Poverty: Medical Technologies and Sociopolitical Choices, 11 Harv. Blackletter J. 115 (1994).

In this article the author asserts that the Hippocratic Oath which provides the ideal standard of medical care is often ignored when the patients are minorities. The article begins with a historical overview of the medical abuses endured by African Americans in the United States. The most documented of these abuses was the famous Tuskegee Syphilis Study. For forty years the United States government performed research on the effects of syphilis using poor, uneducated black men in Alabama. These patients were denied penicillin, which is the most effective cure. 

The author then describes modern eugenics policies in the United States. This discussion is divided into two parts. First, the author discuses how the court system ignores the Supreme Court decision in Skinner v. Oklahoma, which established that individual’s have a fundamental right to procreate. [9]. Yet, this right is increasingly ignored by sentencing judges which allow child abuse and rape defendants the choice between sterilization or incarceration.

Secondly, the author warns that legislative and judicial sanctions of Norplant will have a disparate impact on minority communities. The author implies that making Norplant a condition of probation will coerce welfare mothers into using the contraceptive. 

Scott J. Jebson, Conditioning a Woman’s Probation on Her Using Norplant: New Weapon Against Child Abuse Backfires, 17 Campbell L. Rev. 301 (1995).

In this article the author takes the position that Norplant as a condition of probation is unreasonable. In People v Dominguez, the California Appellate Court established a three-part test to determine if a probation condition is reasonable. [10]. Under the Dominguez test a probation condition is unreasonable if it: 1) has no relationship to 

the crime of which the offender was convicted; 2) relates to conduct which is not itself criminal; and 3) requires or forbids conduct which is not reasonably related to future criminality. [11].

The author concludes that Norplant probation conditions fulfill each prong of the Dominguez. First, Norplant sterilization has no relationship to child abuse, because child abuse is the result of poor parenting skills, not to many children. Second, bearing children is not an illegal activity. Third, Norplant prohibits conduct which is not related to future criminality. The court can avoid future incidences of child abuse by placing the victim under protective custody. For these reasons, the author believes Norplant is an unreasonable condition of probation.

In conclusion, the author suggests the court should rehabilitate defendants with Parents Anonymous classes. These classes teach parents appropriate discipline skills.

Smith v. Superior Court of Arizona, 725 P.2d 1101 (1986).

In this case the defendants pleaded no contest to a class five felony (child abuse). The defendants were the parents of the child. The were charged with child abuse which resulted in the death of a nine month old baby. The defendant mother had left the child unattended for several days while the child suffered from a viral infection. A pathologist reported that when the baby was found it was in the initial stages of decomposition, and had not been feed in days. The court noted the child died slowly in great pain and alone, either no one heard or no one cared about his screams for help. [12].

The trial judge sentenced the mother to the maximum sentence of two and one half years. However, he informed the defendants that if they agreed to voluntary sterilization, he would reduce the sentence to one and one half years. The defendants contended the court lacked jurisdiction to impose this condition because no statutory authority allows sterilization as a condition of sentencing. The defendants claimed the judges option was illegal and unconstitutional.

The Supreme Court of Arizona held the trial judge does not have the jurisdiction to impose sterilization as a condition of reduced sentencing. The Court held that specific statutory authorization must be on point for such a sentence.

Cal. Welf. & Inst. Code §11450.04 (West 1998)

This statute places a prohibition on increased welfare payment for any child born into a family already receiving welfare. Except any child who was conceived as a result of contraceptive failure if the parent was using an intrauterine device, a Norplant, or the sterilization of either parent.

Wash. Rev. Code §74.09.800 (1996).

The Maternity care access program shall, consistent with the state budget act, develop a maternity care access program designed to ensure healthy birth outcomes as follows: (8) Provide family planning services including information about the synthetic prosestin capsule implant form of contraception, for twelve months immediately following a pregnancy to women who were eligible for medical assistance under the maternity care access program during that pregnancy.

Kristyn M. Walker, Judicial Control of Reproductive Freedom: The Use of Norplant as a Condition of Probation, 78 Iowa L. Rev. 779 (1993).

This article addresses the primary role of probation in the criminal justice system. Then the author analysis whether the use of Norplant as a condition of probation is reasonable. The author take the position that sentencing Norplant as a condition of probation, does not serve the rehabilitative function. The sentencing of Norplant must have some direct and reasonable relationship to the crime of child abuse. Birth control or sterilization will not cure the psychological problems which cause child abuse. Abuse is a disease caused by many aggravating factors such history of family violence, drug addiction, and financial difficulties. Therefore, using Norplant as a probation condition will not resolve any of these factors. 

The author also determines whether the use of Norplant as a condition of probation is a cruel and unusual punishment under the Eight Amendment. The use of Norplant is an inherently cruel punishment. The use of sterilization is certainly a cruel and unusual punishment because it take away an individuals right of freedom of bodily invasion.

This article also emphasizes the racial impact of Norplant use. The author provides statistics which find that African American women are more likely to be reported for child abuse, because health care professionals are more likely to report minorities. [13].

Darci Elaine Burrell, The Norplant Solution: Norplant and the Control of African American Motherhood, 5 UCLA Women’s L. J. 401 (1995).

This article addresses the legal implication of coercing poor African American women to use Norplant. The article gives a historical analysis of the eugenics movement and the constant devaluing of African American motherhood. This historical movement now takes the form of using Norplant to control poor African American women on welfare and probation sentencing. The article discuses how African American women on welfare and Caucasian women on welfare are treated differently. Essentially African American women are treated as less deserving of the right to bear children. 

The author concludes by calling for a women’s movement to provide a voice for these women. Without this movement poor African American women will not be treated fairly.

People v. Pointer, 151 Cal. App. 3d 1128 (1984).

In this case a woman was convicted for child endangerment and violation of a custody decree. Ms. Pointer endangered her children’s health by imposing a strict macrobiotic diet. This diet of exclusively grain products resulted in the malnourishment and underdevelopment of the children. The defendant refused to listen to medical advice about proper nourishment. This resulted in the youngest child’s hospitalization. Thereafter the state of California took the children into protective child custody.

The trial judge ordered the defendant not to conceive any children during her probation. He felt this condition was in appropriate because the defendant refused to accept responsibility of her conduct and stated she intends to continue her actions in the future.

The California Court of Appeals found the trial court had not abused its discretion, and the condition was reasonable according to the Domiguez test. However, the appellate court found the trail judge had violated the defendants constitutional rights, because there were less restrictive alternative available.

This decision leaves the door open for sterilization if a trial judge can argue sterilization is the least restrictive means. The Appellate Court had the chance to hold sterilization is never permitted, but they decided the case on technical grounds. 

Rita Rubin, Stopping This Birth Control Can Hurt. Removing Norplant Capsules Takes Skill, U.S. News & World Reports, July 25, 1994.

This article describe the difficulty women are facing in having the Norplant contraceptive system removed. The informational booklet describing the Norplant procedure states that removal should take 15-20 minutes. The procedure should only require a local anesthetic. However, some women are having to return for several removal sessions because improper insertion of Norplant was conducted incorrectly. Sometime during the extraction procedure swelling makes some of the strips impossible to locate and remove. Some doctors improperly inserted the strips underneath a layer of fat instead of directly beneath the skin. This has lead many physician to refuse to remove the strips for fear of liability.

Catherine Stevens-Simon & Lisa Kelly, Correlates and Consequences of Early Removal of Levonorgestrel Implants Among Teenage Mothers. (Norplant Contraceptive Implants), 9/1/98 Arch. Pediatr. & Adoles. Med. 893 (1998).

This study was to address the problem of repeated pregnancy among teenage mothers. The authors believe that Norplant could decrease the number of accidental and unintended pregnancies reducing the gap in contraceptive vigilance. The study focused on whether adolescent mothers who request early removal of Norplant implant due to adverse effects. Of the 181 patients, 66 requested early removal of their Norplant strips. A significant portion of the mother that had the implants removed felt they could make their boyfriends pleased by becoming pregnant.

Ninety-one percent of the patients reported adverse effects from the Norplant implants. The most common effect was moodiness (70%), irregular vaginal bleeding (65%), headaches (61%), depression(46%) and weight gain (44%).

The authors conclude that Norplant insertions are the most consistent to reduce unwanted adolescent pregnancy, which remains a significant public health issue for the United States. The authors suggest that more effective counseling before Norplant insertions could result in fewer removals.

Kathryn Ericson, FDA Says Norplant Is Safe, Approves New Package Insert, West’s Legal News, Aug. 22, 1995.

On August 17, 1995, the Food and Drug Administration issued a statement reaffirming its stance that the Norplant contraceptive device is safe. The FDA has found no basis for questioning the effectiveness and safety of the Norplant system. However the FDA approved of new educational materials that include a discussion of possible side effects including vaginal bleeding, headaches, nausea, dizziness and nervousness. 

Linda M. Dinerman, Michele D. Wilson, Anne K. Duggan & Alain Joffe Outcomes of Adolescents Using Levonorgestrel Implants vs. Oral Contraceptives or Other Contraceptive Methods., 9/1/95 Arch. Pediatr. & Adoles. Med. 967 (1995).

This article presents the results of a medical study of 166 sexually active adolescents. The purpose of this study was to gather information about sexual activity of these patients after each chose a form of contraception. The patients who chose Norplant as their contraceptive resulted in one patient (2%) becoming pregnant. Of the patients that chose oral contraceptives, thirteen (20%) became pregnant. The main reason for the failure of oral contraceptives was the patients forgetting to take the pill. Several of the subjects discontinued Norplant use because they suffered headaches, mood swings, weight gain, nausea, amenorrhea and hair loss.

The authors suggest that Norplant implants are a more successful method of contraception for adolescents. The authors also stated Norplant patients were generally satisfied with them. The authors warn that adolescents interested in Norplant should receive extensive counseling about potential side effects. Adolescents who are unable to tolerate menstrual irregularities may not be good candidates for implant use.

One of the issues barely covered was the potential for increased incidences of sexually transmitted diseases due to reduced condom use. The authors stated that the number of STD’s did not differ among the groups.

Avondet v. Blankstien, 692 N.E.2d 1063 (1997).

In this civil case the Ohio Court of Appeals upheld a verdict for woman who became pregnant after implantation of the Norplant system. The Plaintiff later aborted the fetus. The jury awarded $30,000 in actual damages. The trial court granted defendant motion for denial of punitive damages because the defendant had no malice.

I selected this case because it gives a good condensed description of the insertion of Norplant through expert testimony. In this case the plaintiff became pregnant because the doctor implanted the Norplant system after the plaintiff’s menstrual cycle. Therefore the defendant should have advised plaintiff to use other forms of birth control until the next menstrual cycle. 


Rita Rubin, Birth Control Failure Americans -- and Their Doctors--Ignore Some Effective Options, U.S. News & World Reports, Mar. 3, 1997.

This article describes how the use of Norplant as a contraceptive has dropped. In 1994, more than one million women used Norplant, however the popularity has significantly decreased due to well publicized lawsuits against the manufacturer. The lawsuits blame Norplant for a variety of adverse symptoms. Also the lawsuits charge Norplant is to difficult to remove. Wyeth-Ayerst Laboratories which is the manufacturer of Norplant is currently engaged in over 650 lawsuits involving 13,000 plaintiffs. Birth control experts believe this massive amount of litigation is preventing laboratories from researching newer forms of birth control.

A chart reveals that Norplant is the most effective contraception system for preventing unintended pregnancy. Norplant has only a 0.05% failure rate as compared to the 6% failure rate for birth control pills and 18% for condoms.


1. Meredith Blake, Welfare and Coerced Contraception: Morality Implications of State Sponsored Reproductive Control, 34 U. Louisville J. Fam. L.311, 319 (1995-1996).

2. Melissa Burke, The Constitutionality of the Use of the Norplant Contraceptive Device as a Condition of Probation, 20 Hastings Const. L. Q. 207, 207-226 (1992).

3. Joan Callahan, Contraception or Incarceration: What’s Wrong With This Picture?, 7 Stan. L. & Pol’y Rev. 67, (1995-96).

4. People v. Beach, 147 Cal. App. 3rd. 622.

5. 42 U.S.C. §1396 (1986).

6. I.D.

7. 497 U.S. 261, 269 (1990).

8. 381 U.S. 479, 484 (1965).

9. 316 U.S. 535 (1994).

10. 64 Cal. Rptr. 290, 293 (1967).

11. I.D.

12. 725 P.2d 1101, 1102 (1986).

13. Helen R. Neuborne, In the Norplant Case Good Intentions Make Bad Law, L.A. Times Mar. 3, 1991. 


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