This Date in UCSF History: Birth Control Aborted in United States
Originally published in Synapse on October 4, 1990. Americans have fewer choices in practicing birth control than people in many other nations — a situation that has dire consequences for the health of women and children here.
The lack of progress in this country is due largely to political rather than scientific factors, and could be reversed if enough people, particularly health professionals and politicians, become active advocates for reproductive research and choice.
These were the basic themes emphasized Sept. 24 at a major conference held in San Francisco, sponsored by Planned Parenthood and numerous pro-choice and medical organizations, including UCSF’s Institute for Health Policy Studies.
A third-rate nation
“As Americans, we consider ourselves the most technologically-advanced people in the world, but we have fewer contraceptive options than some third-world countries,” said Philip Darney, UCSF professor in residence of obstetrics and gynecology.
“We’ve become a second-, even a third-rate country with respect to the introduction and availability of products for fertility reduction and treatment of infertility as well,” said Sheldon Segal, director of population sciences at the Rockefeller Foundation in New York and a pioneer in contraceptive research.
Reinforcing this idea was Vanessa Bedient, executive director of Planned Parenthood Alameda/San Francisco. She noted that “women in Bangladesh have more birth control options than many women here in Oakland.”
Segal listed a number of technologies widely available in Europe and Asia at present and said these are kept out of the United Suites by a number of forces.
“We require die longest period of time to approve a drug, partly for pseudo-scientific political reasons, our product liability climate is stifling, and there are organized groups in this country who practice ‘industrial terrorism,’ including boycott threats and outright violence against corporate executives or board members.”
Birth control options already available elsewhere include Norplant subdermal progestin implants, injectable progestin, additional lUDs, improved sterilization procedures for men and other formulations of birth control pills.
Potential new technologies being researched and in use in some countries include the intravaginal pouch or “female condom,” an over-the-counter disposable diaphragm, durable anti-viral “super-condoms,” various implantable mechanisms for releasing drugs into the body, contraceptive vaginal rings and pills, hormone-releasing lUDs, transdermal patches and non-surgical sterilization techniques.
Other methods probably further from acceptance here include RU 486, the French pill already widely in use as an early abortifacient in Europe (but with potential application as a contraceptive), better ovulation predictors and long-acting birth control “vaccines.”
None of these options are available and few arc being researched in the United States.
In America, voluntary sterilization is increasingly common and is currently the most commonly utilized contraceptive method among women of reproductive age, said Segal.
He estimates that 22 percent of women using any method opt for sterilization., indicating a level of desperation.
And as younger women elect to be sterilized, there are more instances of women later wishing to reverse the operation, which is a difficult and often unsuccessful procedure.
In addition, when relied upon alone, sterilization does not protect against sexually transmitted diseases.
Each year in this country, 1.5 million women become pregnant while using some method of birth control, and half of those pregnancies end in abortion.
According to Planned Parenthood, many of those pregnancies and the additional 1.9 million unwanted pregnancies occurring in women who do not practice birth control are the result of dissatisfaction with available options, widespread and often unfounded fears about health risks and side effects, or lack of resources and access to contraceptives.
“The irony about our government’s refusal to spend money on birth control is that such spending is one of the most cost-effective things we can do,” said Michael Policar, UCSF assistant professor in residence at San Francisco General Hospital and medical director of the Alameda/ San Francisco Planned Parenthood office.
“Good research shows that every dollar we spend in this area saves seven dollars in associated costs down the road.”
The fate of the planet
In developing countries around the world, observed Segal, 40,000 children die every day from preventable causes.
“But we don’t allow health and humanitarian aid organizations to use American dollars to research, talk about and provide the most effective means of preventing unnecessary infant and child deaths,” he said, referring to contraception and medical abortion.
There are federal restrictions on funding such activities, which shortsightedly defeats their goal — namely to decrease abortions and mortality.
According to the World Health Organization, at least 250,000 women around the world die from the complications of illegal abortion each year. “Research on birth control is actually ‘prevention of child death research’ or ‘abortion prevention research,’” said Segal.
On a global level, birth control could play a crucial role in making the future “livable,” said Joseph Speidel, president of the Population Crisis Committee.
“Unless the use of contraception doubles worldwide, the human population will triple before it levels off,” he said.
Noting that the number of major pharmaceutical companies involved in contraceptive research had declined from 13 in 1970 to four in 1987 (only one of which was American), Speidel said that the lack of research dollars, the liability and regulatory constraints, and the “chilling factor” of the spill-over of abortion-related controversy have also led to a dearth of young scientists entering the field.
“To a great extent, the fate of our planet depends upon the availability of new contraceptives,” Speidel warned. “But it’s stymied by a lack of political will and courage.”
‘Just use something’
Although the general mood at the meeting was one of frustration, a number of suggestions were made for breaking the barriers to progress.
“We need a public policy for birth control which says ‘just use something’ — ‘just say no’ will not work,” said Felicia Stewart of Planned Parenthood in Sacramento.
“We need to demedicalize birth control and make it as accessible as any of the far more dangerous things we advertise and sell over the counter, like guns or alcohol. We need to subsidize non-profitable products like the cervical cap and mobilize the profit motive in the pharmaceutical industry to look at consumer needs and fill them.
“Over 80 percent of Americans favor increased government spending on research and development of new and improved birth control,” Stewart said, referring to a 1988 Harris poll. “Government, scientists, and industry could take advantage of that support, but our leaders do not care.”
The Sept. 24 conference drew almost 200 people and was part of a nationwide series of such events, from which Planned Parenthood will develop an action plan for future years. Coordinators voiced their strong support for two legislative bills already introduced in Congress by Reps. Patricia Schroeder (D-Col) and Olympia Stowe (R-Maine). The bills are aimed at encouraging the United States to regain leadership in birth control and infertility research and development, and to take a practical, preventive approach to abortion issues. Speakers were cautiously optimistic about these and other related bills.
“We’ve got to issue a call to arms,” said Planned Parenthood’s Bedient, “against those who are seeking, so far fairly successfully, to put American women back into the reproductive Stone Age.”