Birth Control: Vanishing Options

By Anastasia Toufexis

Rhonda Issler chose the Pill as her first contraceptive when she was a young adult in the early 1970s. But after five years, news of the Pill's potentially harmful side effects made her switch to an intrauterine device. Soon after, she suffered severe menstrual cramps and a pelvic infection. Issler eventually turned to the diaphragm, but she found its use messy and inhibiting. Now 33 and living in North Hollywood, Calif., the working mother of one relies uneasily on a combination of the rhythm method and the condom. "Birth control is a very important decision, but also a very frustrating one," she says. "The options are so limited."

Issler's lament is a far cry from the sexually liberated pronouncements of the 1960s. "The U.S. is going through a counterrevolution," says Richard Lincoln of New York City's Alan Guttmacher Institute. "We're moving backwards." Reason for the retreat: consumers' health worries and manufacturers' concerns about spiraling liability claims. Last January the IUD was nearly eliminated from the American market when G.D. Searle discontinued the Copper-7 and the Tatum-T. Defending just four Copper-7 liability suits cost the firm $1.5 million in legal fees, even though it won the cases. Sales of the Copper-7 amounted to only $11 million in 1985. A.H. Robins, the marketer of the Dalkon Shield, fared worse. After 9,450 lawsuits that cost $490 million, the pharmaceutical company still faces 6,000 legal claims and last year sought bankruptcy protections.

Loss of the Copper-7 has upset many family-planning experts. "In the past, inferior products have been pulled off the market," notes Dr. Louise Tyrer of Planned Parenthood. "Now superior products are being abandoned because of high insurance costs." The IUD has a failure rate of only 5% in the first year of use, she points out, in contrast to 19% for the diaphragm, l7% to 24% for sponges, 18% for spermicidal foams and jellies and 10% for condoms. But, observes Dr. Bruce Stadel of the National Institutes of Health, "a pharmaceutical company would have to be altruistic to the point of suicidal to market an IUD today."

A similar sentiment may soon apply to the manufacturers of spermicides. Earlier this year, a jury awarded $4.7 million in damages to a woman who claimed that her child's birth defects resulted from her use of Ortho-Gynol jelly. Most scientists have found the product safe, and the company, which is appealing, insists it has no plans to remove its foams and gels from the market. But, says Ortho's James Murray, "if the costs of litigation begin to exceed earnings, we couldn't very well continue."

What's left? Pill use dropped by nearly half in the decade since 1973, when the National Center for Health Statistics reported that 36.1% of married women between the ages of 15 and 44 preferred that method. This month the New England Journal of Medicine reported that the Pill does not increase the chance of breast cancer, even in many high-risk groups. The Journal concluded that the dangers are so small that "the vast majority of users will experience only the benefits." But many women are wary. The most popular birth control is now sterilization. One-third of sexually active women are either sterilized or have partners who are. Another choice is the sperm barrier, especially the condom. Its sales have increased dramatically, mainly because of the fear of sexually transmitted diseases, particularly AIDS and herpes. No longer hidden behind drugstore counters, condoms are openly displayed on self-service racks. The customers have changed too. Today women buy at least a third of all condoms, and they are not shy about asking their partners to use them. Says Deborah Agre of the Coalition for the Medical Rights of Women: "Women feel they can more legitimately ask, if not demand, that men take responsibility." Manufacturers of this vintage prophylactic have been quick to take note of shifting attitudes. Trojans has downplayed its helmet logo to emphasize mood scenes featuring romantic couples. Mentor and Lady Protex are new brands packaged specifically for women and sold next to tampons, sanitary pads and douches.

Birth-control specialists applaud the condom's effectiveness. Still, "it's like the horse and carriage," notes Dr. Harrith Hasson of the Society for the Advancement of Contraception. "It's a fine means of transportation, but if we had been satisfied to stop there, we would never have invented the car and the airplane." Unfortunately, research faces difficulties. Many companies have pulled back because of the cost of testing and the risk of suits. Federally funded research is down as well. Clinical tests of an NIH-developed implant system called Capronor stalled for more than a year because the company designated to study the device could not get insurance. Says Hasson: "We are rapidly becoming an underdeveloped nation in terms of contraception."

Indeed, several birth-control methods are available abroad but not in the U.S. Depo-Provera, an injectable contraceptive that prevents pregnancy for three months, is used in 86 countries. Ironically, it was created by the U.S.'s Upjohn Co., but it has repeatedly failed to win the approval of the Food and Drug Administration because of concern about side effects. Norplant, which releases a hormone for five years, is available in five nations. The implant was developed by scientists of the New York City-based Population Council and will be submitted to the FDA next year. But even if Norplant gains acceptance, it is unlikely that any American corporation will market it domestically because of the liability problems. If the U.S. wants newer, better contraceptives, consumers will have to change their attitudes, says Guttmacher's Lincoln. "The expectations in this country for perfection are unrealistic. There has never been a contraceptive device made that didn't have some risk."

With reporting by Robert Ajemian/Boston, with other bureaus