A Bitter Pill to Swallow

By Philip Elmer-DeWitt

The dirty little secret about the birth-control "revolution" is this: three decades after the introduction of the Pill, many of the more than 57 million American women of childbearing age are still unable to control their reproduction. The proof: about six million unwanted pregnancies occur in the U.S. each year. Not only are all the available methods of contraception inconvenient, only partially effective or potentially risky, but the array of devices to choose from is also getting smaller, not larger. Some women must visit several doctors and spend hundreds of dollars before finding the contraceptive that is best for them. Others, especially teenagers, just avoid the hassle and go unprotected. The situation is forcing men and women to make painful choices -- to have abortions or be sterilized at an early age.

The dismal state of birth control in the U.S. was highlighted last week in a study issued by the National Academy of Sciences (NAS). The report states that American contraceptive research has come to a virtual halt, causing the U.S. to fall far behind other countries in developing new techniques. Methods available overseas but not in the U.S. include an injection that provides two months of protection and a skin implant that can release a contraceptive hormone into the bloodstream for up to five years.

In Europe, which is years ahead of the U.S., pharmaceutical companies are aggressively pursuing male birth-control pills, reversible vasectomies and long-lasting vaccines. Even women in many Third World nations have more choices than their American counterparts. Observes Carl Djerassi, a Stanford chemist who helped develop the first Pill: "The U.S. is the only country other than Iran in which the birth-control clock has been set backward."

Part of the reason lies with the U.S. Food and Drug Administration, which has been extraordinarily slow and cautious in deciding whether new drugs are safe or not. It can take up to $50 million and as long as 15 years to move a contraceptive from the laboratory to approval for use in the U.S. What really frightens pharmaceutical companies, however, is the threat of liability suits, like the legal barrage that drove A.H. Robins into bankruptcy after its Dalkon Shield intrauterine device was found to have damaging side effects. No wonder that of the nine major U.S. firms that were conducting contraceptive research 20 years ago, only one is still doing so.

Efforts to boost federal support for birth control have run up against conservative opposition. Right-to-lifers are particularly determined to block the U.S. introduction of RU-486, a French-made drug that can induce menstruation after fertilization takes place. Opponents call RU-486 the abortion pill. "Contraception," says Judie Brown, president of the American Life Lobby, "means better killing through chemistry."

And yet the failure to develop any new kinds of contraception has helped lead to 1.5 million abortions a year in the U.S. By some estimates, up to half of them could be prevented if women had more birth-control options. Jennifer, a 20-year-old college student in Maine, has already had two abortions, following unsuccessful attempts to use the Pill and a diaphragm. "At this point I'm afraid to have sex," she says. "I don't know what to use."

Amy, a 24-year-old Manhattan film producer, has also searched unsuccessfully for a contraceptive she can trust. First she was fitted with a diaphragm, but felt it was too obtrusive and unreliable. She switched to an over-the-counter spermicidal sponge, but it did not work. She got pregnant and had an abortion. Four months ago, she began taking an oral contraceptive. Her moods became unpredictable, as if she were riding an emotional roller coaster. Lately she has felt better, but she is still terrified about the Pill's long-term health effects. "Something has to be done so a woman doesn't worry so much," she says. "It infuriates me."

The plight of women like Jennifer and Amy will not improve until there is an overhaul of federal policy on birth control. The NAS report calls on the FDA to streamline its stringent rules for the approval of new contraceptives. The authors also recommend that pharmaceutical companies be given federal protection from liability suits so that they will be encouraged to get back into the contraceptive business. Unless something is done quickly, the situation for U.S. women may be no better in the 21st century than it is today.

With reporting by Georgia Harbison/New York and Dick Thompson/Washington