Less invasive and less permanent than vasectomies or tubal ligations, Norplant has breathed fresh life into the prospect of socially prescribed sterilization. A month after the device's approval by the FDA, a California judge gave a woman convicted of child abuse the choice of getting a Norplant or going to jail for two to four years. That same year, 1991, a Texas judge ordered another woman convicted of child abuse to get Norplant as a condition of her sentence. Politicians were a little slower to see the potential; Louisiana gubernatorial candidate David Duke was ahead of the curve in 1991 when he proposed cash payments to welfare mothers who agreed to use Norplant. But in the first half of 1993, 17 legislative measures were introduced in 10 states involving the use of Norplant as a coercive form of birth control for women convicted of child abuse or drug addiction or, in some cases, for any woman on public assistance.

While the use of Norplant as an express tool of social engineering has yet to elicit a court challenge, the ACLU has argued that making a woman "choose" between prison and Norplant violates her fundamental constitutional right to control her own body, particularly since the device cannot be removed without a medical procedure. "Allowing judges and legislators to control the reproduction of some women would legitimize the role of government as an overseer of women's childbearing capacity in general," according to one ACLU paper. As the ACLU puts it, "The incentive plans target women on welfare, and the sentencing tactics have been disproportionately aimed at low-income women of color. These policies are reminiscent of the eugenics movement earlier this century, which targeted low-income, non-English speaking women and women of color for forced sterilization."

The R&D genesis of Norplant gives critics more ammunition. Back in 1974, National Security Council head Henry Kissinger commissioned a study to articulate a worldwide population policy. The resulting report noted that the U.S. comprised just 6 percent of the world's population yet used about a third of its resources, and that one way to avoid increased competition for that lion's share was to restrict local consumption through population control programs. One declassified NSC paper unearthed by the anti-abortion American Life League, entitled "Implications of Worldwide Population Growth for U.S. Security and Overseas Interests," prudently noted that "it is important in style as well as substance to avoid the appearance of coercion." Another NSC document, written two years later, found that, "In some cases, strong direction has involved incentives such as payment to acceptors for sterilization, or disincentives such as giving low priorities in the allocation of housing and schooling to those with larger families. Such direction is the [essence] of an effective program." By 1977, a high-ranking official in the U.S. Agency for International Development (USAID) was quoted as saying that his agency's goal was to sterilize one quarter of the world's women.

Enter Norplant. Wyeth-Ayerst Laboratories, the maker of the device, proudly states in its literature that Norplant has been tested "for over 20 years in 55 countries worldwide." Much of that testing has been carried out by The Population Council, a nonprofit organization founded by international financier John Rockefeller III, with a history of members on its board who are connected to the World Bank, an organization notorious for linking economic monetary policy toward Third World countries with those countries' deference to multinational corporations. A substantial amount of Population Council funding has come from USAID.

During that time there have been periodic media reports of coercive testing of Norplant on Third World women. At a 1990 meeting of the American Public Health Association, Dr. Shayam Thapa claimed that when Norplant was tested in Bangladesh, only one-fourth of the many women who wanted the capsules removed due to negative side effects could find a doctor willing to do so. The BBC television documentary program Horizon reported that the women in Bangladesh were not told their Norplants were part of a clinical trial--in other words, that the women did not give informed consent--and that their complaints of side effects and pleas to have the devices removed were ignored. The television crew filmed records purporting to show that out of 1,300 women involved in the trials, more than 100 were reported as being refused removal of their Norplants. Spokespeople for both Wyeth and the Population Council say that reports of coercion in Bangladesh are sensationalistic and that Norplant was not on clinical trial in Bangladesh.

Meanwhile, back in the United States, a 1993 study by Contraceptive Technology Update found that low-income women were commonly receiving Norplant free of charge through Medicaid, only to find that Medicaid often would not pay for removal when the women complained of side effects. The study found that the women frequently were not informed that they would have to bear the cost of Norplant removal if it was done before the five-year expiration date. Medicaid does pay for removal in cases of medical necessity, but that's not as encompassing as it sounds: One woman in South Dakota gained 65 pounds in 6 months yet was informed there was no medical justification for Medicaid paying for removal of her Norplant.

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