Contraception in U.S. Stalled, Advocates Say : Bemoaning Lack of Research Funds, Experts Claim Birth Control Options Are Decreasing

The doctor’s prognosis was not promising.

“I believe we have a contraceptive Dunkirk,” Malcolm Potts, the president of Family Health International, said gravely. Flashing a slide of a turn-of-the-century intrauterine device, he warned, “We are going to leave this century with fewer methods of contraception than we entered with.”

Addressing a meeting on contraception organized by the Planned Parenthood Federation of America Inc., Potts’ pronouncement had a decidedly ironic tone. Only 21 years ago this month, the U.S. Supreme Court struck down state laws that made the use of birth control by married couples illegal. That landmark decision in Griswold vs. Connecticut helped speed a revolution in sexual attitudes and practices. In two swift decades, the nationwide legalization of birth control was a significant element in other broad changes in American society.

Differences Told

- Death in childbirth has decreased dramatically. From 31.6 maternal deaths per 100,000 live births in 1965, the figure dropped by three-quarters in 1982, to 7.9 maternal deaths per 100,000 live births.

- Infant deaths have declined. In 1965, 24.7 infants under one year of age died per 1,000 live births. By 1982, the figure was 11.2 infant deaths per 1,000 live births.

- Unwanted births--those births that the mother did not want at the time of conception or at any future time--dropped from 21% of births in 1965 to 6.8% in 1982. Unwanted births to women with less than a high school education stood at 28% in 1965; 11% in 1982. For women with 13 years or more of education, the percentage of unwanted births fell from 12.4% in 1965 to 5.2% in 1982.

- Fertility rates have plummeted. In 1965, the average American woman had 2.9 children. By 1982, the total fertility rate had slipped to 1.8 children per woman.

- Contraception has established itself as a firm fact of life for American women of childbearing age. In 1982, 55% of women ages 15 to 44 in this country were using some method of contraception.

Nevertheless, as the Planned Parenthood panel noted, of the 6 million pregnancies American women experience annually, half are unintended. Further, in the last 20 years, the United States has not developed or marketed one new method of birth control.

Much-Touted Sponge

“Even the much-touted sponge,” a Planned Parenthood information sheet reported, “is nothing more than a new delivery system for a spermicide available for many years.”

Research funds have shriveled, development costs have skyrocketed and product liability costs have mushroomed.

Little Spent on Research

“In my local McDonald’s,” Potts said, “I can buy a packet of French fries for 49 cents. That is what you in the United States spend per capita on reproductive scientific research.”

Potts showed a slide of B-1 bombers.

“Just by way of comparison,” he said, “four B-1 bombers cost $6 billion. We spend less than $1 billion on all aspects of contraceptive research in a decade.”

For Emory University obstetrics and gynecology professor Dr. Elizabeth Connell, one of the major promises of future trends in contraception involves injectable hormones, intended to block progesterone and administered at the end of the menstrual cycle.

“We desperately need, I think, an injectable method of contraception,” Connell said. Already, one such injectable substance, Depo-Provera, is available in some other countries. But she said “political pressures” have prevented its use here.

“The fact that we do not have it in this country,” Connell said, “I regard as a national disgrace.”

A vaccine against pregnancy is being tested on animals, Potts said, but for humans the cost of developing such an injection would run “between $35 million and $55 million.” Still, Potts said, “I believe we could have an anti-pregnancy vaccine by the year 2010 if we wanted.”

Some research, Connell said, is proceeding on contraceptive implants--capsules to be placed under the skin with a potential lifetime of up to five or six years. But with dwindling funds here, she added, “a lot of research (in this area) is going overseas.”

‘Totally Disenfranchised’

For the American woman, Connell said, “the bottom line is that she is being totally disenfranchised, and before long she is going to have to go overseas to get her method of birth control.”

Even today, with only a hormone-coated intrauterine device available on the U.S. market, the Planned Parenthood Federation of America reportedly “has been stormed by women asking where can they go, what can they do to get an IUD, and (the federation) is referring women to Planned Parenthood of Canada,” said Jacqueline D. Forrest, director of research and planning at the Alan Guttmacher Institute.

At the Planned Parenthood chapter in San Francisco, Dr. Philip Darney of UC San Francisco Medical Center said, “we have about 100 IUDs left, and they are going fast.” When that supply is exhausted, Darney said, “we won’t be able to get any more.”

Forrest worried that in the wake of the Dalkon Shield controversy and the removal of all but the Progestasert IUD from the American market, “we are concerned about premature movement to sterilization by some of the women” who might otherwise have selected an intrauterine birth control device. Male and female sterilization has become the most popular method of birth control in this country.