Witnesses Criticize Norplant Proposals : Capitol: Women lawmakers hear testimony opposing any legislation that mandates use of the birth control device.

A Visalia judge forces a poor black woman convicted of child abuse to choose between jail and a contraceptive implant. A Kansas lawmaker proposes that welfare mothers who agree to have the implant be paid a $500 cash bonus.

Back in California, Gov. Pete Wilson opens a discussion on whether implants should be mandatory for female drug abusers.

In less than a year since the contraceptive device Norplant was introduced as a highly reliable form of birth control, it has provoked a storm of controversy and become viewed by many as a new threat to women’s right to reproductive choice.

On Wednesday, the Women’s Caucus of the California Legislature heard from an array of witnesses who urged lawmakers to make the device more readily available to poor women but at the same time to ensure that it not be used for “social ends.” The caucus listened to the testimony but took no position.

Dr. Elena Gates, from the UC San Francisco department of obstetrics, gynecology and reproductive sciences, warned that Norplant, the first new type of contraceptive to be made available in 25 years, was in danger of becoming a “coercive tool” that could present ethical dilemmas for physicians and undermine women’s basic right to medical privacy.

“Because of its clinical characteristics, Norplant lends itself to use by those who seek to use the force of the law to limit reproduction among women whom they see as unfit mothers,” Gates said.

Norplant is used as a set of six matchstick-sized capsules that are surgically implanted under the skin in the upper arm. The capsules slowly release a synthetic hormone called levonorgestrel to prevent conception. Once inserted, the device is considered effective for five years although it can be removed and fertility will return.

Gates said the procedure is considered a major breakthrough in the field of contraception because it fulfills the demand for a convenient form of birth control “that is also perceived as safe.”

But these same characteristics, she said, led a white male judge in Visalia last January to order Darlene Johnson, a black welfare mother who admitted abusing two of her four children, to accept a Norplant implant as a condition of probation. Although Johnson agreed to the implant, it was never done and her attorney has since appealed the judge’s decision.

Meanwhile, in Kansas and Louisiana, she said, lawmakers have introduced legislation that would provide a cash bonus for welfare mothers who agree to be implanted with the device.

If these moves become a trend, Gates said, physicians and other medical practitioners may increasingly be faced with deciding if they should obey a court order and insert the device even when they think it is not in the best interest of the patient.

She said the device is not appropriate for some women with heart and other problems and it often causes side effects--such as erratic bleeding and headaches--that are usually minor but in a few women have been severe.

“How likely is a woman to examine the risks and benefits carefully when Norplant is the only birth control method for which she will be paid a bonus?” she asked. “In offering incentives, the state is, in a sense, urging women to overlook their own best medical interests in pursuit of state interests.”

Anne Brick, an American Civil Liberties Union attorney representing Johnson in the Visalia case, said the new device raises constitutional issues because the courts in California have long ruled that women have the right to reproductive choice.

But in cases such as Johnson’s, she said, “We find the court usurping the role of both physicians . . . and the individual to choose an appropriate form of birth control.”

Wilson last May raised the possibility of making Norplant mandatory for drug abusers, telling a reporter he and his staff “haven’t decided” whether to propose that step. But on Wednesday, Molly Coye, his newly appointed director of health services, said she has seen no recent effort by the governor to pursue that idea. And Wilson’s press secretary, Bill Livingstone, said “I don’t think there’s any interest in making it mandatory.”