Birth Control Implants at Valley School Defended

Los Angeles school officials, stung by a sudden outbreak of protests against implanting long-term birth control devices in San Fernando High School girls, defended the practice Thursday, saying the issue was settled last summer.

The operator of a controversial clinic at the high school blamed “sensationalism” aimed at groups in a Roman Catholic area who fought and lost a determined battle six years ago against distribution of birth control devices at the school.

Los Angeles Unified School District administrators called a news conference Thursday to defend the clinic’s use of the Norplant System--which is implanted beneath the skin of female recipients and releases birth-control chemicals into the bloodstream for up to five years. San Fernando High School has one of only a handful of school-based clinics in the nation that use the implants.

The clinic will continue to use the implants, which were authorized in a public meeting last summer after a review by a committee of parents, teachers, administrators and health officials, the administrators said.

The clinic opened in 1987 and has been offering more conventional forms of birth control, such as condoms, birth control pills and, in the case of girls with two or more children, intrauterine devices, or IUDs.

Although Norplant uses a standard hormone treatment to inhibit ovulation, what makes it unique is that the system is implanted semi-permanently under the skin of the upper arm, requiring no further effort or thought on the recipient’s part. The high school clinic began offering it to students in September.

So far, eight students between the ages of 16 and 19 have received the devices. Under state law, the girls’ parents are not notified.

Robert L. Smith, executive director of the Northeast Valley Health Corp., which operates the clinic, said community protests against the practice “are just sensationalism, basically, in a Catholic area. We went through this four or five years ago, and this kind of sensationalism is just unconscionable.”

When plans to open a clinic on campus were first announced in the mid-1980s, opposition flared up in the heavily Catholic community. Clinic opponents hired a plane to fly overhead towing a banner that read “No Clinic Here,” and collected 7,000 signatures on petitions. The clinic was criticized at masses at the five Roman Catholic parishes in the school’s attendance area and about 2,000 people turned out for a protest march.

When a Baltimore high school began offering Norplant implants in January, it erupted into a national controversy over reproductive rights. And when word that the system was being offered at San Fernando High got out this week, some local critics came forward to express outrage.

“There’s absolutely no way that unmarried children under 18 should be using this kind of birth control,” said Yvonne Lovato, a community activist in San Fernando who protested against the clinics when they first opened six years ago.

“Kids should be concentrating on school, not sexual activities,” Lovato said.

“The insertion of these Norplants is being done surreptitiously,” said Eadie Gieb, head of Parents and Students United in San Fernando, one of the groups that protested the installation of the clinic. “Why weren’t parents notified? That’s of great concern.”

But Jan Marquard, director of the clinic at the high school, said that would be illegal: “By law, minors are protected in California. They wouldn’t go for desperately needed services if parental consent was required.”

The school does give the parents the option of refusing to allow the clinic to give reproductive care to their children by signing a form withholding permission for any services. Once they allow their children to have reproductive services, they are not told what type of services the student receives.

“Norplant is an excellent choice for certain women,” said Susan Mitchell, the nurse practitioner who implants the device at San Fernando High. “Other than abstinence, it is certainly the most effective method. One does not have to remember to take a pill or use a device, and there are no serious risks as there are with an IUD.”

One of those who received Norplant at the school is Gracie Ramirez, 18, a senior from San Fernando.

“I didn’t want to have children so young,” she said Thursday. “A lot of my friends have kids and I see what it has done to them. I didn’t want to end up like that.”

Ramirez, who said she wants to finish school and become a veterinarian, said her boyfriend doesn’t like to use condoms and “the pill is a real hassle.”

She had the six matchstick-size implants inserted in January and has had no side effects. She did not notify her parents, she said. “My mother said I’m old enough to make my own decisions about sex.”

Ramirez said that without the clinic, “I wouldn’t have taken responsibility for birth control . . . . I was afraid to go anywhere else. Even with people here telling me to go, it took a awhile.”

But other students were not so sure. “Norplant sounds kind of scary,” said Maria Bracamontes, 17, a junior. “They should be giving something like that in a hospital, not here.”

School board President Leticia Quezada said in a phone interview that she believes “the clinic is operating as it should.” Asked whether she supports its decision to offer Norplant, she replied, “That’s not my decision.”

She said Northeast Valley Health Corp., which operates the clinic under a contract, is “best able to say these are the services that should be provided. The moment we start making decisions about health care we are out of the business of education.”

The clinic is one of three in the district operated on a $1.3-million budget that comes mostly from foundations, corporations and other private donors with an interest in health care. The school district supplies about $85,000 worth of support services.

At San Fernando High, students paid about 3,700 visits to the clinic last year, making it one of the busiest in the country, said Michael A. Godfrey, coordinator of school-based clinics for the school district.

About 15% of those visits were for reproductive services, including gynecological exams and birth control, he said. Girls interested in using Norplant must watch a 20-minute videotape that includes information about possible side effects.

“We’re not promoting anything and we’re not keeping anything a secret,” said clinic director Marquard.

Norplant is available only to youngsters who have Medi-Cal or can afford to pay the $365 cost, she said.

Since its approval by the Food and Drug Administration in December, 1990, the Norplant System has been implanted in 600,000 women in the United States, according to Audrey Ashby of Wyeth-Ayerst Laboratories in Wayne, Pa., marketer of the system. Although it was developed in 1966 in the United States, the system is manufactured by a Finnish company.

Norplant consists of six matchstick-sized, 1.3-inch-long capsules that are placed under the skin during a minor surgical procedure. The capsules release a hormone, levonorgestrel, that is already used in several birth control pills.

Wyeth-Ayerst contends the system is 99% effective in preventing pregnancies.

Side effects can include irregular menstruation and headaches. According to Dr. Reinhold Ullrich, an obstetrician and past president of the Los Angeles County Medical Assn., “minimal side effects” occur in 20% to 25% of recipients.

Dr. Mary Doyle, medical director of the corporation that operates the San Fernando High clinic, said the method is safe for use by teen-agers.

“They certainly are not being used as guinea pigs,” Doyle said, adding that the clinic would remove the implants free of charge from any recipients who request it.

The controversy around Norplant has centered not so much on medical issues as social ones. Some conservatives have complained that the ease of use encourages teen-agers to have sex. But some liberals have also argued against the implants, contending they could be used in a genocidal campaign to reduce the numbers of poor minority races.

“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,” Dr. Elena Gates of the UC San Francisco department of obstetrics, gynecology and reproductive sciences has said.

These concerns were exacerbated when the Philadelphia Inquirer urged in an editorial two years ago that welfare mothers be offered incentives to use the device. Lawmakers in Kansas and Louisiana introduced legislation offering cash bonuses for welfare mothers who received the implants.

Dr. David Grimes, former chairman of the National Medical Committee of the Planned Parenthood Federation of America, said genocide arguments are “specious” because preventing unwanted pregnancy is relevant to all economic groups. “If we put at the disposal of poor people the same contraceptive that is available to persons who are more affluent, that is a social equalizer,” he said.

The Baltimore high school, Laurence Paquin School, became a lightning rod for reproductive debate when it began offering the Norplant System to its students in January. A spokeswoman at the school said Thursday that the Norplant System is still being offered there in spite of the protests, but declined to say how many students had received the devices.

The Norplant Birth Control System

The Population Council’s Center for Biomedical Research in New York developed the Norplant System in 1966 and Finland became the first country to approve its use in 1983. Composed of six small sticks, the system is implanted under the skin of the inside of the upper arm in a minor surgical procedure. The system works by inhibiting ovulation, using a hormone present in conventional birth control pills. The system is effective for five years, when it must be removed. 1. After cleansing the patient’s upper arm with an antiseptic solution and numbing it with a local anesthetic, a scalpel is used to make a shallow incision about 2 mm long. 2. Each capsule is then inserted beneath the skin through a hollow needle, called a trocar. The capsules are pushed through the tip of the trocar. 3. The trocar is then partially withdrawn and maneuvered to position the other five capsules in a fan-like pattern. 4. When finished, edges of the incision are held together with a skin closure. Sutures are unnecessary. The area is then dressed with a dry compress.