When it comes to birth control, Americans are still fumbling in the dark. Thirty years after the pill promised a contraception revolution, the effort to find a cheap, easy-to-use, safe and effective method has proven a bitter failure. Men and women feel cheated. And not even researchers talk in terms of magic pills anymore. Instead, at a time when more than half of all pregnancies are unplanned and sexually transmitted diseases are growing at the rate of 12 million to 13 million new cases a year, the options are shrinking. The manufacturers of the Today Sponge pulled it off the market in January; the IUD has all but disappeared, and the diaphragm is literally as unpopular as abstinence.
Our frustration is playing out not just in the bedroom but in the operating room. A stunning new National Center for Health Statistics survey reports that, for the first time, more women are opting for sterilization than any other form of birth control – a trend that used to be associated with Third World countries, not leading industrialized nations. But while few were paying attention, voluntary sterilizations have risen sharply in the last decade. Of all American women using contraception in 1990, the last year for which figures are available, 29.5 percent had tubal ligations, surpassing even the once dominant pill. Add in vasectomies and the number of women relying on some type of sterilization tops 42 percent.
Worldwide, Americans rank near the top of the list of women relying on sterilization. In 1988, the last year for which comparable data exist, more than 36 percent of married American women used sterilization. That puts the United States up there with China (35 percent) and India (31 percent) and well ahead of Westernized countries like Britain (23 percent) and the Netherlands (15 percent). Not surprisingly, most Americans getting sterilized are in their 30s and 40s, a sign that baby boomers are nearing the end of their childbearing years. But the steady increase in couples of all ages opting for permanent methods underscores how fed up they are with the choices.
Yomari Ortiz is planning to get her tubes tied next month – and she’s only 21. After two children in two years, Ortiz has mapped out her life – a high-school-equivalency diploma, college, a job as a radiology technologist and marriage – and more children are not in the equation. Neither is hassling with birth control. The young Chicagoan says she was using condoms when she conceived her son, who is now 3, and was on the pill when she got pregnant with her daughter, who’s 2. And though her doctor’s assistant tried to talk her out of sterilization, her boyfriend supports her. Ortiz is adamant. ““I might as well just cut my tubes now and throw them away,’’ Ortiz says with a chilling matter-of-factness.
Is this where the Sexual Revolution was supposed to lead us? Symbolism aside, the pill was designed to let women control when and if they got pregnant. Of course, it also freed them to go to work and allowed them – and their partners – to view sex as recreation. But that was before sexual freedom gave way to increasing numbers of out-of-wedlock births. In the years since, policymakers have grown frustrated trying to stem the tide – to the point where a new, unabashedly conservative Congress threatens to take welfare benefits from single mothers who bear more children. Abortion isn’t a solution. With anti-abortion protests becoming more violent, the number of counties with doctors willing to perform abortions has shrunk to 16 percent.
Politics, coupled with the high cost of developing new contraceptives, has taken a mighty toll. ““The pharmaceutical industry has washed its hands of birth control,’’ says the father of the pill, Stanford University chemist Carl Djerassi. In the space-race ’60s – when women demanded, ““If we can put a man on the moon, why can’t we come up with decent birth control?’’ – nine major American companies were doing contraceptive research; now only one is still committed. Djerassi blames U.S. regulators for being hypercautious. It took Depo-Provera, a progestin that’s injected every three months, 25 years to win Food and Drug Administration approval, in 1992. Even benign methods aren’t immune. The sponge wasn’t the most effective option on the market; tales are legion of teenage girls who read the ““wet before inserting’’ instructions and thought they could use spit or Coca-Cola. It was cheap and readily available. Yet Today Sponge manufacturer Whitehall-Robins Healthcare pulled it off the shelves, saying it would cost too much to upgrade its plant to meet new FDA safety rules.
Nowhere are the battles more fierce than with RU-486, the so-called French abortion pill. It isn’t close to getting on the market here. U.S. firms refused to touch it, frightened by controversy and threatened boycotts by abortion opponents. And the French manufacturer, Roussel Uclaf, handed over U.S. rights to the drug – a potential $50 million market – to the nonprofit Population Council, which is conducting clinical trials. It’s not just RU-486. Companies have fled the entire contraceptive market because the risk of lawsuits outweighed any possible jackpot. ““We live in a very litigious society,’’ says Polly Harrison of the National Academy of Science’s Institute of Medicine.
With all the talk of high-tech solutions, it’s no small irony that the only contraceptive to get excited about these days is the old low-tech condom. The first polyurethane condom, Avanti, is slated to go on sale nationwide this fall. Its British manufacturer, London International Group, says it’s thinner and more sensitive than the standard latex condom – but thinner and more sensitive isn’t likely to alter the sort of biases that most men pick up long before they’ve had their first date. As Sam, a 28-year-old carpenter from Worcester, Mass., puts it: ““Nobody likes making love to a balloon.’’ Even if it’s a woman wearing it. In the nearly two years since Reality, the female condom, was introduced, it’s been applauded for giving women control over STD prevention and criticized for esthetics: it looks like an oversize male condom, feels like Crisco and squeaks. It takes getting used to. ““I had never used a diaphragm, so it’s an awkward feeling,’’ says Rita Wanser, 35, of Middletown, N.Y.
But even if people don’t like condoms, a decade’s worth of public-service campaigns against AIDS and STDs have forced a growing number to agree they’re essential. Condom World, on the funky end of Boston’s Newbury Street, sports more condoms than a frat house – more than 150 varieties in all. The atmosphere here is far different from a corner drugstore, where condoms are still dauntingly hidden away. Indeed, on a sunny Saturday, customers browse the way they do at neighboring Tower Records. ““It’s just a fact of life these days,’’ says Zeb Robbins, 25, an engineer from Newton who wandered into the shop with two female friends. The young blond allows how condoms have helped his sex life; women, he says, like that he’s willing to use them.
The more pressing question is, how willing are teenagers to use condoms – or anything else? Susie Carrillo and her boyfriend, Sam Vongkorad, tried to use condoms, but she concedes that ““sometimes they weren’t at hand.’’ Two months ago Susie, an Aurora, Ill., 17-year-old, gave birth to a girl. Even a few years ago doctors rarely debated that the first choice for a teenager was the pill. Now they’re not so sure. By the age of 21, according to the Centers for Disease Control, one in four young people is already infected with an STD. But the chances of getting kids to ““double Dutch’’ – as teens in the Netherlands call the pilland-condom combo – are small. So health experts find themselves in the troubling position of having to decide between putting teens at risk for pregnancy or AIDS.
The solution, of course, is a method that does it all – which puts us back on the magic-pill hunt. Researchers are already trying to develop microbicides, ““detergent’’ suppositories or foams that kill off anything from sperm to disease. Next best, they say, would be a ““menses inducer,’’ a pill that women could take if they’ve had unprotected sex. Actually, morning-after methods already exist – a doctor can prescribe large doses of birth-control pills to a woman or insert an IUD – but no company is willing to market a morning-after label.
All the confusion leaves women like Jennifer Wohlenberg still searching. After running through the entire contraceptive medicine cabinet, she’s more frustrated than ever. ““I wish there was a pill for men,’’ she sighs. But the promise of a male contraceptive by the millenniun is unlikely. Instead, Djerassi suggests, men could freeze their sperm and then get vasectomies. But that won’t protect against AIDS and STDs. And it won’t affect men who refuse to get involved. Which makes even that futuristic option no option at all.
In 1990, nearly 60 percent of women age 15-44 used contraception. Surgical sterilization was the most-used method; in 1982, it was the pill.
Female sterilization 29.5% Pill 28.5 Condom 17.7 Male sterilization 12.6 Diaphragm 2.8 Periodic abstinence 2.7 IUD 1.4 Other methods 4.8 SOURCE: NATIONAL CENTER FOR HEALTH STATISTICS
