ARTICLES

Evil by Another Name

ANTI-PREGNANCY SHOTS AIMED AT TEENS

Allyson Smith

'Birth control you think about just four times a year" reads the headline at the top of drug manufacturer Pharmacia Upjohn's web page. Upjohn is referring to its Depo Provera contraceptive injection. The message-- that using Depo-Provera is a "no brainer" compared to using the Pill-- is one reason why Depo-Provera is finding an audience among women who contracept, particularly teenagers. (Depo-Provera is administered via intramuscular injection in either the upper arm or the buttocks once every thirteen weeks.)

Since its introduction to the U.S. market in 1993, Depo-Provera use has skyrocketed amongst teenagers, particularly blacks aged 15-19, where it accounted for 19 percent of contraceptive use in 1995. This rise in use parallels a seven-year decline in teenage births. According to an article in the San Diego Union-Tribune last July, the Center for Disease Control reported that the percentage of unmarried black women giving birth dropped to a record low in 1996.

Angelica Tavizon of Planned Parenthood of San Diego and Riverside Counties, explains Depo-Provera's popularity locally. "As many as 30 percent of clients choose it. A lot of people who decide [to use Depo-Provera] are teenagers because you can't tell if they've had the shot and they don't have to hide a pill pack from their parents. Other women like it because they don't have to remember to take a pill every day. Smokers use it because the ingredients in it pose less of a risk of blood clots." When asked if Planned Parenthood administers Depo-Provera and other contraceptives to teenagers without notifying parents, she confirmed that parental involvement is not required by law.

Aurelia Stevens, a nurse at the East County Community Health Services clinic in El Cajon, confirmed that "lots of East County women use Depo-Provera because they don't like the Pill and because it's convenient." She added that East County teenagers are about equally divided between the Pill and Depo-Provera; many do not choose Depo-Provera because they are afraid of getting a shot.

When asked how Depo-Provera works, Stevens replied that it prevents ovulation and also changes the cervical mucous to create a barrier to sperm, "but it doesn't act as an abortifacient as far as I know." Planned Parenthood's fact sheet on Depo-Provera concurs, stating that, in addition to suppressing ovulation, "Depo also causes changes in the cervical mucous which prevents sperm from entering the uterus."

However, Pharmacia Upjohn's own patient literature for Depo-Provera indicates otherwise. It says, "DEPO-PROVERA . . . causes changes in the lining of your uterus that make it less likely for pregnancy to occur." For that reason, says Anne Fitch-Dececchi of the Fitch Fertility Center in San Diego, "Depo-Provera acts not only as a contraceptive but also as an abortifacient by making the lining of the uterus hostile to the implantation of a fertilized egg." Father Paul Marx of Human Life International agrees, calling Depo-Provera "the injective abortifacient" in his November, 1998 "Special Report No 187."

Depo-Provera is frequently distributed through taxpayer-funded agencies like Planned Parenthood and public and community health clinics. Typically, women who seek contraception at such facilities have low incomes; thus the cost of providing contraception is often partially or fully financed by government family planning programs.

In California, the Office of Family Planning provides funding for Depo-Provera and other contraceptives Under this office's aegis, any man or woman in California with incomes at or below 200 percent of the federal poverty level can have access to "comprehensive family planning services, including contraceptive methods. According to Planned Parenthood's Tavizon, the applicant must be a California resident and "they must be willing to use, or currently be using, some sort of birth control. If they want a child, they are disqualified. They are also disqualified if they have had sterilization such as a tubal ligation or hysterectomy."

The actual cost of one Depo-Provera injection for those who do not qualify for a subsidy is $40. "This is the same price Planned Parenthood pays," said Tavizon. "We do not make any profit from sales. It averages out to only slightly more than a three-month supply of the Pill, which costs around $11 per pill pack."

Depo-Provera is not without side effects. The most common side effect is menstrual irregularity due to lack of estrogen. Some women have sporadic menstrual periods (an indication that ovulation is still occurring), others have prolonged ones, but most (about 80 percent) have no periods at all. Along with weight gain, another notable drawback of Depo-Provera is the time it takes for a woman to return to fertility after using it, nine months on average and up to one year in some cases.

Because of these negative side effects, Pharmacia Upjohn has been working to produce a successor to Depo-Provera, another injectable contraceptive called Cyclo-Provera. According to its November 12, 1997 report, last year the company filed a New Drug Application for Cyclo-Provera, with plans to file for mutual recognition in Europe in early 1998. The product has already been approved in Mexico.

Several clinical studies of Cyclo-Provera are currently being conducted across the country, including one which started in November at the Medical Center for Women's Clinical Research in San Diego. The study, the second one of its kind conducted by the Medical Center, will test the effectiveness and level of patient satisfaction between Cyclo-Provera and other forms of birthcontrol, including Depo-Provera and the Pill, amongst women 18 years of age and younger. Women under 18 who participate in the study must either be emancipated or have the signed permission or a parent or guardian.

Dr. William Koltun, a gynecologist who is overseeing the study, thinks Cyclo-Provera is a promising advance in birth control technology. "It's a monthly intramuscular injection that contains both progestin and estrogen," he said, "so you don't have all the problems, such as irregular menstrual periods, associated with a lack of estrogen." He added that the average length of time from cessation of injections to return to fertility is about 40 days.

When asked if women in past studies objected to receiving Cyclo-Provera once a month instead of once every three months, he said no. "It's still more convenient for them than the Pill."