Implant for birth control on way out

A contraceptive implant hailed as the perfect method of birth control at its launch in 1993, has been "killed off" by lawyers, the media and a government reluctant to pay for it, its manufacturers are claiming.

Prescriptions for Norplant have dwindled from up to 5,000 a month in the first year of its launch to fewer than 20, as allegations of side- effects and threats of legal action against the drug company have grown.

In addition, since October 1995, GPs have been advised not to fit or remove the implant by the British Medical Association, on purely financial grounds after a dispute with the Department of Health over fees.

Family planning experts say that as a result, thousands of women, particularly younger women, are being denied the most reliable form of contraception to date, which lasts for five years but is reversible within 24 hours of removal, and is cost-effective.

They say there are no medical grounds for concern, with continuation rates after one year of use of between 85 to 90 per cent, according to a recent report in the British Medical Journal.

A total of 475 women - less than 1 per cent of 53,000 women who are using Norplant in the United Kingdom - have sought legal advice on possible compensation claims, after suffering side-effects, particularly heavy bleeding, or problems with insertion or removal of the implant. No writs have been issued to date.

Caroline Foster, 26, of the Norplant Action Group, which has campaigned over the implant, has had three operations on her arm after a botched removal of the implant. But she said yesterday she did not want to stop women using it. "We just wanted to sit down with the company and get them to acknowledge the problems that hundreds of women are suffering - acne, weight gain, heavy bleeding, mood swings - that their doctors didn't warn them about."

Known as the "fit and forget" contraceptive, Norplant - made by Hoechst Roussel - has been used by millions of women for over 20 years with no major problems reported. However, it attracted criticism in the United States from the moral majority and religious groups for encouraging promiscuity.

Norplant also became something of a civil rights issue there after some judges appeared to be adopting it as a form of punishment for women who abused their children. Schools in Los Angeles and Baltimore provided it for pupils and there were claims that benefit agencies were forcing young, single mothers to use it as a condition of benefit.

Norplant consists of six matchstick-sized rods worn under the skin of the upper arm which release the hormone levonorgestrel. They cannot be seen but can be felt. Doctors have to be trained in insertion and removal and about 8,000 have taken the course to date. Problems have arisen when untrained doctors have attempted to fit or remove the implant.

Ruth Griggs of the Family Planning Association said yesterday: "Unfortunately, no one can stop untrained doctors from doing this but it has resulted in problems for some women. Norplant is safe and effective for many women. It has received a disproportionate amount of bad publicity."

A spokesman for Hoechst Roussel said prescriptions for Norplant were 100 per cent down on the same period last year. "In the long-run, women are the losers. We have here a product which has been well received by the medical profession and by the vast majority of users, killed off by an unholy alliance of the media, lawyers and government bureaucracy. There were a small number of problems blown out of all proportion but women have been left with the feeling there is something 'dodgy' about this."

David Bromham, senior lecturer in obstetrics and gynaecology at St James's University Hospital, Leeds, says that the "trial by media" was unjustified and would prevent new and improved implants becoming available.