A History: the Progestin Implant
Nexplanon/Implanon is a type of birth control that lasts three years and is over 99% effective at preventing pregnancy. A health care professional inserts the implant in your arm, and it is thin plastic rod that releases progestin. Over the 30 years since the implant was introduced, it has gone through many phases and several versions have existed. It all started in 1966 when scientists at the Population Council began investigating the use of silicone rubber capsules as a way to continuously release steroid hormones. They found that this was possible, with effects from the hormones lasting a year or longer in animal models. This research advanced quickly, and by 1974 there were several studies being conducted that compared the effects of different synthetic hormones being delivered through six contraceptive rods. In 1975, a randomized control trial taking place in six countries determined that the implants containing levonorgestrel were the best option in terms of safety and efficacy. In 1983, the Finnish pharmaceutical company Leiras Oy was licensed to produce the six-rod contraceptive system, known as Norplant, and by 1984 the The World Health Organization (WHO) evaluated and recommended the system worldwide to regulate fertility. Soon after its approval in Finland, it became available in several other countries throughout the world, and was finally approved by the FDA in 1990. Since 1984, the Population Council estimates that 10.5 million sets of Norplant have been distributed across the globe in the more than 60 countries it has been approved in.
Partly because of issues with the six-rod Norplant, a newer 2-rod system called Jadelle/Norplant II was approved by the FDA, but this product was never marketed in the US. While Norplant and Jadelle are still available outside the US, neither are available here. Norplant was eventually removed from the US market in 2002 because of issues with insertion, removal and inexperience of some health care providers in administering the implants. In 1998 Implanon was introduced, a single-rod implant containing the hormone etonogestrel, which differed from the previous usage of levonorgestrel. Implanon suffered from fewer problems than its predecessors, but women and health care providers were still reporting issues during the insertion or removal process. For example, women were still getting pregnant after they had undergone the insertion procedure. Studies found that about 50% of the unplanned pregnancies that occurred during use of Implanon were because the implant had never been inserted or was expelled after insertion. There have also been reports of “deep insertions” that made it difficult to feel if the rod was implanted. When the rod is not palpable under the skin, women have to undergo X-rays to try to locate the implant. Nexplanon was introduced as the most recent iteration of the subdermal implant and it will hopefully address these problems. It has a new pre-loaded insertion device and the rod now contains 15 mg of barium sulphate to allow for detection by X-ray.
Although progestin implants have allowed women to control their reproductive lives, there is also a darker side to the history of these devices. Contraceptive devices such as implants have historical roots in population control and eugenics, and have the potential to be used as a tool of oppression. An editorial from the Philadelphia Inquirer suggested that Norplant could be used as a way to reduce the birth rate of black women, thereby decreasing the number of black children living in poverty. This sparked a debate about the potential to coerce women into using the device through public assistance incentives. Several states also introduced legislation incentivizing the use of Norplant and even forcing women who had committed crimes to get the implant. Women who claimed that they were not adequately informed about the side effects of Norplant before getting the implant also sued the makers of Norplant.
Further reading:
http://articles.philly.com/1990-12-12/news/25920681_1_black-children-norplant-black-middle-class
http://www.popline.org/node/334007
http://www.aclu.org/reproductive-freedom/norplant-new-contraceptive-potential-abuse
References
http://www.arhp.org/publications-and-resources/clinical-proceedings/Single-Rod/History
http://jfprhc.bmj.com/content/36/4/187