In: Appadurai A. A vida social das coisas: as mercadorias sob uma perspectiva cultural. UFF; The method adopted in this work is the study of controversies. Shapin S, Schaffer S. Leviathan and the air-pump: Hobbes, Boyle, and the experimental life. Princeton: Princeton University Press; We have used both written and oral sources. Our work included compiling scientific articles published between and in the journals Contraception and Studies in Family Planning by researchers from the Population Council, accessed via the CAPES periodicals website.
We also tracked down reports produced by Brazilian newspapers and magazines published in the s: O Globo, Jornal do Brasil and Veja. The oral sources consisted of interviews with researchers and feminists involved in the Norplant controversies, conducted in and We utilized controversy analysis techniques, revisiting the versions of those involved, investigating the understandings each had of the situation, and the effects which the disputed object produced in their networks, tracing the ways through which they sought to enlist allies, and following the assemblages and associations that the thing under dispute provoked — or in sum, how social life was generated in this process.
Diving into these materials, we are left dealing with a puzzle: we never really know whether they are sufficient. The notion of saturation is unsuited to this type of study. We are guided by clues, seeking to join pieces together and approach the history gradually from various angles.
This is why the controversies surrounding Norplant can and should be revisited still, new aspects, documents and testimonies should emerge and, with this, show more clearly how its history has genealogical connections to contemporary dilemmas that pervade the relations between the sciences, the State and society. Norplant is a subdermal hormonal implant composed of six flexible silicon capsules containing levonorgestrel, a synthetic derivative of progesterone.
Inserted under the skin of the forearm using an anaesthetic, the capsules slowly release the chemical compound. Its effect lasts for five years and the recommendation is for the capsules to be removed afterwards since they are not biodegradeable 11 Segal SJ. Scientists from the Population Council were responsible for introducing the concept of a contraceptive implant, which combined three core principles: the diffusion of biological materials through the walls of silicon capsules; the continual and long-lasting release of chemical substances via these recipients; and the possibility of preventing pregnancy with low doses of progestogen.
The association of materials-techniques-scientists enabled the design of subdermal hormonal contraceptive implants. Recruitment of pharmaceutical companies — Wyeth United States and Leiras Finland — cleared the way for the search for a reversible contraceptive with a long-lasting effect 11 The first clinical trials with implants were conducted in Chile, India and Brazil in the s.
Population Council ; Jan Variables like the size, thickness and number of silicon capsules, the type and quantity of hormone, collateral effects, and the time that the contraceptive effect lasted all formed part of the jigsaw puzzle of attaining the idealized method: safe, efficacious, acceptable and low-cost, and effective in responding to the demographic problem 11 Brazil was an important field for the clinical trials of contraceptive implants.
By Coutinho had already published articles on the research 13 Coutinho EM. Contraception ; 2 5 By Coutinho had tested eight hormones on 5, women. He concluded that the methods had a high level of acceptability and effectiveness; the side-effects were well tolerated and amenorrhea, the main alteration, could be advantageous in underdeveloped countries where malnutrition and anaemia were common 14 Coutinho EMD.
Clinical experience with implant contraception. Contraception ; 18 4 Coutinho's links to the Rockefeller Foundation date from the end of the s.
Its support enabled him to spend three decades investigating injectable, oral, vaginal and implanted hormones, as well as vaccines, intrauterine devices, male pills and other methods. Scientific and political motives were intertwined in his work with Coutinho self identified with the ideas and strategies of the global establishment concerning population control 15 Manica D.
Campinas: Universidade Estadual de Campinas; In Brazil, the Bahia group was the only team involved in the contraceptive implants project during the s and s. Dias TM. In the years prior to the research with Norplant, reproductive scientists and the Brazilian public seldom communicated. The Brazilian State was either unaware of the research or judged that it had no role to play in the laboratories. Contemporary conceptions of the ethics of research involving human beings were still rudimentary and the idea of scientific autonomy was shaped along traditional lines.
In , researchers from the ICCR published the findings of the international multicentred study with two implants: levonorgestrel and norgestrienone. Contraception With long acting subdermal implants I: an effective and acceptable modality in international clinical trials. Contraception Oct; 18 4 Coutinho et al. Contraception with long acting subdermal implants: II measured and perceived effects in internacional clinic trials. The evidence indicates that the method with 6 capsules containing levonorgestrel is ready to be introduced at a limited scale.
In expanded clinical trials attention should be given to ensuring the women are adequately prepared for the menstrual irregularities that they may experience 11 The Population Council was preparing the way for the worldwide introduction of Norplant 11 As sociotechnical objects, the prototypes of the contraceptive implants mediate new associations and networks, putting into social circulation concepts, ways of making, human actors and things silicon, hormones, institutions, organisations, scientific journals.
Give me a laboratory and i will raise the world. Science observed: perspectives on the social study of science. London: Sage; In the s, the commercial sale of Norplant was authorized in countries of Europe, Asia and Latin America and, in , in the United States 11 Norplant Worldwide. The Population Council ; Aug 5. However, the implant would never actually be sold in the country. Its circulation was brief, lasting only as long as the clinical trials.
He had been part of Salvador Allende's socialist government, working in the Ministry of Heath, coordinating the Women's Health Program. He moved to Brazil in , bringing his experience in research, teaching and management 22 The Campinas Reproductive Health Research Centre and the Department of Obstetrics and Gynaecology of the UNICAMP Faculty of Medical Sciences is organising trials for a new hormonal contraceptive method that, according to the medical literature, would present clear pharmacological advantages compared to those in use currently 23 In the letter, technical and scientific aspects of Norplant are described in minute detail.
What would the convenience be? Why had it not been convenient until then to inform the authorities about the studies that had already been undertaken in Brazil? At this juncture, the political setting was different to the s: the transition to democracy was already under way, social movements were up and running, the State was more receptive to public demands and participation, controversies surrounding family planning in Brazil were at a peak, and, as remarked earlier, the profile of the researcher heading the research was very different.
In both groups, blood pressure and hemoglobin were not affected, whereas body weight tended to increase. It can be concluded that both contraceptive systems demonstrated excellent contraceptive efficacy and were well tolerated. Compared with Norplant, there was less frequent bleeding with Implanon, whereas the incidence of infrequent bleeding and amenorrhea was higher.
Implanon was significantly quicker to insert and to remove than was the multiple capsule system. PIP: This study compares the contraceptive efficacy and bleeding patterns of a single-rod Implanon and a six-capsule Norplant contraceptive implant for 2 years, with an optional extension of up to 4 years, among healthy female volunteers in China.
Women were administered with Implanon for They contain the same amount of etonogestrel and they have the same side effects. So if both devices are equally effective, what is the difference between the two of them?
The only difference between Implanon and Nexplanon is the safety features that are in Nexplanon but not in Implanon. Nexplanon has two safety features designed to ensure proper insertion. Nexplanon has replaced Implanon, and Implanon is no longer being manufactured.
The arm implant branded as Implanon is no longer commercially available in the United States. On rare occasions, insertion errors during Implanon implantation risked the ability of Implanon to prevent pregnancy or could allow the implant to migrate to other parts of the body. Insertion errors that occurred with Implanon included placing the implant too deeply. To eliminate the risk of insertion errors, the makers of Nexplanon designed a special applicator.
Nexplanon is produced with a preloaded applicator that makes it faster and easier to insert with accuracy than was possible with Implanon. Also, the Nexplanon implant contains a small amount of barium sulfate. Barium sulfate makes the implant visible with an X-ray, MRI, or other types of imaging tools. This safety feature allows doctors and other health care providers to ensure it was inserted correctly and pinpoint the implant location after insertion if needed.
Nexplanon starts working almost immediately if you have it implanted in the first five days of your period. However, if you have it implanted in the middle of your cycle, you will need to use condoms or another form of birth control for about one week.
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