PIP: The US Food and Drug Administration 1st approved the Norplant Contraceptive System in December 1990. Norplant clinical trials with 55,000 volunteers in 41 countries attest to its effectiveness as a safe and convenient longterm and reversible contraceptive. In 10-15 minutes, clinicians can insert the system's 6 silastic capsules containing levonorgestrel under the dermis of the inner side of the upper arm. Within 24 hours after insertion, Norplant can effectively protect from pregnancy. The capsules continuously release the levonorgestrel over 5 years to protect ovulation. Norplant can be used by almost all women including adolescents, postpartum women, and lactating mothers 6 weeks after delivery. It is especially suitable for women who want longterm birth spacing, to abstain from sterilization, who have encountered problems with other contraceptives, and who do not want to take estrogen. Women with active thrombophlebitis, thromboembolic disease, cardiovascular disease, undiagnosed abnormal vaginal bleeding, known or suspected pregnancy, acute liver disease, benign or malignant liver tumors, and breast cancer should not use Norplant, however. Its side effects include prolonged bleeding, spotting, and amenorrhea. High initial costs for Norplant in the US (range $500-1000) are preventing many women from adopting its use. In Tennessee, Medicaid and some private insurance companies cover Norplant insertion. Clinicians must provide adequate counseling, education, and patient advocacy in addition to proper skills for Norplant insertion and monitoring. Wyeth Laboratories has trained 25,000 physicians who have trained their medical colleagues and nurse practitioners. The nurse practitioner training programs at Emory University in Atlanta, Georgia includes Norplant insertion skills in its curriculum. The Tennessee Department of Health offers the public a network of trained Norplant providers. It also is working on developing Norplant guidelines including policy, procedures, medical management, counseling, and informed consent.