Indian Health Service physicians are prescribing Depo-Provera as a contraceptive for some American Indian women, although the Food and Drug Administration has not approved the drug for that use because of evidence that it causes cancer, a House panel was told yesterday.
Dr. Everrett R. Rhoades, director of the service, confirmed that 25 to 30 Indian women are receiving it and that it has been given to as many as 200 women in recent years, many of them mentally disabled.
The drug, given by injection, provides protection from pregnancy for three months or longer and stops menstruation. According to Indian Health Service documents, it is primarily prescribed to halt menstruation and "contraception is an added benefit."
Rep. Sam Gejdenson (D-Conn.), chairman of the Interior and Insular Affairs investigations subcommittee, said the practice raises the question of whether the service is putting "convenience" above the well-being of Indian women.
"The frightening conclusion is that the predominant reason they give this to women who are developmentally disabled is that it reduces janitorial service," he said. "It seems to me that we are injecting these women with a potentially carcinogenic drug to stop them from menstruating."
Rhoades rejected Gejdenson's suggestion but said hygiene is a legitimate medical concern and plays a part in the decision to use Depo-Provera. "For some women, menstruation can cause severe psychological stress," he said.
In 1979, the FDA declined to approve Depo-Provera as a contraceptive, and its only approved use is as a palliative in some cases of advanced and inoperable cancer. However, doctors may legally prescribe FDA-approved drugs for other purposes.
Rhoades said the limited number of Indian women receiving Depo-Provera, fewer than three dozen in a population of 225,000 women of child-bearing age, reflects the "sensitivity and caution" of health service doctors.
Women who receive it, or their guardians if they are mentally disabled, must sign consent forms for its use, he said.
However, the Justice Department has repeatedly warned the service that the consent forms do not offer information on alternative forms of birth control and tend to minimize the drug's adverse side effects.
Other witnesses at the hearing said that 90 countries, including Canada, Great Britain and Sweden, have approved Depo-Provera as a contraceptive and that as many as 1.5 million women use it worldwide.
Under prodding from Miller, Rhoades said that the Indian Health Service would consider issuing uniform guidelines for the use of Depo-Provera.