Winig says he offers advice to those unsure about birth control after what he calls the "front-line"--the internists and Bisbee--talk to the patients. Winig says he recommends IUDs as good alternatives to the pill or the diaphragm, and finds that two-thirds of the women to whom he has given IUDs are happy with them. Only one-third have asked for them to be removed, he says. The removal is a far easier process than insertion; the UHS emergency room can remove them if necessary, Winig says.

But regardless of Winig's endorsement, the doctors downstairs don't encourage women to ask for IUDs, especially if the woman has not had childbirth. "I'm not very fond of the IUD," says Blevins. "I don't think women tolerate their IUDs very well. I could learn to put them in, but I won't."

Wacker says the IUD is way down on his list of recommended birth control methods. The IUD peaked two years ago in popularity, he says. In women who have not given birth, the IUD tends to have some side-effects--including severe cramps, especially during menstruation, Wacker says. The UHS, however, does offer a smaller IUD for women who have not had children.

The UHS's policy of inserting IUDs only when women are menstruating makes it even more difficult to procure IUDs. It hurts too much to put them in when the cervix isn't dilated, Winig says. Because women can schedule appointments only one time during four-week periods, and because the gynecologists must frequently cancel appointments to deliver babies--about 30 per month--women can wait for months before they finally see a gynecologist. Winig, however, says he was unaware that many women have had difficulty procuring IUDs until interviewed, and says he may bring the problem up at a UHS board meeting this week.

Unwanted pregnancies at Harvard, Wacker says, are fairly rare--resulting usually because the user's birth control method has failed, and not because the couples were unprotected. Students who forget to take the pill regularly, or those who inserted their diaphragm poorly, are the cause for many of the unwanted pregnancies, Wacker says.

UHS policy toward those couples who face unwanted pregnancies is "to expedite whatever is the reasonable choice," according to Wacker. If the woman wants an abortion, the UHS will not handle it, but can make the arrangements. The UHS works on an "ad hoc" basis for a couple of which only one member is Harvard-affiliated, Wacker says. For most women who want abortions, the University recommends that they go to small clinics such as the Crittenden Clinic in Boston.

If there is any flaw in the logic of the decentralized system, it may be in the doctors' confidence that there is enough birth control education on campus. Room 13 staffers, who average one to two late night telephone requests for birth control information, have already had to tell a couple of callers that the morning-after pill must not be taken as soon as the sun rises the next day. Wacker says the people he sees seem well-educated about birth control. But what he may be overlooking with a system as subtle at Harvard's birth control program is that his patients may be self-selecting. "The people in the UHS think that the students they see are well-educated in birth control," says one Room 13 staffer, "but in reality students have to be educated just to know to go in there."