While “The Pill” launched a sexual revolution, the more enigmatic intrauterine device (IUD) has been mostly relegated to a place of obscurity or distrust. However, the IUD offers liberation from taking thousands of pills over the course of five or ten years. The Pill releases estrogen and progesterone throughout your entire body; one IUD on the market releases progesterone locally in the uterus and another is strictly non-hormonal, using copper instead. Both have high prevention rates (over 99 percent). However, imperfect use causes much higher failure rates in the Pill.
In the past few months, the American Academy of Pediatricians has joined the American College of Obstetricians in recommending IUDs as the safest and most effective birth control option for teenagers. According to Guttmacher Institute’s self-reported surveys about sexual activity, only 4.5 percent of female teen contraceptive users reported relying on IUDs in 2009, an increase of almost tenfold since 2002. In comparison, more than half reported using the pull-out method or the Pill, and almost all sexually active teenagers reported using condoms. In a Washington University in St. Louis (WUSTL) study, researchers offered teenagers free birth control and counseling, including a range of less common options like the IUD. The resulting pregnancy and abortion rates over the course of three years were less than a quarter of the national average.
In a New York Times op-ed, Isabel V. Sawhill suggests that IUDs and other “long-acting reversible contraceptives” (LARCs) could reduce the rates of unplanned pregnancies among less affluent single women, who would suffer the most financially otherwise. LARCs make sense economically in several senses. Brookings Institute researchers discovered that for every dollar invested in birth control, taxpayers save around five dollars.
Although the 1000 dollar device is now covered by the Affordable Care Act and Medicaid, the larger issue is encouraging doctors to educate teenage girls about the benefits and options of long-term birth control. Shefali Luthra from The Atlantic cites the main reason for IUDs’ rarity as widespread lack of knowledge among pediatricians regarding IUD insertion. It also reports that only 12 percent of women who use birth control use IUDs. Since pediatricians only spend about a month on “adolescent medicine” during residency, few are adequately trained in the procedure and thus are much less likely to recommend the procedure than gynecologists are to older female patients.
According to a recent study conducted by the Center for Disease Control, doctors untrained in IUD insertion are more likely to emphasize their risks to patients. Luthra also notes that lack of confidentiality and outside referrals act as obstacles. Although these may seem like minor inconveniences, the repercussions of an unplanned pregnancy—40 percent of which result from misuse of contraceptives—can change lives.
Sawhill also makes the interesting assertion that young Americans should look beyond the antiquated idea of matrimony and toward “a new ethic of responsible parenthood.” Birth control is no longer an issue of lack of medical knowledge, but rather public knowledge and advocacy to help younger girls make choices and feel a sense of sexual agency.
The main barriers for the IUD aren’t actual health concerns, but rather lingering fears due to older models such as the 1970s’ Dalkon Shield IUDs (which increased the risk of pelvic inflammatory disease). Furthermore, some doctors and providers fear that teenagers may regret their decision to use an IUD. However, the procedure for removal is simple, and would give teenage girls more agency to decide when they want to start having children, if ever.
Doctors and sexual education programs are now considering IUDs as a more reliable and convenient alternative to standard birth control options—for the sake of both teenage girls and public health at large.