POSITIVE

05.30.14

Forget The Pill, IUD Is The New Queen of Birth Control

With an estimated 4 million unintentional pregnancies each year, gynecologists are urging their patients switch from oral contraceptives to an intrauterine device (IUD). Just three years after doctors cast it off as unsuitable, the IUD is reigning supreme.

When teen pregnancy numbers hit an all-time low (PDF) this May, no less than the experts at the Brookings Institute pointed to the fear-mongering power of MTV’s Teen Mom and 16 and Pregnant as the driving factor behind it. Watching the social lives of new parents fizzle while their stress levels soared did for the American teen, it seems, what decades of free condoms and sex talks could not.

But a strict adherence to safe sex didn’t completely take over the rhetoric, especially not among the actual grown-ups. Of the 4 million live births in the U.S. each year, half are estimated (PDF) to be unplanned or unintended—the largest majority of which come from women in their 20s. Out of these pregnancies, four in 10 will end in abortion.

Birth, as it were, is not under control.

But if we listen closer to gynecological experts, it soon could be. With the questionable efficacy of condoms and the widespread misuse of birth control, has come an easier and more effective alternative, one that is now the official recommended birth control of the American College of Obstetricians and Gynecologists: an intrauterine device (IUD). With less than one pregnancy per 100 women in a year, according to (PDF) the Centers for Disease Control, it’s the most effective birth control on the market. So why are only 10 percent of us using it?

At least (PDF) 2 million births in America in 2011 came unexpectedly. From married couples in their 50s getting a surprise fourth child to 20-year-olds who believe the old saw about hot tubs and fertility, at least half of U.S. women will have an unintended pregnancy by 45. The prevalence of this phenomenon in twentysomethings, illustrated by the fact that 58 percent of abortions in America each year stem from this age group, is particularly alarming.

Once women exit the free condom havens of high school nurses and college health centers, it seems, they forget that safe sex includes birth control as much as STD tests. According to Dr. Tina Raine-Bennett of the Women’s Health Research Institute at Kaiser Permanente Northern California, “20-24-year-olds have highest number of unintended pregnancies across all demographic groups while over one-third of unintended pregnancies end in abortion.”

But two recent developments may change those numbers drastically. The first, a decades-long shift in official recommendations for birth control. In late 2012, the American College of Obstetricians and Gynecologists got behind the IUD recommending it as the preferred birth control option for all women, even those who haven’t yet given birth. Long acting reversible contraceptives, generally an IUD or implant, have been around for decades, but early models were given only to women who already had children because of some complications in usage.

Since then, the almost fail proof methods have been relegated to the back of the line behind the easy to forget or run out of pill. Dr. Raine-Bennett notes, “Overcoming myths and concerns is an issue for both the women using the methods and the providers who implant it. Before, ‘the pill’ was queen and transformed life for women in the 60s so there’s a mind shift from that as the standard for birth control to methods like IUDs that make it easier to use and prevent pregnancy. The mind shift there is tremendous.”

As with any drug or implant, IUDs do come with risks. Smaller issues that result from IUDs mirror those of other contraceptives, such as menstrual cramps, spotting, or infection. But more dangerous issue can, in rare cases, arise. One in about 1000 users may experience perforation (the IUD puncturing the uterus wall), while others may experience expulsion (the IUD falling out completely).

But the majority of doctors see the benefits as far outweighing the risks.

Some 30 percent of women in Asia use IUDs, compared to the U.S., where rates languished below 5 percent for years. Recently, it has started to climb to a recent all-time high of 10 percent usage. At up to $1000 for an IUD, the bimonthly cost is not prohibitive but the up front affront to the wallet can be a particular challenge for those in their teens and 20s. Of course, younger users also struggle more with drug adherence—that is, remembering to take medicine correctly and consistently. Perhaps it’s no surprise that a 2-year study in St. Louis, MO in 2008-2010 showed a 20 percent drop in abortion from a control group who received free birth control over the same period.

Once informed about the risks and efficiency of various methods, 75 percent of study participants chose IUDs or implants. The results are striking. Teen pregnancy rates among the group were just 6.3 per 1000 girls and abortion rates for all ages were 6 per 1000 women. Comparatively, in the same period the American averages were 34.3 teen pregnancies per 1000 and 20 abortions per 1000.  

The drop is impressive and the study’s policy recommendations are perhaps not surprising. One of the most hotly contested parts of Obamacare is covering birth control for women much like any other preventative medicine. The backlash was fierce, with cases going to supreme courts and concerns of both religious freedom and increased costs being thrown around by a primarily male Greek chorus of worry. The timing could not have been better to spur an explosion in IUD usage, three years ago the IUD was considered both unsuitable and too costly for most teens and women in their 20s, now it is the recommended first line of defense and mostly free to obtain.

Effects are already being seen says Karen Shea, Planned Parenthood Federation of America Director of Medical Standards. “While we haven’t seen numbers from the Affordable Care Act yet, we have seen increasing IUD use among Planned Parenthood patients in the past few years. From 2011-2012, we saw a 19 percent increase in IUD patients. Since 2008, it’s gone up 75 percent.” The switch might be driven by the doctors themselves, suggests Raine-Bennett. “IUDs are the number-one method of birth control for OB/GYNs. More and more, patients come in because their friends suggest it after getting one themselves. Provider education and professional organizations are working on awareness.” 

Of course, even a decades old device takes time to catch on. A recent visit to the Freelancer’s Union Clinic, a next generation insurance provider with a holistic medical clinic replete with free aids tests, health coaches who accompany doctors in the exam room and community acupuncture classes, showed that they do not provide IUDs and were unaware of their standing as the new gold standard.

For a practice that makes its money on hip 20 and 30 sometime New York City creatives, the oversight is glaring. Shea notes a different approach at Planned Parenthood, saying “all full-service Planned Parenthood health centers provide both copper and hormonal IUDs. The best birth control method is one that fits a woman’s needs, and those needs can change throughout a woman’s life. Birth control methods are not one-size-fits-all. Planned Parenthood always provides patients with the full information about the benefits and risks of any specific birth control method and answers any questions they may have when helping a woman make an informed decision about the method that’s best for her.” 

Raines-Bennett sees hope for the near infallible device, “there are studies that show that women have higher satisfaction than IUDs and may be replacing the pill as the new standard. Think of the IUD first because it is the most effective and has the highest satisfaction rate.”

No word on if the IUD will have an effect on the endless stream of baby pictures populating Facebook but for those who aren’t expecting, that could be an unplanned bonus.