CDC Report Tracks The IUD Renaissance

You might call it the “Comeback Contraception.” In any case, it seems, IUD use is on the upswing.

This week’s CDC National Health Statistic Report highlights the surge: The number of women using long-acting reversible contraception (LARC) has almost doubled in recent years, and most of the increase is due to the growing popularity of IUDs.

From the report:

Among women currently using contraception, use of LARC increased from 6.0% for 2006–2010 to 11.6% for 2011–2013. Use of IUDs makes up the bulk of this category, with 10.3% of current contraceptors using an IUD during 2011–2013.

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

Intrauterine devices remain less popular than other forms of contraception, according to the report. The pill ranks as the most widely used method (it’s taken by 25.9 percent of women who use contraception, or 9.7 million women), followed by female sterilization (25.1 percent, or 9.4 million women) and the male condom (used by just over 15 percent, or 5.8 million women).

Still, LARC devices, including IUDs and contraceptive implants, were used by 11.6 percent or 4.4 million women, according to the report: “While the most commonly used methods — female sterilization, the pill, and the male condom — appear to remain consistent over time, an increase has been noted in the use of LARC methods, primarily the IUD.”

A confluence of events have contributed to the IUD’s renaissance, experts say, including an improved product, a drop in price and more promotion by doctors, including the American Academy of Pediatrics, and backing by the family of Warren Buffett.



Coming To A Clinic Near You: The $50 IUD With A Fascinating Backstory

The new Liletta intra-uterine device (Courtesy of Medicines360)

The new Liletta intra-uterine device (Courtesy of Medicines360)

Zoe Reiches got her first IUD this August — a new model with the lilting name Liletta.

Reiches, 25 and a human resources specialist in Boston, is now happily set for birth control for at least three years. “It’s convenient, I don’t have to worry about it, and I didn’t have to pay for it because of insurance,” she said. “I’m lucky in that sense.”

Millions more American women share her luck now that Obamacare has mandated birth control coverage with no co-pays for most insurers.

But the Liletta, which is just starting to roll out at clinics and hospitals here in Boston and around the country, is not only a device for the lucky — quite the opposite.

Its whole reason for being is to serve poor and uninsured women, to make IUDs — which can cost $1,000 or more — affordable to all, and available on demand at publicly funded health centers.

“This has never been done before,” said Jessica Grossman, the new CEO of Medicines360, the nonprofit pharmaceutical company behind the Liletta. “Our whole mission is to offer this low-cost product.”

Very low cost, compared to the usual thousand-plus dollars. At least until the end of the year, a special program guarantees that insured women who get a Liletta will pay no more than $75 out of pocket for it, Grossman said. A permanent patient assistance program will also provide Lilettas for free to women who qualify.

‘Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’

And, behind the scenes but even more important, public health clinics can order the Liletta for a mere $50 each.

In Massachusetts, all six Planned Parenthood clinics have begun to stock the Liletta, and it’s starting to enter “formularies” — the approved prescription lists — from major hospitals to cash-strapped community health clinics. Medicines360 reports shipping Liletta to 49 states, with more than half of the devices going to clinics that serve low-income patients.

The idea is to make the devices affordable enough that clinics can stock plenty, Grossman said, so that a woman can come in and say, “’Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’ ”

The Anonymous Donor

The Liletta is the latest chapter in the story of the great resurgence of IUDs in the United States, featuring billionaire investor Warren Buffett in a key cameo.

A New York City subway sign that is part of the new "Maybe the IUD" campaign (Courtesy of Dr. Deborah Kaplan)

A New York City subway sign that is part of the new “Maybe the IUD” campaign (Courtesy of Dr. Deborah Kaplan)

After the 1970s debacle of the Dalkon shield, which caused infections and even a few deaths, IUDs fell almost completely out of use among American women. Then, in 2001, a new, hormone-emitting device came on the market — the Mirena.

IUDs steadily gained popularity as a relatively safe, set-and-forget, long-acting but reversible option for many women. (As a no-complaints Mirena user for a decade, I’m one of them.)

More than 10 percent of American women who use birth control now choose IUDs, the most recent data show — the Mirena or the Skyla, which emit tiny amounts of hormones, or a simpler copper IUD, the Paragard.

The latest evidence of the IUD’s full rehabilitation: New York City’s Health Department this week launched its “Maybe the IUD” campaign to encourage New York women to consider an IUD.

The campaign talks about “reproductive justice,” reflecting in part a troubling trend: Unintended pregnancy is increasingly a poor woman’s problem. Look at the trend in the Guttmacher chart below: Continue reading


Even Without Warren Buffett, IUDs Have Some Upside



Don’t miss this fantastic bit of reporting by Bloomberg’s Karen Weise that uncovered the juicy news that through a charitable foundation, Warren Buffett “has become the most influential supporter of research on IUDs.”

It turns out the Buffett-funded foundation paid for myriad studies of the once-shunned type of contraception that is now undergoing a renaissance of sorts. (Shunned, of course, due to the infamous Dalkon Shield, a type of intrauterine device eventually linked to complications, including infertility, infections, even death.)

Here & Now covered the story this week and posted these details:

First, an anonymous donor funded a multi-year study in St. Louis, finding that when given the choice, 75 percent of women chose IUDs or IUDs and hormonal implants. Further, the study revealed that IUDs had over a 99 percent effectiveness rate — in addition to being extremely safe. That study was written up in 50 medical journals, and was also used to promote extensive initiatives in Colorado and Iowa, where an anonymous donor funded low cost IUDs, as well as training programs for medical professionals on IUD use and counseling. In Colorado, the results showed the teen birth rate dropping by 40 percent. Finally, with the evidence of the IUD’s safety and effectiveness indisputable, the anonymous donor funded the development of a new, low-cost IUD known as Liletta.

Well, it turns out that the anonymous donor, in every case, was the Susan Thompson Buffett Foundation — a philanthropic organization funded by its founder billionaire Warren Buffett.

OK, so Buffett has long been a supporter of expanding access to contraception. Does that mean the IUD should not be given a second look? We’ve written a fair amount on this topic: Carey wrote about her own IUD here, and also offered a thoughtful, news-you-can-use post, “10 Reasons To Get An IUD, And 5 Downsides.” Continue reading

Word To Pediatricians: IUDs And Implants Top Choices For Teen Birth Control

From a Planned Parenthood video on the IUD (YouTube)

From a Planned Parenthood video on the IUD (YouTube)

By Veronica Thomas
Guest contributor

When a teen girl tells her pediatrician she’s thinking about having sex, the response is often a brief talk about abstinence, a handful of condoms, and a referral to the family planning clinic across town.

But a new recommendation makes pediatricians likelier to discuss the whole gamut of birth control methods—with IUDs and hormonal implants topping the list.

Released today by the American Academy of Pediatrics, the recommendation says doctors should discuss a broad range of birth control options with sexually active teens, but should start with the methods that protect against pregnancy best: long-acting reversible contraceptives, which include the hormonal implant, copper IUD and two hormonal IUDs.

Teen pregnancy rates have dropped dramatically over the past two decades to a record low, but the U.S. still has one of the highest rates among developed countries: more than 750,000 pregnancies each year. Though most sexually active teens use some form of birth control, they rarely pick the most effective methods and often use them incorrectly—whether it’s missing a few doses of the pill or accidentally tearing a condom.

“It’s sort of a set-and-forget method.”

– Heather Boonstra, Guttmacher Institute

Because IUDs and implants don’t rely on any action from the user, they’re a particularly good fit for teens, says Heather Boonstra, Director of Public Policy at the Guttmacher Institute.

“It’s sort of a set-and-forget method,” she says. Once inserted by a trained professional, an implant or IUD can last from three to ten years, and will be over 99 percent effective. The implant is a matchstick-sized rod inserted in the upper arm; the IUD is a small, T-shaped device placed into the uterus.

Their use has been rising for years in the general population. From 2002 to 2009, implant and IUD use nearly doubled among women overall. But while use of these long-acting methods has also been increasing among teens, less than five percent of all teen contraceptive users currently choose them.

That’s because most teens have never even heard of the implant or IUD, says Boonstra. Continue reading

Mass. Candidates React To ‘Abhorrent, Disturbing’ Hobby Lobby Decision

u.s. supreme court

It doesn’t have the local angle of last week’s abortion-clinic buffer zone decision. But reactions to today’s Supreme Court Hobby Lobby decision, allowing some companies to refuse to cover contraception, have begun to roll in from Massachusetts gubernatorial candidates. We have four so far, from — in alphabetical order — Democrat Don Berwick, Democrat Martha Coakley, Evan Falchuk of the United Independent Party and Democrat Steven Grossman, and will update as statements come out:

Don Berwick:

“Today’s abhorrent Supreme Court decision is yet another affront to women’s health. Every woman deserves access to quality reproductive health care, and I hope that Congress will take swift action toward ensuring that contraceptives are available to women, regardless of their employer’s religious affiliation.

“This ruling also serves as a reminder that it is past time to decouple health coverage from employment and move to a publicly accountable single payer health care system, similar to Medicare for all.”

Martha Coakley:

“Today’s ruling undercuts important protections for women seeking access to affordable contraceptive services. For-profit corporations should not be allowed to prevent women from receiving necessary health care based on the religious beliefs of managers and shareholders. This decision undercuts vital efforts to ensure equality both here in Massachusetts and across the country, and we will continue our fight for quality health care coverage.”

In January 2014, AG Coakley, along with California Attorney General Kamala Harris, led a coalition of 14 other states in filing an amicus brief with the U.S. Supreme Court supporting access to FDA-approved contraceptive coverage.

Evan Falchuk:

Today’s 5-4 Supreme Court decision in the Hobby Lobby case, allowing companies to opt out of the federal mandate to cover certain contraceptives, is a disturbing precedent for those who care about women’s health and access to reproductive health services. I wholeheartedly agree with Justice Ginsburg when she writes in her dissent “The court, I fear, has ventured into a minefield.” Continue reading

Morning-After Pill Disappoints, On To Plan C: More Effective Methods

Morning After Pill

They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.

The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.

But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.

Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.

“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”

Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.

Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.

Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading

Birth Control: Talking ‘Bout The Pullout Generation

When a recent study concluded that nearly 1 in 3 straight, sexually active young women used the withdrawal method for contraception, the media breathlessly coined a neat phrase to characterize these 15- to 24-year-olds: “The Pullout Generation.”

Elite Daily asked: “Gen-Y Or Gen-Pullout? Coitus Interruptus Is The New Form Of Birth Control” and New York Magazine breezily headlined its coverage, “No Pill? No Prob. Meet The Pullout Generation.” The Huffington Post held a forum, asking “Is this an appropriate method of birth control in this day and age?”

youngloveThe truth is, “pulling out” is old news. Indeed, it’s perhaps the oldest form of contraception (besides abstinence) and has been practiced for millennia. Though clearly not the most effective method of birth control, and offering no protection against STIs, withdrawal is free and when done with skill it can be somewhat effective.

According to Planned Parenthood:

–Of every 100 women whose partners use withdrawal, 4 will become pregnant each year if they always do it correctly.
–Of every 100 women whose partners use withdrawal, 27 will become pregnant each year if they don’t always do it correctly.
–Couples who have great self-control, experience, and trust may use the pull out method more effectively. Men who use the pull out method must be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. If you cannot predict this moment accurately, withdrawal will not be as effective.

To find out more, I crowd-sourced the issue on SurveyMonkey and asked why my 20-something peers — savvy, educated — relied on such a frowned-upon form of contraception. I got over 30 responses that fell into five overarching categories: Continue reading

Should Parents Stock ‘Plan B’ At Home In Case Teens Need It?

Plan B emergency contraception (AP photo)

Plan B emergency contraception (AP photo)

I’ve been thinking lately about the sexual stupidity of my youth. The foolish chances I took. The silly expectations born of “uncontrollable passion” scenes in bodice-buster books. The deep need for approval as demonstrated by desire.

The trigger for these regretful ruminations was last Friday’s landmark ruling on “Plan B,” also known as “the morning-after pill.” A federal judge ruled that it should be available over the counter to all ages. He not only overruled an Obama administration decision to require prescriptions for girls under 17, he derided that age limit as “scientifically unjustified.”

That ringing endorsement prompted this disconcerting train of thought: “Wow, Plan B sounds amazingly safe. Wish they’d had it when I was young and stupid. Hey, wait. Does this mean that when my kids are old enough to enter the danger zone, I should stock some Plan B for them? If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?”

It felt outlandish and loving at the same time. I could already imagine the speech: “Please, please, please don’t have unprotected sex. But if somehow you do, you don’t even have to face me or talk to me. The Plan B is on the top shelf in the bathroom. Use it as soon as possible. And I hope when you’re ready, we can talk.”

If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?

Could that kind of tactic even make any sense? And mightn’t it encourage irresponsible behavior? And is Plan B really that safe, or does it carry even minor risks?

I called over to the contraception and sexual education experts at the Planned Parenthood League of Massachusetts, who had — unsurprisingly — heartily praised last week’s ruling.

First, their medical reassurance, from Dr. Danielle Roncari, the league’s medical director:

“Emergency contraception, we know, is safe and highly effective. We also know from multiple research studies that it’s safe for women of all ages to use, and that increased access to emergency contraception doesn’t lead to increased sexual activity, it just leads to increased use of contraception.

We also know that it’s a very safe medication. There’s really virtually nobody that this medication isn’t safe for, and we also know that teenagers are able to use it just as easily as adult women. Research backs this up.”

Two additional safety points she mentioned: Plan B will not impact an existing pregnancy, so no pregnancy test is needed; and repeated usage is not unsafe either, though it is a concern because emergency contraception is not as effective as regular contraception – Plan B is up to 89% effective at preventing pregnancy, compared to daily birth control pills, which are up to 99% effective.

So, then, I asked, is this a good idea, to keep Plan B in the house? Continue reading

ACOG: Screen for Lesser-Known Abuse, ‘Contraception Sabotage’

According to the nation’s leading obstetricians and gynecologists, “reproductive and sexual coercion” — behavior intended to maintain power and control in a sexual relationship — is, sadly, not uncommon.

While homicide is one of the leading causes of death for pregnant women, The American College of Obstetricians and Gynecologists (ACOG) reports that many abused adolescent girls and women are also the subject of another, lesser-known form of abuse: “contraception sabotage,” the most common form of reproductive coercion.

In a just-released committee opinion ACOG notes that victims of such abuse have “male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections, or force them into having unwanted pregnancies or abortions.” This type of “reproductive coercion” says ACOG, can even go as far as male partners “forcefully remove intrauterine devices (IUDs) and vaginal rings, poke holes in condoms, or destroy birth control pills.”



ACOG reports:

Sexual coercion includes a range of behavior that a partner may use related to sexual decision making to pressure or coerce a person to have sex without using physical force. This behavior includes repeatedly pressuring a partner to have sex, threatening to end a relationship if the person does not have sex, forcing sex without a condom or not allowing other prophylaxis use, intentionally exposing a partner to a sexually transmitted infection, including human immunodeficiency virus (HIV), or threatening retaliation if notified of a positive STI test result. Continue reading

Pregnancy Prevention Progress: Easier Pills, Plan B At Teen Check-Ups

Birth control pills

This looks like quite a convergence. In a country where roughly half of conceptions are still accidental, we’ve just seen two significant steps toward helping women avoid unwanted pregnancy, both coming from groups of doctors who can rule on safety as well as urgent need.

On WBUR’s Cognoscenti, writer Judy Foreman posts here today:

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.
It’s about time.

And also last week, the American Academy of Pediatrics recommended that doctors routinely counsel teenagers about emergency contraception — better known as Plan B or the morning-after pill — and prescribe it in advance, even if the teen is not sexually active. Currently, girls under 17 need prescriptions for the pills.

WBUR’s Here & Now discusses the issue here, and the segment elicited this cogent comment:

Well how about the boys? Isn’t it time we gave them a script for the morning-after-pill to give to their partners?

Readers? Interesting scenario, isn’t it? How might that dialogue in the steamed-up car go?