NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Thursday, September 3, 2015

After decades out of favor, the intrauterine device is making a comeback. This small, T-shaped form of birth control, which is placed in a woman’s uterus and prevents pregnancy for between three and 10 years, has carried a stigma in the United States ever since the 1970s, when one notoriously flawed model, the Dalkon Shield, caused septic miscarriages and infertility in thousands of American women. But now, health-care providers are trumpeting the safety—and efficacy—of the models currently on the market. The American College of Obstetricians and Gynecologists concluded as early as 2005 that IUDs and hormonal implants (which are inserted in a woman’s arm) are the most reliable forms of birth control, and should be among the top options offered to all women; the American Academy of Pediatrics released a similar recommendation in 2014.

Public health officials have good reason to be excited. Unlike more popular types of birth control—condoms and pills, the patch and the ring—these long-acting devices don’t require women and girls to fill a prescription, or to bring along protection every time they have sex. Accordingly, these devices are far more effective at preventing pregnancy. IUDs fail less than one percent of the time. The benefits of widespread adoption are potentially huge: When a privately funded experiment made IUDs and implants available for free across the state of Colorado, both the teen birth rate and the abortion rate dropped by about 40 percent.

Despite some recent buzz about long-acting birth control, though, only about nine percent of American women are actually using IUDs or implants—and perhaps only 50 percent have even heard of them. Here are five studies that explain why public health experts are so committed to driving those numbers up—and what needs to happen for them to succeed.

Women Who Use Long Activg Birth Control Are More Likely to Stick With It, And Less Likely to Get Pregnant

In 2007, four researchers at Washington University in St. Louis set out to assess the information gap: If teens and young women were educated about long-acting birth control, would they want it? And if they got it, would they like it? The researchers offered free birth control to over 9,000 14- to 45-year-olds, counseling them on a host of options—including IUDs and implants as well as the patch, the ring, and the pill—by starting with the most effective methods and proceeding in order of reliability. After the counseling, 75 percent of the participants chose implants and IUDs. A year later, 86 percent of the women who’d chosen a long-acting method were still using it, compared with only 55 percent of those using one of the other methods. Pill, patch, and ring users were 22 times more likely to have an unintended pregnancy in the first year of the study than IUD and implant users.