Wednesday, 20 July 2011

The IUD comeback

When I was in college, I remember IUDs being completely dismissed as a form of contraception - they were barely even discussed, but I got the impression that they were some quasi-medieval little device that was only used by women who had already had at least 4 children.

Come grad school, IUDs were a hot topic in my MCH class, both academically and personally. For the personal side, at least a third of our cohort got IUDs, and academically they came up in almost every class discussion of family planning as an increasingly popular and very effective method of long-term contraception.

This Wired article does a nice job of summarizing the history behind the rise, fall, and rise again of the IUD.

By the early 1970s, 17 IUDs were under development by 15 different companies. The problems started with the fourth one to actually hit the market: the Dalkon Shield. AH Robins (which also made ChapStick and Robitussin) marketed one version of it as a smaller option for women who didn’t have children. Like all medical devices at the time, the Shield wasn’t vetted by the FDA. While drugs got careful screening, safety and efficacy claims on device labels did not. The FDA stepped in only if people started reporting problems. And report they did. ...

The new research [in the 90s] and thinking on IUDs had important implications for the future of the device. For one thing, it’s clear that doctors should not put it into women who have an active STD infection. (And even then, it’s only bacterial infections like chlamydia and gonorrhea that are problems; infection with the widespread human papillomavirus doesn’t disqualify anyone.) For another, inserting it under sterile conditions is paramount. To the people running these studies—and the doctors who read them in medical journals—the results were reassuring. There was nothing wrong with IUDs as a technology. ...

IUDs are on the verge of a remarkable return to popularity. Nationally, 5.5 percent of women using contraception choose them. That sounds unimpressive, but it’s the first time in more than 20 years that the number has risen above 2 percent; in 1995, it was 1.3 percent. By that baseline, 5.5 percent represents a sea change. And a few pharmaceutical companies believe that number is poised to grow.


There is plenty of reason to believe that more American women will be adopting the IUD when you compare our IUD use prevalence to that of other European countries, including Norway which tops out at 27% prevalence IUD use!

One interesting note is the price of getting an IUD in the U.S.

Also, the devices are expensive—the ParaGard costs $500, the Mirena $850. “It’s absolute highway robbery that these companies charge so much,” Espey says. “If you went to Home Depot and got the raw materials for a copper IUD, it would cost less than 5 cents.” And the hormones don’t contribute much more to the cost, she adds.

In fact, amortized over years of use—10 for the ParaGard and five for the Mirena—an IUD is far cheaper than birth control pills, which can cost $30 or more a month. But the initial outlay is difficult for some women to manage, and it’s not always covered by insurance. Schnuriger, who comes from a working-class St. Louis family, split the $450 cost of her IUD with her boyfriend. She used money earned from a work-study job to pay her half. If she keeps the ParaGard the full 10 years, it will end up having cost $3.75 a month.


Most people I know had insurance that did cover a pretty decent amount for the IUD and the appointment to get it inserted. But if you're paying out-of-pocket, it is a big investment even knowing that in the end it will probably be cheaper than other methods. Compare the prices we are paying in the U.S. with this: I have a friend working on an IUD project in West Africa. They offer only the Paragard (copper) IUDs. Price for the IUD + insertion? $3. Her expat friends get their IUDs before they come back to the U.S.