Demand for IUDs increases as women fear losing healthcare

by Emily DeLetter

Sarah Dolen has tried other forms of birth control before, but none are as effective as her IUD. The device’s convenience was a no-brainer.

“There’s no user error because once it’s inserted properly, you can’t mess up,” Dolen said. “When I was first thinking about it, I realized how simple it was. No taking a pill every day, no cost of condoms or any chance of condoms not working. Once you get it inserted, you don’t have to worry about it.”

Demand for the Interuterine Devices, or IUD, is skyrocketing. Planned Parenthood President Cecile Richards said in an interview with CNN that women requesting the device has increased 900 percent in the last year. She pointed to threats to the Affordable Care Act, which covers the device, as part of the reason.

Women are “desperately concerned that they might lose their access to healthcare,” Richards said.

The IUD is the most effective form of birth control available. The copper IUD is 99.7 percent effective while the hormonal versions are 99.8 percent effective at preventing pregnancy.

According to Planned Parenthood’s website, the IUD is a small, T-shaped piece of plastic planted in a woman’s uterus that makes menstrual periods manageable and prevents pregnancy. The device comes in different forms that prevent pregnancy in different ways.

Some versions are wrapped in copper, which help deter sperm from finding an egg, while other forms use the hormone progestin, which thickens cervical mucus and stops ovulation from occurring, thus preventing pregnancy.

Kate Harris is nurse practitioner in gynecology subspecialties at the University of Kentucky. According to Harris, hormonal forms of IUDs are effective from three to five years, depending on the brand the user chooses. ParaGard, the copper nonhormonal IUD, lasts for 10 years but has side effects that wouldn’t make it the best choice for every user.

“The ParaGard makes periods heavier and many women experience heavier cramping,” Harris said. “For women already dealing with heavier monthly periods, an IUD that uses hormones instead of copper would be a better fit.”

Overcoming the stigma

There is still a heavy stigma surrounding the IUD due to the Dalkon Shield IUD from the 1970s, which in some cases caused infertility, perforation of the uterus, or even death. Lawsuits and settlements from victims of its side effects eventually put the company out of business.

Harris said she believed that the bad name associated with the IUD due to the Dalkon Shield is getting better, especially with younger women.

“Many of my patients come totally against IUDs at first because their moms remember the 70s and still think they’re dangerous,” Harris said. “But many younger women aren’t aware of it’s past history and choose it over other forms [of birth control].”

Helen Holthaus has had her IUD since October 2016. Holthaus said she was interested in trying a different kind of birth control after still experiencing heavy periods and weight gain while on the pill. When the hormonal IUD was first presented as an option, she said she at first felt very felt tentative.

“I was nervous because I heard from other people that you get bad cramps, it really hurts to insert and remove, you can gain weight, and sometimes it can puncture your uterus,” Holthaus said. “But I talked to my doctor, and she told me there was a low chance of that happening. Getting it inserted didn’t even hurt that much, and I feel so much better than when I was on the pill.”

Measuring Effectiveness

The New England Journal of Medicine published a study that concluded no association between tubal infertility and IUD usage. Researchers in China found similar results- normal pregnancy rates persist after the removal of the device.

While it is effective in preventing pregnancy, the Center for Disease Control reports that the IUD does not protect against contracting sexually transmitted infections or HIV/AIDS.

Harris said that after insertion, there is minimal room for error and women have almost no chance of pregnancy for at least three years, depending again on what form of IUD they choose.

An Unknown Future

Almost all insurance plans cover the cost and procedure to place the IUD 100 percent, according to Harris. Price is dependent on the brand of IUD, but without insurance and including the placement procedure they are usually around $1500.

IUD cost and placement procedures are also included under Medicare and Medicaid.

“Many women I see have insurance plans that cover their IUD fully, but those that do pay out of pocket choose Liletta, because [at $600] it is the cheapest,” Harris said.

But many women are worried that the current administration and new healthcare plans proposed to replace the Affordable Care Act will make access to birth control much more expensive.

CNN estimated that over 11.4 million people were covered through the Affordable Care Act, which President Donald Trump has promised to repeal.

“Real change begins with immediately repealing and replacing the disaster known as Obamacare,” Trump said during his candidacy for president.

Trump signed an executive order May 4 to offer “unspecified ‘regulatory relief’ for religious objectors to an Obama administration mandate, already scaled back by the courts, that required contraception services as part of health plans”, according to the Washington Post.

The decision to repeal the Affordable Care Act was pulled from the House on March 24, but House Republicans voted on a plan to change key parts of the current healthcare bill May 4, passing with 217 to 213 votes onto the Senate.

The Senate is expected to begin debating the bill in June.

The American Health Care Act will likely no longer require coverage of birth control without a co-pay.

The Congressional Budget Office estimated that over 24 million people would be left without insurance if the ACA was repealed, and would increase budget deficit by over 137 billion over a 10 year period.

The US government healthcare website lists covered contraceptive methods, which include FDA-approved contraceptive methods prescribed by the woman’s doctor. IUDs are listed, as well as other forms such as the pill and emergency contraception.

Harris said she noticed a large increase in women requesting IUDs because of their longevity since the most recent presidential election.

“Many of the women who come in are looking for something that lasts at least four years,” Harris said. “They’re nervous that their access could go away, so they’re looking for something that will be more long-term.”

She also credited the increase due to awareness about IUDs.

“A lot of women thought they had to have had babies in order to have an IUD, but that’s not the case,” Harris said. “There has also been a large number of teenagers requesting them.”

For CatyBeth Gooding, getting her IUD wasn’t just to prevent pregnancy. She said she believed hers was a necessity.

Gooding tried other forms of birth control to help manage her period for years, everything from the hormonal patch to the pill. But none of those forms were doing anything to help her excessive cramping and nausea that would show up every month.

“My cramps before would get so bad that I would throw up and couldn’t get out of bed and make it to class,” Gooding said. “It’s an essential thing that I need to be productive in my life, and if I wouldn’t be able to afford it without insurance. Without [the hormonal IUD], my quality of life would greatly decrease.”

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