Why IUDs?

 

Based of the most recent estimate (2006), nearly half of all pregnancies in the U.S. are unintended (49%), and 43% of these pregnancies end in abortion.[i]  In the U.S. each year, there are an estimated 1.5 million births resulting from unintended pregnancies.[ii]    

IUDs are HIGHLY EFFECTIVE in preventing pregnancy

  • IUDs are 99% effective in preventing pregnancy. They are one of the most effective forms of birth control.[iii]
  • IUDs do not require daily compliance or attention like oral contraceptives (the pill).[iv]

 

WOMEN WANT IUDS and LIKE IUDs once they have them

  • Two-thirds of women of child-bearing age in the U.S. currently use birth control, and the use of IUDs is on the rise within this group: from 2% in 2002 to 7.7% in 2009.[v]
  • In a recent study in St. Louis among 10,000+ women who received counseling about the most effective forms of birth control and were provided any contraceptive method free of charge, 67% of women chose LARC methods (56% IUDs, 11% implants).[vi]
  • The same study found that at 24 months after choosing their birth control method, women continued using IUDs longer than any other birth control method: 77% and 79% for Paragard and Mirena, respectively, compared to 43% for the pill.[vii]

 

IUDs are SAFE and RECOMMENDED for use by most women

  • The American College of Obstetricians & Gynecologists (ACOG) recommends that LARCs be offered as first-line contraceptive methods and encouraged as options for most women,[viii] including adolescents.[ix]
  • Skyla and Paragard are FDA-approved for use among women who have never had children (referred to clinically as nulliparous women).[x],[xi] Mirena is FDA-recommended for women who have had at least one child and women seeking a birth control method that helps treat heavy menstrual bleeding.[xii] 
  • IUDs can be safely inserted directly postpartum and postabortion.[xiii]  Inserting an IUD or implant immediately after an abortion significantly reduces the risk of subsequent abortions.[xiv]
  • Infertility is not more likely after discontinuation of an IUD than after discontinuation of other reversible methods of contraception.[xv]
  • In 2013, the CDC developed the United States Selected Practice Recommendations for Contraceptive Use, which provides guidance on how contraceptive methods can be used and how to remove unnecessary barriers for patients in accessing and successfully using contraceptive methods.[xvi] The report offers guidance on when to initiate IUDs and clinical guidance on special considerations, advisable testing, routine follow-up and IUD management.
  • In 2010 the Centers for Disease Control and Prevention (CDC) developed the United States Medical Eligibility Criteria for Contraceptive Use, which provides guidance on the safety of contraceptive methods, including IUDs, for women with specific characteristics and medical conditions.[xvii]
     

IUDs can be LONG-LASTING, but are easily removed at any time

  • IUDs can last from 3 to 10 years, depending on IUD type,[xviii] and can be easily removed at any time by a healthcare provider.
  • Rates of continuation and removal of IUDs are similar for adults and adolescents.[xix]

 

IUDs can be AFFORDABLE

  • Under the Affordable Care Act,[xx] all contraceptive methods (including IUDs) and associated services (insertion, removal, and maintenance) must be covered by a health plan without cost-sharing.
  • The National Women’s Law Center[xxi] and Bayer HealthCare Pharmaceuticals (manufacturer of Mirena and Skyla) [xxii]  have developed materials to help women and providers navigate obtaining health insurance coverage of IUDs without cost-sharing.
  • IUD manufacturers (Teva Women’s Health and Bayer HealthCare Pharmaceuticals) provide IUDs at reduced cost[xxiii],[xxiv] to medical facilities that qualify for the 340B federal drug pricing program.[xxv]  IUD manufacturers also have patient assistance programs that offer IUDs free of charge for those who qualify and are uninsured.[xxvi] 
 

[i] Finer, L.B., Zolna, M. Unintended Pregnancy in the United States: Incidence and disparities, 2006. Contraception, 2011, 84, 5, 478-485.  Accessed from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338192/

[ii] Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982–2010. National health statistics reports; no 55. Hyattsville, MD: National Center for Health Statistics. 2012. Accessed from: http://www.cdc.gov/nchs/data/nhsr/nhsr055.pdf; Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012. Accessed from: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf

[iii] Trussell, J. “Contraceptive Failure in the United States.” Contraception 83 (2011):  397-404.  Access from: http://www.kupferkette.info/downloads/contraceptive-failure-in-the-united-states---2.pdf

[iv] Grimes, D, “Forgettable Contraception.” Contraception, 80,6 (2009): 497–499. Accessed from: http://www.sciencedirect.com/science/article/pii/S0010782409003047

[v] Finer, L. B., Jerman, J., & Kavanaugh, M. L. (2012). Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertility & Sterility, 98(4), 893-897.

[vi] Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol 2010;203:115.e1-7. Accessed: http://www.sciencedirect.com/science/article/pii/S0002937810004308

[vii] Peipert, J. F., Zhao, Q., Allsworth, J. E., Petrosky, E., Madden, T., Eisenberg, D., & Secura, G. (2011). Continuation and satisfaction of reversible contraception. Obstetrics & Gynecology, 117(5), 1105-1113.  Accessed: http://www.ncbi.nlm.nih.gov/pubmed/21508749

[viii]ACOG. (2009). Increasing Use of Contraceptive Implants and Intrauterine Devices To Reduce Unintended Pregnancy. ACOG Committee Opinion No. 450. American College of Obstetricians and Gynecologists. Obstet Gynecol, 114, 1434–8. Accessed from: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Increasing_Use_of_Contraceptive_Implants_and_Intrauterine_Devices_To_Reduce_Unintended_Pregnancy

[ix] ACOG.  (2012). Adolescents & Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Committee Opinion No. 539 American College of Obstetricians and Gynecologists. Obstet Gynecol, 129, 983-8. Accessed from:  https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Adolescents_and_Long-Acting_Reversible_Contraception

[x]Federal Drug Administration. “Skyla Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/203159s000lbl.pdf

[xi]Federal Drug Administration. “Paragard Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/018680s060lbl.pdf

[xii] Federal Drug Administration. “Mirena Prescribing Information” FDA Access Data.(2000). Accessed from:  http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021225s027lbl.pdf

[xiii]Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. CDC MMWR, 2010, 59 (No. RR-4):  52-64. Accessed from: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf

[xiv]Goodman, S., Hendlish, S., Reeves, M., Foster-Rosales, A. “Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion.” Contraception 78 (2008): 143-148.  Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/18672116

[xv] ACOG. "Adolescents & Long-Acting Reversible Contraception: Implants and Intrauterine Devices." Committee Opinion No. 539 American College of Obstetricians and Gynecologists: Obstet Gynecol, 2012. 983-8. Vol. 129

[xvi]Centers for Disease Control and Prevention. U.S. Practice Recommendations for Contraceptive Use, 2013. CDC MMWR, 2013, 62(RR05), 1-46. Accessed from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm?s_cid=rr6205a1_w

[xvii] Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. CDC MMWR, 2010, 59 (No. RR-4):  52-64. Accessed from: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf

[xviii]Federal Drug Administration. “Skyla Prescribing Information” FDA Access Data.(2013). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/203159s000lbl.pdf; Federal Drug Administration. “Mirena Prescribing Information” FDA Access Data.(2008). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021225s019lbl.pdf; Federal Drug Administration. “Paragard Prescribing Information” FDA Access Data.(2005). Accessed from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/018680s060lbl.pdf

[xix] Yen, S., T. Saah, and P. J. Hillard. "IUDs and Adolescents--an Under-utilized Opportunity for Pregnancy Prevention." Journal of Pediatric & Adolescent Gynecology 23 (2010): 123-28.

[xx] US Federal Register. (2013). Coverage of Certain Preventive Services under the Affordable Care Act. U.S. Federal Register. Vol. 78, No. 127, Part III. http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf

[xxi] NWLC. Getting Coverage You Deserve: What to Do If You Are Charged a Co-Payment, Deductible, or Co-Insurance for a Preventive Service. National Women Law Center website. N.D. Accessed from: http://www.nwlc.org/resource/getting-coverage-you-deserve-what-do-if-you-are-charged-co-payment-deductible-or-co-insuran

[xxii] Mirena. Mirena and the Affordable Care Act: What it means for you. Bayer HealthCare Pharmaceuticals Website.  Accessed from: http://hcp.mirena-us.com/ordering-and-reimbursement/coverage-news-for-mirena.php; Mirena. Getting Mirena for free. Bayer HealthCare Pharmaceuticals Website. Accessed from: http://www.mirena-us.com/how-to-get-mirena/getting-mirena-for-free.php

[xxiii] Securing Affordable Contraceptive Drugs and Devices for Title X Providers. National Family Planning & Reproductive Health Association – Policy Brief. Accessed from: http://www.guttmacher.org/pubs/gpr/13/1/gpr131310.html

[xxiv]  Paragard Direct Application for 340b Eligible Organizations - https://www.paragarddirect.com/content/paragard/ParaGard_Direct_bus_print.pdf

[xxv] HRSA. “340B Drug Pricing Program & Pharmacy Affairs”. U.S. Department of Health and Human Services – Health Resources and Services Administration. N.d. Accessed from: http://www.hrsa.gov/opa/

[xxvi]  ARCH Foundation: Patient Assistance Program for Mirena IUD -http://www.archfoundation.com/about.htm; Paragard IUD Patient Assistance Program - http://www.patientassistance.com/profile/duramedpharmaceticalsinc-426/