Reporting on health and quality of life in South LA

IUDs had a bumpy, sometimes deadly beginning; now they're easy, effective birth control

IUD

+mara/Flickr Creative Commons

Intrauterine devices, one of which is pictured above, gained a bad reputation in the '70s after a long-since discontinued brand known as Dalkon Shield killed at least 18. IUDs are now safe, say experts, and are among the most effective forms of birth control.

Intrauterine devices (IUDs) are just as safe for teenagers as they for adults, according to new research from the University of Texas Medical Branch. And they're really safe for adults, said the study's authors.

It's the latest in a series of studies highlighting the efficacy and safety of IUDs, and it comes as acceptance of IUDs is slowly growing in the U.S. nearly four decades after the Dalkon Shield fiasco.

IUDs are a long-term reversible form of birth control, of which there are two types: copper and hormonal. In both cases, a small T-shaped device is inserted into the uterus, resulting in what experts agree is one of the most effective forms of reversible birth control.

It's also believed to be among the safest. According to a statement, after looking at private insurance claims from more than 90,000 women and teenage girls, the study's authors found that serious complications arising from IUD use occurred in less than 1 percent of women, regardless of age.

They were looking for complications like pelvic inflammatory disease (PID), ectopic pregnancy, IUD failure or periods that were painful, light or absent. Noting that teenagers and older women discontinued using their IUDs early at about the same rate, researchers also inferred that teens didn't experience any more complications than their older counterparts did. Hormonal IUDs were associated with fewer complications than the copper kind.

The findings appeared in the journal Obstetrics & Gynecology.

"A bad rap"

IUD use has trailed behind other contraceptive methods ever since the infamous Dalkon Shield, marketed by by A.H. Robins Company, was pulled off the market in 1974. The device's design, coupled with a filament that could allow bacteria to enter the uterus, led to numerous reports of complications – and even some deaths.

A 2011 report by Jennifer Couzin-Frankel in Wired Magazine describes what happened soon after women began using the Dalkon Shield:

Women with the Shield came to doctors ravaged by infection. Some complained of uterine bleeding or pain during sex. In others, the symptoms were less severe, like vaginal discharge or vague abdominal pain. Doctors diagnosed some of them with a condition called pelvic inflammatory disease—PID—which can be caused by chlamydia and gonorrhea or by normal vaginal bacteria. The women took antibiotics and usually got better, though a few rare cases led to hysterectomies. Furthermore, the Shield had a higher failure rate than originally reported, and some women who became pregnant with the Shield in place experienced spontaneous septic abortion, a miscarriage complicated by infection. At least 18 died. In 1974, faced with a flood of Shield-linked complaints, AH Robins took it off the market.

The public doesn't easily forget something like that. Serena Josel, the director of public affairs for Planned Parenthood Los Angeles, acknowledged as much.

"I think that [IUDs] kind of got a bad rap," she said. "They got better but the public and provider impression didn't necessarily improve with the medical improvements made to the devices."

Which may have something to do with the fact that, despite the claims of IUD efficacy, they're far from the most popular form of birth control in the United States. The Guttmacher Institute says statistics from 2006-08 show that 5.5 percent of women who use contraceptives chose an IUD – far below the rates for birth control pills (28 percent), tubal sterilization (27 percent) and condoms (16 percent).

Do IUDs work – and are they safe?

Last April, another study appearing in Obstetrics and Gynecology found that almost 1 in 3 women had "misconceptions about the safety of IUDs" for women who hadn't had children yet.

A month after that, another study found that IUDs are the most effective form of emergency contraception – even compared to the morning-after pill.

And not even a month after that, another study in the New England Journal of Medicine said that women who used IUDs are 20 times less likely to have an unintended pregnancy than women who use the pill, the patch or vaginal rings as birth control.

The Association of Reproductive Health Professionals says out of every 100 women who uses an IUD, maybe one woman – but "most likely no one" – will become pregnant every year. (To contrast, about 8 percent of women who use the pill will become pregnant every year – and that's assuming it's taken properly, every time.)

As for the safety of IUDs, the American College of Obstetricians and Gynecologists wrote in 2007 that "[data supports] the safety of IUDs for most women, including adolescents."

In late 2012, the College replaced that opinion with one whose conclusion said "adolescents should be encouraged to consider [long-acting reversible contraception] methods" like IUDs, which "are the best reversible methods for preventing unintended pregnancy, rapid repeat pregnancy, and abortion in young women."

That's a far cry from the Dalkon Shield.

IUDs in South L.A.

IUDs aren't necessarily more expensive than birth control pills, condoms or other short-term methods of birth control, but they do put a different sort of financial burden on people who want to use them.

"It's very much a difference between paying a small to moderate amount every month versus having a large up-front cost and then not having to worry about it for several years," said Planned Parenthood's Serena Josel.

IUDs run between $500 and $1,000 for the insertion procedure, according to U.S. News & World Report, but can last as long as 12 years. Over that decade-plus, an IUD that costs $1,000 up front has a yearly price of a little over $83. Compare that to birth control pills, which can run between $160 and $600 every year. Add the price of condoms to that – and say they're used twice a week – and that's another $150 annually.

Area health providers have to balance that with South L.A.'s teen pregnancy rate. According to the L.A. County Department of Public Health, there are nearly 59 births for every 1,000 teenage girls in South Los Angeles. That's far and away the highest in the county, and that's why Ann Cavanagh, a family nurse practitioner at St. John's Well Child and Family Center in South L.A., said she advocates for IUDs among her sexually-active teen patients. Condoms, after all, require perfect use and are far from the most effective method of contraception – especially for teenagers who already have a child.

"Their lives are chaotic, so I try to stress the long-term contraceptives like the implant or the IUD," she said in early April.

But not all providers are like Cavanagh, said Josel.

"Across the county, we don't see as many providers who are comfortable with IUD insertion," she said, noting that it's equally important to educate clinicians and the public alike to help dispense of any misconceptions regarding the safety of IUDs.

Still, phone calls to area clinics suggest that those providers don't appear to be the majority in South L.A.: St. John's, UMMA Community Clinic, South Central Family Health Center, T.H.E. Clinic and the county's Hubert Humphrey Comprehensive Health Center all offer IUD insertion.

Central City Community Health Center does not, but Liz Hernandez, the administrator of the clinic's South L.A. site, says that's because there's no OB/GYN on-site. She said the IUD is one of the more popular family planning choices at Central City, and the health center will refer a woman who wants one to another provider.

"Most of the time the patient will go for the IUD because it really doesn't have that many hormones," she said, meaning patients choose the copper over the hormonal variety.

Josel from Planned Parenthood says there's increasing interest in IUDs in the area, especially among young people.

"This is a method that many young people didn't know about, just never considered," she said. "So the more they learn about them, there's a lot of interest."

One very important note about IUDs, though: While they could help curb the area's high unintended pregnancy rates, they won't curb the area's high rates of sexually transmitted infections.

"It's important to remember while an IUD can be a great option for pregnancy prevention, it doesn't provide any protection against STDs," said Josel. "It's still very important to use condoms and other forms of latex barriers."

IUDs are FDA-approved and so are required to be covered with no cost to the patient by all new insurance plans under the Affordable Care Act. Family PACT can also be also a conduit to a variety of contraception for low-income patients.

Photo by +mara via Flickr Creative Commons.

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