News Contraception

The Copper IUD as Emergency Contraception: A Neglected Option

Peter Belden

Did you know that for emergency contraception (EC), the copper IUD is more than 99 percent effective?

Did you know that for emergency contraception (EC), the copper IUD is more than 99 percent effective while EC pills are less than 90 percent effective?  That means that you are ten times more likely to get pregnant if you take EC pills rather than using and IUD as EC.  Despite that fact, a recent study found that only 15 percent of family planning providers in California had offered the copper IUD as EC to their EC clients.  Women seeking EC deserve to be offered not only EC pills, which are convenient, but also the copper IUD as a more effective EC option.  Two studies found that when the copper IUD is offered, more than 10% of women seeking EC were interested in having a copper IUD inserted as EC. 

View the editorial on the copper IUD as EC by Peter Belden, Cynthia Harper, and Joe Speidel in the journal Contraception.

News Abortion

Senate Democrats Propose ‘Affordability Is Access’ Bill for Over-the-Counter Birth Control

Emily Crockett

Not to be outdone by Republicans who say they support expanding “access” to contraception by making birth control available over the counter, Senate Democrats unveiled a proposal Tuesday to make sure that if that does happen, women can still get birth control through their insurance without paying extra.

Not to be outdone by Republicans who say they support expanding “access” to contraception by making birth control available over the counter, Senate Democrats unveiled a proposal Tuesday to make sure that if that does happen, women can still get birth control through their insurance without paying extra.

Sen. Patty Murray’s (D-WA) Affordability Is Access Act would require insurance companies to cover birth control pills without cost-sharing from patients if the Food and Drug Administration (FDA) decides they can be made available without a prescription.

The bill has at least 28 co-sponsors in the Senate, including Sens. Barbara Boxer (D-CA), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Harry Reid (D-NV), Jeanne Shaheen (D-NH), and Michael Bennet (D-CO). All of the co-sponsors are Democrats except for Sen. Bernie Sanders (I-VT), who caucuses with the Democrats.

Murray introduced the bill to reporters on a Tuesday press call with representatives from Planned Parenthood, NARAL Pro-Choice America, and the American Congress of Obstetricians and Gynecologists (ACOG), all of whom strongly support the legislation.

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“Access to birth control doesn’t mean much unless it’s affordable access,” said Planned Parenthood president Cecile Richards on the call. “You can make birth control available over the counter at every pharmacy in America, but if it still costs $600 a year, it will be out of reach for many women.”

Only the FDA has the power to make medication available over the counter, but that didn’t stop Sen. Cory Gardner (R-CO) from promising on the midterm campaign trail that he would fight for over-the-counter (OTC) birth control if elected to Congress. He kept that promise by introducing a bill last month designed to encourage birth control manufacturers to apply for OTC status.

Women’s health advocates and health-care providers weren’t impressed, calling the bill a “sham” and a cynical attempt to undermine the no-copay birth control benefit.

“Anti-choice politicians have wanted to repeal the ACA—they’ve tried every trick in the book—and to force women to pay the full price of their birth control on top of what we pay for our health insurance premiums out of pocket,” said NARAL president Ilyse Hogue on the Tuesday press call.

Advocates say Gardner’s bill is part of an effort to distract from his extreme anti-choice record by letting him claim he wants to expand “access” to contraception, a term more typically used by pro-choice supporters of the Affordable Care Act (ACA).

“This Republican approach of access without affordability is like offering somebody a single shoe,” Murray said on the press call. “You really need the pair.”

The ACA requires insurers to cover all forms of birth control without copays, but that requirement only applies with a doctor’s prescription. Unlike the Democrats’ bill, the Republican proposal doesn’t change that in the event that birth control gains OTC status, which could mean that women with insurance would pay extra if their preferred birth control went OTC and their insurance stopped covering it as a result. The GOP bill would also restrict over-the-counter contraception to women over the age of 18.

“What we’re saying with this legislation is, if you’re paying for your insurance, you shouldn’t have to pay twice,” Murray said.

Unlike the Republican proposal, Murray’s bill doesn’t offer any specific mechanism to try to make birth control go OTC any faster. The GOP bill tries to give pill manufacturers an incentive to apply to the FDA for over-the-counter status by offering a priority application review and a fee waiver, but some observers don’t think those incentives will work.

“I think we have to be very careful not to put political pressure on the FDA to approve drugs without going through the regular process,” Murray said when asked by Rewire about why her bill doesn’t include similar incentives. 

“Having said that, I think that we are making progress. I do expect at some point that birth control will be offered over the counter,” Murray added. “And in that case, when that happens, our bill makes sure that insurance companies still cover it.”

Uninsured women would presumably still have to pay for OTC birth control, but they at least wouldn’t have to pay for doctor’s visits or take time off of work to schedule them, which would make them more likely to use contraception.

A recent study in the journal Contraception found that interest in OTC pills is high and that the benefits could be great, especially for low-income women.

Over-the-counter birth control pills could result in up to 25 percent fewer unintended pregnancies—as long as there are no out-of-pocket costs. Women’s use of contraception “varies widely” depending on the out-of-pocket pill pack cost, the study’s authors note.

For this reason and others, ACOG president Mark DeFrancesco said on the call, over-the-counter birth control access has many more plusses than minuses. DeFrancesco came out against the Republican OTC proposal, but supports over-the-counter birth control in general.

“Overwhelming evidence supports the safe and effective use of oral birth control without a prescription,” DeFrancesco said. “No medicine is without risk, but oral contraceptives have similar or lower risk of side effects than other types of medicines that are already available over the counter.”

DeFrancesco also said that he wasn’t worried about women not coming in for routine gynecological exams if the exams aren’t required for birth control access.

“I don’t think this will lead to a lot of people wholesale ignoring their health,” DeFrancesco said. “I think women are smarter than that, and I think they come to see us for good health care, and not only for that prescription.”

Analysis Contraception

2014: The Year of the IUD?

Elizabeth Dawes Gay

Several developments could help make this the year of the intrauterine device: the Affordable Care Act's birth control benefit, a new tool that could make insertion easier and less painful, a possible generic IUD arriving on the market, and more.

In the world of contraception, 2013 was an amazing year. Plan B One-Step emergency contraception (EC) was made available on store shelves without unnecessary and harmful age restrictions. A new intrauterine device (IUD), Skyla, made its debut on the market and was met with astounding popularity. And the implementation of the Affordable Care Act (ACA) is helping more and more people get the contraception they need and want without cost sharing, such as copays or insurance deductibles. Moreover, the Guttmacher Institute reports that improved access to and increased use of highly effective contraceptives could be contributing to fewer unintended pregnancies and abortions in the United States.

Despite ongoing battles over contraceptive access and sexual and reproductive health, 2013 was a good year, but where does that put 2014? Our prediction at the Reproductive Health Technologies Project: 2014 could be the year for IUDs to shine.

Zero Cost-Sharing

Before the implementation of the ACA, an IUD could have cost a user as much as $1,000 if it was not covered by a health insurance plan. Now, all plans are required to cover contraceptive methods and related services, including counseling, insertion, and removal, without copays or deductibles. This means that a highly effective method with a high price tag is now available to individuals with insurance coverage—private insurance and Medicaid—at little to no cost. It remains to be seen how many more people will choose to use the IUD now that the barrier of cost is theoretically eliminated for those with insurance. Some insurance companies are illegally denying coverage of more expensive contraceptives like the IUD, making it difficult for patients to acquire this safe, effective health-care product. To combat this, we’re recommending that advocates continue to monitor ACA implementation and work to ensure individuals are able to access their preferred method. 

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Still, other barriers to IUD use remain: challenges with keeping the product in stock and available for same-day insertion; billing codes that make it impossible to bill for IUDs on the same day other services, like maternity care and abortion, are provided; and difficulty with reimbursement providers experience that could result in delays for patients. However, access should be easier than ever before. 

If someone is denied health insurance coverage of their desired method of contraception, reach out to the National Women’s Law Center hotline for assistance (1-866-PILL-4-US or info@nwlc.org).

Easier Insertion

While the ACA should make IUDs more affordable for more people, barriers to use may still exist. An important barrier that does not receive a lot of attention is pain. For some, the fear of pain and cramping associated with the insertion process—mainly caused by holding the cervix open and measuring the uterus for insertion—can serve as a barrier to choosing an IUD. Online contraceptive information resource Bedsider points out that pain is subjective and varies from person to person. So far, no methods of pain relief have been proven effective, and providers often underestimate a patient’s pain during insertion. 

Fortunately, a new IUD insertion tool from Bioceptive could ease the process. The inserter’s inventor, Benjamin Capiello, says that it could not only make insertion easier and safer, but more comfortable for the patient by putting less pressure on the cervix and eliminating the need to measure the uterus. The tool could prove a major opportunity for expanding access to IUDs in underserved areas in the United States and in the developing world by simplifying the process so that community health workers could provide insertions. Currently in its final stages of development, the Bioceptive inserter could enter clinical trials in 2014.

The Intrauterine Ball

Researchers have conducted a study of the newly invented intrauterine ball (IUB), a copper intrauterine device that, when inserted in the uterus, takes a three-dimensional spherical form and acts to prevent pregnancy. The IUB is expected to be less painful during insertion and reduce incidents of uterine perforation, malposition, and expulsion. Given that insertion pain is often a barrier to choosing an IUD, the IUB could encourage more people to take advantage of one of the most effective forms of reversible contraception. A subsequent study is now underway to compare the efficacy of the IUB to the IUD.

Mirena as Emergency Contraception

Researchers and clinicians have known for some time that the copper IUD, marketed as ParaGard in the United States, is a highly effective form of emergency contraception. When inserted within five days of unprotected sex, it reduces a woman’s risk of pregnancy to one in 1,000. Given the new data showing that Plan B One-Step and generic equivalents may be less effective in women weighing over 165 pounds, and ineffective in women weighing over 176 pounds, many more women might turn to ParaGard for emergency contraception. Now there are murmurings that the hormonal IUD Mirena might be effective as an EC option. There is no scientific data available at this point, but research is ongoing and it’s possible that 2014 could yield something in this area.

The First Generic IUD

A levonorgestrel IUD (similar to Mirena) could arrive on the market, not only encouraging market competition that could drive down the price of IUDs for insurers and patients without insurance, but also providing users with a wider array of options. Medicines360, the company developing the IUD, is in the process of completing clinical trials necessary for review at the Food and Drug Administration. 

With all of these developments, it is more critical than ever that reproductive health, rights, and justice advocates continue working to ensure people have access to all of the information they need to make the best decision for themselves and that those health-care decisions are respected. 2014 might be the year of the IUD, but only if all people have adequate and appropriate information and access.