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.
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 firstname.lastname@example.org).
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.