Leah Sanchez, 26, of Los Angeles is a married woman who wants kids
someday, but not now. Crystal Nelson, 31, of St. Louis is single,
doesn't have kids and doesn't plan to have any. And Lydia Huston, 44, of
Florrisant, Mo., is a married mother of three who has decided her
family is large enough.
These women have one thing in common: They all are using birth control methods that are gaining new popularity in the USA.
The methods, known collectively as "long-acting reversible
contraceptives" or LARCs, are intrauterine devices (IUDs) and hormonal
arm implants. A decade ago, such methods were used by just 2.4% of U.S.
women who used any method, but by 2009, they had caught on with 8.5%,
with IUDs leading the way by a large margin, according to a recent study
from the non-profit Guttmacher Institute. New federal data show the
And that trend is likely to pick up steam in the next few years, family planning experts say.
One reason: Under the new federal health law, insurers must cover
all contraceptive methods, meaning the high up-front cost of IUDs and
implants (estimated at $500 to $1,000) will disappear for many women.
Meanwhile, the influential American College of Obstetricians and
Gynecologists has started recommending these methods as first-line
contraceptives, not only for adult women but for teens.
The impact could be big, suggests one recent study published in Obstetrics & Gynecology:
When 9,000 teens and women in the St. Louis area were offered no-cost
birth control, 75% chose IUDs and implants - and teen pregnancies and
abortions fell dramatically, compared to national rates. Earlier, data
from the same study, published in the New England Journal of Medicine,
found that IUDs and implants, with a yearly failure rate of about 0.3
per 100 users, worked up to 20 times better than hormonal pills, patches
and rings to prevent pregnancy among participants - who included
Nelson, Huston and Sanchez.
When cost is not a barrier, "we
learned what is most important to women is that a method works really
well," says researcher Jeffrey Peipert, of Washington University School
of Medicine, St. Louis. "And many women liked the idea that these were
long-term methods. They could get it and forget it."
A Mirena IUD, which contains the hormone progesterone, lasts five
years; the copper ParaGuard IUD lasts 10 years and the Nexplanon
(formerly Implanon) implant, which contains progesterone, lasts three.
Nelson, a hairdresser, says she never felt secure with pills
and hormone shots. "I'm not really good at remembering to take a pill at
the same time every day." She got her Mirena IUD more than a year ago
and says she's happy to have birth control off her to-do list for
another four years.
Sanchez was dating her now-husband when
she got her five-year IUD three years ago. "We're married now but I
just finished a master's degree and we are still young," she says, so
avoiding pregnancy for a while longer "definitely fits into our plans."
Huston had just learned her insurer would not cover sterilization
surgery when she entered the study in 2008. "I was too old to have to
think of something every day," she says. She chose the implant, a
matchstick-size rod placed under the skin of her arm, and got another
one when it expired. She says it's an option her own doctor never
That's not uncommon, says Lawrence Finer, director
of domestic research at Guttmacher. "There are many providers who are
not giving complete information about the full range of methods
One reason is that many doctors have not been
trained to insert and remove the devices. Many older doctors also
remember problems with IUDs, especially the Dalkon Shield, back in the
1970s, says David Hubacher, senior epidemiologist at Family Health
International, Durham, N.C. That device was linked to pelvic infections
Studies now suggest the increased risk of
infection with IUDs is small and limited to the 20 days after insertion,
says Tina Raine-Bennett, research director at the Women's Health
Research Institute, Kaiser Permanente Northern California. She led the
ACOG committee that recommended the devices for teens and says that the
old fear that IUDs would endanger the fertility of women who still want
children was unfounded.
In fact, she says, IUDs are great
choices for women who become sexually active in their late teens or
early 20s but don't want children for many years.
methods are not for everyone," Hubacher says. Some women just don't
like the idea of an object in their bodies, he says. IUDs are inserted
and removed through the cervix; implants are placed just under the skin
of the upper arm. Women must see doctors for insertion and removal.
As with any method, there are side effects and risks.
For the copper IUDs, side effects can include increased menstrual
bleeding and cramps. The hormonal IUD often stops periods - which many
women consider a benefit, Raine-Bennett says - but also can cause
irregular bleeding. The Implanon/Nexplanon implants also can cause
irregular bleeding and may increase the risk of blood clots, especially
And none of these methods protect against sexually transmitted diseases, so they don't eliminate the need for condoms.
Some religious and conservative groups strongly oppose the new
birth control coverage rules because they say they violate the
conscience of some employers who must provide the insurance coverage. In
public arguments over the rules, some singled out IUDs as particularly
objectionable because of a long-standing belief that they might stop
fertilized eggs from implanting in the uterus. Some view that as
But studies designed to find out how IUDs work have
never shown they work that way, Hubacher says. Instead, the copper IUD
"creates an inflammatory environment" that stops sperm from swimming and
reaching the egg, he says, and the hormonal IUD inhibits sperm, partly
by thickening cervical mucus. It is true, he says, that the hormonal
version also thins the lining of the uterus and that might stop any
fertilized eggs from implanting and growing.