The copper iud for emergency contraception, a neglected option
The copper IUD for emergency contraception, a neglected option
It can be argued that the most important failing of modern
of contraception with every client, those seeking EC deserve
family planning is the persistent epidemic of unintended
information on the major options: oral levonorgestrel or
pregnancy. In developing countries, about 75 million
ulipristal and the copper IUD. In fact, withholding
pregnancies annually are unintended, a number close to the
information about the copper IUD as EC raises ethical
80 million growth of world population each year . In
concerns about quality of care. Emergency contraceptive
the United States, about half of pregnancies are unintended
pills will always be an important option as well, as they are
By the age of 45 years, about half of women in the
easier to access and can be available at 24-hour pharmacies.
United States will have experienced an unintended preg-
There are additional benefits to offering the copper IUD
nancy, and one third will have had an abortion The
as EC beyond its high efficacy. It confers protection beyond
fact that 47% of the 1.2 million annual abortions in the
a single act of unprotected intercourse. Unprotected
United States are repeat procedures is additional evidence
intercourse typically occurs many times among young
of ineffective or nonuse of contraception
women seeking EC, not just as a single episode . Higher
Reducing unintended pregnancy requires a multifaceted
use of IUDs as an ongoing method of contraception would
approach that includes better education about sexuality and
lead to fewer unintended pregnancies and would address not
contraception, improved access to higher-quality family
only a client's immediate need for EC, but also her ongoing
planning counseling and services, and more affordable
need for the most effective contraception
methods and services. A transition from contraceptive
Yet, several barriers to broader availability of the copper
methods that require continuing motivation and conscien-
tious use to long-acting reversible contraceptives (LARC)would markedly reduce unintended pregnancies.
• Many providers lack training on IUD insertion; even
One neglected gateway to LARC use is to offer women
if a clinic has a trained provider, that individual would
seeking emergency contraception (EC) or after experiencing
not necessarily be available all days or hours .
“pregnancy scares” the copper intrauterine device (IUD) —
• Clinic staff may be concerned that offering the IUD as
a safe and effective method of EC The copper IUD
EC would lead to longer appointments that have not
is more than 99% effective as EC, whereas that of
been scheduled and to clinic flow problems.
oral levonorgestrel pills or ulipristal acetate is less than
• Some family planning clinics (especially those relying
90% Although a few large studies in China and a
heavily on Title X) are challenged by limited funds for
small pilot study in the United States have demonstrated
acceptability and continuation rates of the copper IUD as EC,
• Some clients cannot afford the full price or co-payment
Sustained efforts of the reproductive health community
• Some providers believe an insufficient number of
have resulted in the availability of levonorgestrel EC at
women would choose the IUD as EC because of
pharmacies to women aged 17 years or older, and most
inconvenience, cost or not wanting a long-term
contraceptive providers currently offer EC pills at their
practices. However, a California study of contraceptive
• Some providers erroneously assume that IUDs are not
providers showed that only 14.5% offered the copper IUD as
appropriate for EC clients, particularly young women,
EC to their clients at least once The overwhelming
nulliparous women or women who have recently had
majority of women seeking EC in the United States are not
being offered the most effective method of EC.
Two studies in the United States found that more than
Many of the same barriers listed above have also been
10% of women seeking EC in a family planning clinic were
cited by those working to increase access to IUDs for women
interested in the copper IUD While it is neither
at the time of an abortion Encouragingly, efforts to
practical nor desirable for providers to discuss every method
increase availability of postabortion IUDs have obtained
0010-7824/$ – see front matter 2011 Elsevier Inc. All rights reserved.
Editorial / Contraception xx (2011) xxx–xxx
great success and yielded significant demand for IUDs
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