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 [2] Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health2006;38:90–6.
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[5] Wu S, Godfrey EM, Wojdyla D, et al. Copper T380A intrauterine EC clients should be a routine practice because of a device for emergency contraception: a prospective, multicenter, cohort commitment to providing choice for clients and to helping clinical trial. BJOG 2010;117:1205–20.
[6] WHO Task Force on Postovulatory Methods of Fertility Regulation.
The estimated annual cost of family planning per client Randomised controlled trial of levonorgestrel versus the Yuzpe in publicly supported programs in the United States is regimen of combined oral contraceptives for emergency contraception.
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$203 (ranging from $124 and $487) With 17 million [7] von Hertzen H, Piggio G, Ding J, et al. Low dose mifepristone and two women in the United States reliant on public funding for regimens of levonorgestrel for emergency contraception: a WHO contraceptive services, an annual expenditure of about multicentre randomized trial. Lancet 2002;360:1803–10.
$3.5 billion is needed . Yet public outlays for [8] Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus contraceptive services were only $1.85 billion in 2006 — levonorgestrel for emergency contraception: a randomized non-inferiority trial and meta-analysis. Lancet 2010;375:555–62.
about one half of the total needed . Moreover, an [9] Turok DK, Gurtcheff SE, Handley E, Simonsen SE, Sok C, Murphy P.
estimated $11 billion is spent annually on unintended A pilot study of the copper T380A IUD and oral levonorgestrel for pregnancy in the United States — prevention of these emergency contraception. Contraception 2010;82:520–5.
pregnancies would save taxpayers more than $5 billion.
[10] Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating Thus, the additional outlays to increase access to contracep- evidence to practice: the provision of intrauterine contraception. ObstetGynecol 2008;111:1359–69.
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that may exacerbate ongoing poverty .
[12] Schwarz EB, Kavanaugh M, Douglas E, Dubowitz T, Creinin M.
Additional funds for family planning and related Interest in intrauterine contraception among seekers of emergencycontraception and pregnancy testing. Obstet Gynecol 2009;113:833–9.
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[15] Goodman S, Hendish SK, Benedict C, Reeves MF, Pera-Floyd M, Foster-Rosales A. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception [16] Bednarek PH, Creinin MD, Reeves MF, Cwiak C, Espey E, Jensen JT. Immediate versus delayed IUD insertion after uterine aspiration.
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[17] Frost JJ, Sonfield A, Gold RB. Estimating the impact of expanding Medicaid eligibility for family planning services. Occasional Report Bixby Center for Global Reproductive Health No. 28. New York (NY): Guttmacher Institute; 2006. See [18] Sonfield A. Preventing unintended pregnancy: the need and the means.
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[19] Frost JJ, Sonfield A, Gold RB. Ahmed FH. Estimating the impact of serving new clients by expanding funding for Title X. New York (NY): [20] Sonfield A, Gold RB. Public funding for contraceptive, sterilization and abortion services, FY1980–2001. New York (NY): Guttmacher [21] Monea E, Thomas A. Unintended pregnancy and taxpayer spending.
[1] Singh S, Darroch JE, Ashford L, et al, editors. Adding it up: the costs Perspect Sex Reprod Health 2011;43:88–93, doi:.
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