- Fertility & Reproductive Systems
The IUD: Changing the Conversation
The IUD: Changing the Conversation
On July 15, lawmakers in the state of Colorado rejected a proposal that would continue funding a program that provided women free or reduced cost intrauterine devices or IUDs. The program begun with private anonymous funding in 2009. The program provided 30,000 women with the IUD and between the years 2009 and 2013 there was a 40% drop in teen pregnancy and a 35% drop in abortions. It is estimated that the state of Colorado saved $80 million dollars in Medicaid costs for new mothers and babies. Colorado Family Action, a conservative group that opposed the bill, gave this as one of the reasons funding should not be granted:
"We believe that offering contraceptives to teens, especially long-acting reversible contraceptives, while it may prevent pregnancy, does not help them understand the risks that come with sexual activities,"
I would argue that helping teens understand the risks involved with “sexual activities” comes with maturity. Providing protection against pregnancy while one matures is the best way to ensure that lesson is learned.
Economic Benefits to the IUD
Providing women with long term contraception is the single best way to fight poverty. It is one of the best options for cutting health care costs to taxpayers, the need for programs like, WIC, Supplemental Nutrition Assistance Program (SNAP), and Section 8. When women have more control of their reproductive lives, they are able to wait until they are financially stable to start a family. They are able to choose partners based on wisdom, not circumstance. Women that have control of their reproductive lives are essentially more in control of every facet of their lives to some degree.
Safety and Usage of the IUD
The IUD is a small device implanted into the uterus preventing pregnancy for 5-7 years. The IUD is between 93%-99% effective. There is no need to remember to take a pill, and there are very low incidents of side effects severe enough to discontinue use. The IUD is also a very effective form of birth control for nursing mothers, since insertion of the IUD does not affect lactation. The IUD is completely reversible. Its removal will immediately allow a return to normal fertility. Despite the IUD’s safety, efficacy, and convenience, it is only used by 8% of women in the US. We have nearly the lowest percentage of women using it in the developed world. The question now is, why are we falling so far behind on usage of the IUD?
Why is it Underutilized?
During the 70s and 80s there was an IUD that caused infections and infertility. It was called the Dalkon Shield. Here is an excerpt on a report about the problems with this device during this period:
“Only a few months after the Dalkon Shield went on the market in 1971, reports of adverse reactions began pouring into the headquarters of the manufacturer, A. H. Robins Co. (See "A Case of Corporate Malpractice," by Mark Dowie and Tracy Johnston, MJ, Nov. '76.) There were cases of pelvic inflammatory disease (an infection of the uterus that can require weeks of bed rest and antibiotic treatment), septicemia (blood poisoning), pregnancies resulting in spontaneous abortions, ectopic (tubal) pregnancies and perforations of the uterus. In a number of cases, the damage was so severe as to require a hysterectomy. There were even medical reports of Dalkon Shields ripping their way through the walls of the uterus and being found floating free in the abdominal cavity far from the uterus. According to a recent and probably conservative U.S. medical estimate, the Dalkon Shield caused over 200,000 cases of serious uterine infections in this country alone. For every million dollars in profit the manufacturer has made on the Shield, U.S. women -- those who could afford medical care at all -- spent an estimated $20 million for medical care on problems arising from its use. By 1974, there were reports of deaths clearly attributable to the Dalkon Shield -- not one or two, but 17.”
The stigma of this still lingers, particularly in women who experienced this era. Many young women who would like to try to the IUD may be discouraged by other women, particularly older women like Mothers or Aunts. The fear associated with this device is understandable, but misguided. Education is needed. The IUDs today are different from the IUDs that caused these painful consequences. The IUDs today are safer and more efficient than any other birth control besides abstinence. For some conservatives who are trying to block the use of the IUD, abstinence is the only option they wish to discuss with young girls and women. 46% of teens are sexually active so clearly that approach is ineffective, and illogical.
Impacts on the Black Community
The benefits to providing young women the option of long term birth control are far reaching, particularly in the black community. The family structure has been eroding in our communities for some time and we must address this. In 1965 the Moynihan Report was published by Daniel Patrick Moynihan. In his report he pointed out how the history of slavery in the United States had devastating consequences on the black family. He describes the way the family structure was becoming increasingly “Matriarchal” and how the black father was being pushed out of the home. He ascertained that over time the economic impact on this would be devastating. At the time of the report, he noted that in 1963 the white rate of illegitimate births was 3% while the black rate was 23%. Today the national average of children born out of wedlock is around 40% while that same number lingers around 70% for black people. At the time the Moynihan report was released it was criticized for reinforcing stereotypes of black people and victim blaming. Now I see it as unfortunate that it wasn’t taken more seriously.
The CDC reports that black teenagers are 3 times more likely to give birth than white teens, and children born to teenage mothers are 33% more likely to become teenage parents themselves. The cycle of teen pregnancy in our communities is going on at an alarming rate. The IUD is one way to assist in creating a break in this cycle. Unfortunately it would be political suicide for any of our rank and file politicians to even suggest the black community start an IUD program. It would be too reminiscent of the eugenics movement that some accuse Margaret Sanger, the founder of Planned Parenthood, of proposing. I have also noticed that when I bring this topic up to black women, especially older ones, their first thought is that it is too close to the “sterilization” some black women were victims of during the 1920s to the 1960s. This is not the same thing at all. This is taking control of the option for ourselves.
Making it Happen
The American Academy of Pediatrics (AAP), The American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention have all recommended the IUD as the first choice for birth control in teenage and adolescent girls. The Affordable Care Act provides the IUD under many plans so we need to encourage our young women to entertain this option. We need to remove the stigma from the debate and replace anecdotal stories with facts. The economic and emotional impact of teen pregnancy is one that is easily avoided. If we don’t encourage our young women to adopt practical measures, we are sentencing them and our future generations to a cycle of poverty. If a 16 year old girl utilizes the IUD, she will be at least 21 before she would need to revisit birth control options. In that time, she could have graduated college, gained work experience, or discovered a new path for herself. Invariably within that time she would have matured. She would have had more time to know herself. She would not have been irrevocably tied to a partner she would not have chosen under different circumstance. My vision is for young women to be allowed the necessary time to decide for themselves if and when they would like to become mothers. It is up to today’s mothers to empower the mothers of tomorrow. We can’t let our own fears and misinformation cost our daughters needlessly.