Hormonal implants and IUDs are now 5 times more popular compared with a decade ago
A new report from the Centers for Disease Control and Prevention (CDC) in the United States has identified a change in birth control preferences within American women. Long-acting reversible contraceptives (LARCs) such as subdermal hormonal implants and intrauterine devices (IUDs) are now more popular than they were ten years ago.
Back in the 1970s LARCs were commonly used in the USA. However, following the lawsuits over the injuries caused by an early IUD called the Dalkon Shield, fears over the safety of these devices lead to a decline in their popularity as more women returned to using other contraceptive methods such as the birth control pill. Yet, there has been a lot of focus on improving the design of IUDs and implants to make them safer and more effective. As a result, there is now a growing interest in using 5-year contraceptive implants (first approved in 1990) and IUDs.
Studies reveal 9% failure rate associated with the birth control pill. This is largely due to users forgetting to take their contraceptive daily, rather than problems with the actual oral birth control. With the failure rate for IUDs less than 1%, it’s not surprising that more women are seeking this alternative.
From 1982 to 1988 the use of LARCs decreased according to the CDC’s data gathered by the National Center for Health Statistics (NCHS). Up until 2002, this trend remained constant, however over the past decade this figure has increased almost five-fold.
Who is using LARCs?
Statistics show that 7.2% of women between the ages of 15-44 used IUDs during 2011-2013 compared with only 1.5% in 2002. In particular, women aged between 25 and 34 are now twice more likely to use LARCs compared with other age groups.
Centers for Disease Control and Prevention figures also show that women who had already had children favoured the use of LARCs compared with women that have not had children. Statistics show that over time, these differences increased.
Over the past 30 years the CDC has identified a change in LARC use between different ethical and cultural backgrounds. For example, the use of LARCs tripled among while non-Hispanic women between 2002 to 2010, and quadrupled among black non-Hispanic women.
However, during the same period there was a 10% declined in LARC use among Hispanic women. Since this time there has been a rise in the use of LARCs among Hispanic women by 129% recorded between 2011 and 2013. The report highlights white non-Hispanic women as being traditionally less likely to use LARCs.
Why the shift towards LARCs?
There are several reasons why LARCs are becoming more popular:
Public awareness of LARCs is increasing. Doctors are giving women different contraceptive options and there are more marketing campaigns targeting the use of LARCs. Research shows that women who are better informed about the types of contraction options available are more inclined to opt for LARCs over transdermal patches or the oral birth control pill.
LARCs cause infertility
There has been a lot of controversy surrounding LARCs, especially IUDs in the 1970s following the commonly used Dalkon Shield. This early IUD made women more susceptible to pelvic infections and subsequently increased the risk of infertility. However, this device was bands and since the 1980s there have been much better designed IUDs enter the market.
Today studies show that the risk of infertility as a result of using a hormonal implant or IUD is highly unlikely and for most women, normal fertility levels return quickly after removal.
ARCs cause negative side effects
Like all medical treatment there are side effects associated with LARCs. These reactions are usually associated with changes in bleeding patterns, yet they are overall very minimal. Compared with short-acting contraception, such as patches, condoms and the birth control pill, there is a lower discontinuation rate with LARCs. Women are less likely to stop using LARCs because they are more reliable and have fewer side effects.
Women that haven’t given birth can’t use IUDs
There is a common misconception that women are unable to use IUDs if they haven’t previously had a baby. However, The American Congress of Obstetricians and Gynaecologists states that there is very little evidence that inserting IUDs into the cervix is more difficult for nulliparous women.
More cost effective
While there is an upfront cost using implants or IUDs, they are very cost effective over time. There is no need for regular monthly payments associated with the birth control pill or patches. Furthermore, many health insurance providers will offer coverage for some LARCs.
How does the situation in the United States compare with Europe?
Throughout Europe, the use of IUDs and implants has always been much higher than in the United States. This is largely due to more positive attitudes among health providers and users of contraceptives in Europe. The benefits, drawbacks, side effects, and safety appear to be better understood.
Notes: European data are from 2006; U.S. data are from 2002. U.S. data do not distinguish between copper and hormonal IUD users. Source: Sonfield, A. (2007). Popularity Disparity: Attitudes About the IUD in Europe and the United States. Guttmacher Policy Review, Volume 10, Issue 4.
The advancements in IUDs and implants has seen more women throughout Europe use these forms of contraception, while women in the United State have been somewhat more hesitant.
Although the birth control pill continues to remain the most popular form of contraception, more women are increasingly turning to LARCs. With new developments in IUDs and implants, it’s likely that this trend will continue.
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