IUD insertion immediately after abortion: Time to break down the barriers

Although women get abortions for many reasons, the majority of women choosing abortion do so because they got pregnant when they didn’t want to be. It stands to reason that at the time of the abortion is a perfect time to help women start using highly effective contraceptives. One of the most effective methods, the IUD, is an ideal choice for women without plans to become pregnant in the short-term because once inserted it is effective for 7-12 years (depending on which IUD is chosen) and requires no ongoing maintenance, unlike other methods which require visits to clinics and remembering to take a pill daily, change a patch or ring, or get a shot every 3 months. All of this ongoing maintenance requires time and money.

So the IUD offers women a simple, long-term, easily reversible contraception that is as effective as tubal ligation (having one’s tubes “tied”). It is also the most cost-effective method available (when used long-term; the costs over the first few years are higher than other methods). So what’s the hold-up? Why do only 5.5% of Americans use IUDs?

Women do not get the most effective contraceptive care for the same reasons that many Americans don’t get the most effective health care in general. We have a system built on a fee-for-service model that relies on short-term membership in private insurance plans, which disincentivizes investment in preventive, cost-effective care that has up-front costs. We have a system that bills per service rather than for caring for a patient. We have a system in which pharmaceutical and device companies raise their prices significantly with impunity. (We also have a culture that systematically misinforms teens and adults alike about sex and contraception, but you can read about that here, here, and here).

Many women with private insurance find that their insurance does not cover one of the most effective, and the most cost-effective, methods available. The IUD itself can cost over $800, with the insertion fee from the physician easily bringing the cost to $1200 or more. Because many young people will change from insurer to insurer as they change jobs, the companies generally do not want to invest that kind of money into pregnancy prevention for their members. What makes sense for the individual, or even our society as a whole, often does not make sense for a profit-driven insurance company.

Billing is another barrier. Unfortunately, all clinics providing reproductive health care must pay attention to their bottom line. They can’t provide the vital services they offer if they don’t stay afloat. So unnecessary requirements, such as lack of reimbursement from insurance companies for IUD insertion done on the same day as an abortion, substantially hamper access for women. The result has often been that women have to wait until their follow-up appointment to get their IUD inserted, meaning they have to go through another procedure (when the IUD could easily have been inserted in less than 1 minute if done immediately after the abortion) and also have to make it to a follow-up appointment, which means more time off from work, more money for child care and transportation, and often more money for the visit to the clinic.

Barriers within the medical system also get in the way; some physicians believe that inserting an IUD immediately after abortion is more likely to cause complications and more likely to self-expulse (or fall out).

Because of these barriers, many women who want to use an IUD for contraception after an abortion are leaving without one. Although they are given follow-up appointments and theoretically should as a result have good access to IUDs, the fact is that many women are slipping through the cracks.

Fortunately, a new study shows that IUD insertion immediately after an abortion is safe and effective, and most importantly prevents repeat unintended pregnancy. 575 women who wanted an IUD after their abortion were randomly assigned to two groups: one group that had the IUD inserted immediately while the other was given a follow-up appointment for the IUD two to six weeks after the abortion. Not surprisingly based on prior studies, the group that had the IUD inserted immediately after the abortion had a slightly higher expulsion rate (5% vs. 2.7%) than the delayed insertion group. Though this might sound like an argument against immediate insertion of IUDs after abortion, what’s actually important is how the individual woman is affected. Despite this higher expulsion rate, NONE of the women in the immediate insertion group were pregnant within six months, as opposed to FIVE in the delayed insertion group. All of those pregnancies occurred among the 29% of women who never managed to get their IUD after their abortion.

Bottom line: immediate IUD insertion after abortion is safe, effective, saves money, and most importantly, prevents unintended pregnancy! I hope that policy-makers and doctors will take note of this study and take action to break down the medical, policy, insurance, and financial barriers that keep women from getting the best care possible.

Dangerous Trends: Using Pregnancy Hormones to Lose Weight

These days, I weigh 130 pounds, stand 5’2″ tall and wear a size 4.  That probably makes me medium sized, but since I once weighed over 200 pounds, I alternate between thinking of myself as a “former fat girl” and just being flat out shocked by the thin person who stares back at me in the mirror.  For me, weight loss came when I got off the decade long diet merry-go-round, threw out the tasteless containers of fat-free yogurt, not to mention the remnants of attempting Weight Watchers three or four times, and began living again.

Very few people take control of their eating habits the way that I did though, which is why it is unsurprising that in addition to being vaunted as a special time in the spotlight, pregnancy is also seen as a nine month all-you-can-eat buffet.   Of course, as women who have given birth can attest, it is not a buffet that is without consequences;  it is the rare woman who is able to return her body to its pre-pregnancy form. What if you could get the guilt-free pass on eating reasonable portions without having to, you know, actually get knocked up?

The latest in a long line of increasingly creepy diet trends is a twist on pregnancy’s guilt free smorgasbord, using hCG, (human chorionic gonadotropin), a fertility treatment to suppress women’s appetites.  One recent article quoted women claiming that they were able to get by on as few as 500 calories a day.  The Food & Drug Administration has consistently denied any weight loss effects, but that has not stopped thousands of women from spending gross amounts of money on injections that will allow them to starve themselves in the name of beauty.

Meanwhile, many actual pregnant women glory in using the excuse that they are “eating for two” to finally set aside years of disciplined diet and exercise in favor of giving in to cravings during their pregnancy.  Although the different potential downsides of maternal obesity during pregnancy have been well documented, ranging from gestational diabetes to Graves’ disease, this does not seem to stop many women from embracing their pregnancy as an opportunity to eat as much as they please. For the first time since they hit puberty, they can eat without fear of judgment.

The mainstream media lauds pregnant women as sexy, beautiful or otherwise praise worthy.  One result of this inability to criticize anything pregnant women do is that  women who become pregnant while at a “normal” weight are likely to gain 25 to 35 pounds during pregnancy, while a woman who is already overweight will gain just 15 to 25 pounds.  Statistics like that reinforce the stereotype that overweight women are already shoving everything in sight into their mouths, and perhaps they are.  Or, maybe, like me, they would rather have a healthy relationship with food than be super thin while injecting themselves with expensive and potentially dangerous hormones like hCG.