The hypocrisy of the ever-increasing state government attacks on choice is simply appalling as laws have no bearing on whether a woman has an abortion or not. For example, in Africa and Latin America where abortion is largely illegal the rate is 29 and 32 abortions per 1,000 women of childbearing age (respectively). In Western Europe, where abortion is largely legal and relatively affordable, the rate is 12 abortions per 1,000 women of childbearing age (Lancet 2012).

As certain state governments (Texas, Virginia, Oklahoma…there’s more, but it’s depressing to list them all) are so interested in offering reproductive medical advice and even legislating where a women with Medicaid can (or can’t) get her Pap smear and birth control pills, I propose they consider legislation that might actually be beneficial: IUDs with no co-payment.

The precedent is there. Under the Affordable Care Act in many circumstances vaccinations and other preventative care services have no co-payment. In addition, as contraception is far cheaper for a health insurance company than pregnancy it’s actually a win-win if more women chose highly effective contraception. No one has to get an IUD (or use any form of contraception for that matter), but as IUDs are the most highly effective, reversible method of contraception (with a hormone-free option) it’s hard to argue against making them more accessible. In addition, IUDs are underutilized in the United States versus other countries, so a public health campaign about the safety and efficacy would go a long way.

IUDs are very safe and have relatively few contraindications (a uterus that is too big or small, an active pelvic infection, or Wilson’s disease for the copper IUD only). IUDs also do not cause infertility (a large study published several years ago proved there was no association between IUDs and tubal factor infertility) and fertility returns the next cycle after removal.

But what about the claim from the far-radical right that IUDs cause abortion of a fertilized egg pre-implantation? Well, studies say no. Several publications have actually looked at flushing out the uterine and tubal contents in IUD wearers to look at the state of the sperm, eggs, and for any embryos (gotta love the women who sign up for these studies, thank you ladies from the bottom of my heart). The copper IUD studies find deformed sperm and damaged eggs, not blastocysts. This is because copper is toxic to both sperm and ova (the egg, so pre-fertilization). There are fewer studies with the Mirena (the IUD with the hormone levonorgestrel), but it appears that the local inflammatory response and hormonal effects are likewise sperm and ova toxic.

So there you have it. IUDs are the most effective, reversible form of contraception and they don’t cause abortion.

To claim a higher agenda of “reducing abortions” and “preserving life” while enacting legislation that will not advance that goal is disgusting and hypocritical, especially considering there are evidence-based medical recommendations that could reduce abortion.

So legislators of Virginia, Texas, Ohio, Oklahoma et. al., you have the attention of a lot of people. If you “care about life” as much as you claim, access to contraception should be your #1 goal. Anything else is just a state sanctioned, misogyny-fueled, theocratic power trip. And I hope everyone remembers that come November 6th.

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  1. I’m not sure if it was my insurance company (BCBS TX) or my employer (Halliburton) but I just had a Mirena IUD inserted two days ago with a $0 copay – as of 2013, all FDA approved birth controlled methods are fully covered. Great for me!

  2. I like many of you believe that women have the right to obtain and use contraception but, when did it become the government’s responsibility to provide it free of charge? Just saying and that said….
    I am conflicted, I also believe that it would be in the government’s best interest to provide surgically implanted contraception to the poor. Obviously, if the poor cannot afford to pay for contraception it would be a better use of the people’s tax money to pay $200 to sterilize a woman rather than the tens of thousands on welfare programs so she could raise her child.

    1. It’s not the taxpayers funding this. The HHS issued a mandate that insurance companies cover contraception as preventative care (no co-pays). This is in regards to private health insurance, part of one’s compensation for employment. We are already paying for it.

      Men and women have different health care needs. Health care that women need that men don’t isn’t “extra.”

      Also several health insurance companies already covered IUDs at no co-pay. They aren’t very common in the US and are very cost effective. Pretty much any form of contraception is going to be cheaper than a birth, which makes providing it a no brainier for companies. It’s also less expensive for the employer, fewer parental leaves/benefits needed.

      Based on the cost for my daughter’s birth, it would be cheaper for the insurance company to provide me with IUDs from puberty to menopause (I estimated 15-55 years old), than to pay for one birth!

      People who are actually concerned with lessening health care costs would be pushing for free contraception for everyone (whether through private insurance or government programs), condoms, BC pills/patch/ring/etc., IUD, Depo, implants…everything. It’s much less expensive than paying for births. Unless of course their argument isn’t really about health costs but about punishing women for sex, either through high costs for contraception or through babies.

  3. Hey Dr. Jen- Have you read this short story? If the old white men had their way, this would be the U.S. in a few years. Terrifying.

    I love that you quote facts and statistics. Sadly, our lawmakers are deaf to such reason. Our rights and freedoms are going to hell in a handbasket, ladies. And until we have more reasonable men or non-brainwashed women in government, this war on women will continue.

    Vote. Vote! VOTE!!!

  4. As Georgia above says, here in the UK we have access to free contraception on the NHS. While the NHS is flawed, not to mention the Tory gov, it is a relief to know I have such easy access to birth control. I think if anything the gov here has realised the point Jen has made in this arguement: it is cost effective if nothing else. Providing me with a Mirena coil is far, far less expensive than the medical care I will need throughout pregnancy, and then all of the costs of a child later – medical, education, child benefit and so forth.

    I find it shocking that in the US there are politicians, and not just ones on the fringes, who are trying to impose such restrictions on women. It is so unenlightened, and truly unrealistic. These men speak from a priviledged, white, middle-class position, tainted with a desire to impose their religious beliefs on others. They do not understand nor wish to understand the significant and varied reasons women need access to contraception. It truly disgusts me, it really does.

    There are women here across the pond who are on your side!

  5. Texas WHP will still be available, you just won’t be able to go to places like Planned Parenthood for it as any providers who perform abortions or are affiliated with abortion providers (they are counting PP as this). Most WHNPs and CNMs in private practices take TWHP. I know I, as a CNM, still do and will continue to do so here in San Antonio. In fact I called our local PP office to get my name on a list that women using Texas WHP can be referred to for care when this change is made.

    1. Good to know, I was under the impression that the whole program would be scrapped. Now I have to find someone in DFW that I can go to for this IUD insertion.

  6. And just to preempt anyone asking for a reference to one of those studies, here you go:

    Ortiz ME, Croxatto HB. 2007. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 75(6 Suppl):S16-30. PMID: 17531610.

    I’m somewhat new here, but would like to thank Dr Gunter for disabusing me of the common notion that I had shared with Karen above. I learned something new today!

  7. And IUDs are free in the UK too! So glad to live here – even with the current conservative government, they wouldn’t dream of taking our free birth control away. Quite rightly, that would be electoral suicide for them, rather than a vote-winner, as it often can be in the US.

  8. It would really be nice if the FDA would approve more than the Paragard and the Mirena. I suffered through a Paragard for 3 yrs and finally had enough of it being in my cervical canal all the time and yanked it; I am only 5 1/2cm deep, too small for a Paragard and a Mirena. I am now waiting for my Flex T 300 to get here from a Canadian pharmacy and then I am gonna have to find someone to insert it for me which won’t be easy, as it’s not an FDA approved device AND as of March 14 the Women’s Healthcare Program in Texas will be nonexistent – thank you Gov. Perry and HHS Comm. Suehs – so my healthcare coverage is going to evaporate.

    IUDs are awesome and I know that I am one of the few women who has had a child and is still too small for an IUD but more options are almost always a good thing. Most European countries have at least 4 – 6 options for IUDs and the UK has 12 options, it’s time for the FDA to get with the program!

  9. I’m really glad to know that blastocysts have not been found in these studies. Personally, I was under the impression that IUD’s prevented pregnancy, not necessarily conception.

    IUD’s got a bad rap back in the 70’s & early 80’s with the Dalkon Shield. It’s time to bring them back to the table as a viable, long-term, inexpensive option for contraception, and dispel the perception that they are harmful.

  10. I find it disgusting that in this day and age men’s health is still better taken care of than women’s health and that so many people seem to think they should be able to tell a woman what she can and can’t do with her body.

  11. As someone who currently has a copper IUD in place I whole heartedly agree with you (lucky my health insurance at the time was awesome and covered the entire cost). Due to medical reasons my birth control options are limited to hormone free options which are there are few of.

    I think one problem IUD’s must overcome is the perception most women have of them if they have even heard of them. After various conversations with my friends few had even heard of IUDs and even after my explanation they were scared of “having something inside them” (which was really funny coming from one of my friends who had used NuvaRing). I haven’t had any problems with my IUD and love the fact that I don’t have to think about birth control for 10 years less I decide I want kids in that time frame.

    I really hope this crazy crusade some politicians are on stops soon but I have a feeling it’s going to be a long hard battle.

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