Why are women so divided about IUDs?

The XX Factor
What Women Really Think
Aug. 24 2011 10:02 AM

IUDs are Awesome. So Why are Women So Divided About Them? The Results of My Informal Survey

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I was excited to see Amanda Marcotte’s recent article about how health care reform is going to lead to big changes on the contraception market, now that all birth control will be considered preventative care and available without co-payments. This could mean that IUDs, the best-kept secret in the world of safe, effective birth control, may finally find their place in the mainstream.

Amanda’s article focuses on cost (up to $1,000, which isn’t covered by all insurance companies) as one of the major reasons why IUDs are currently only used by around 5.5 percent of contraception users. While this is up from 1 percent in 1995, they're hardly taking the world by storm.

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To me, the IUD seems like a great choice when placed side-by-side against the pill. It’s actually MORE effective and there are no hormones or hormone-related side effects that bother some women, no daily pills to remember, and little chance for human error. There’s virtually no maintenance required—you are good to go for 5 to 10 years, or until you want to have a baby. The basic facts of the IUD seem to indicate that it should be at least as popular as the birth control pill. I decided to ask colleagues and friends in an informal poll if they’d considered using an IUD and what their experiences had been if they had one.

My group was not a scientific sampling—about 17 mostly college-educated, professional women responded. But interestingly, no one mentioned cost as a deciding factor in their decision to get one or not.

The women I polled who had entertained the idea and decided against it mainly said that they were afraid that the insertion would be painful or they felt that the idea of something put inside of them was “creepy,” a word multiple people used. It seemed like the psychological barrier to the IUD was bigger than the potential upsides, although one woman noted that her aversion wasn’t totally logical: “I am super squeamish and so didn't like the idea of keeping something inside of me—[but] apparently not squeamish at the thought of ingesting hormones/chemicals every day for over a decade.”

These reactions seemed in stark contrast to the testimonials for the women who actually have one:

“I would say my married sex life was comical before I got the IUD [with trying various forms of non-hormonal birth control]. I'm not sure why I didn’t get an IUD more quickly. It seemed distant, and maybe a little extreme. Now that I have one I feel stupid for having waited all those years,” said one woman.

Others continued with rave reviews.

“I have one—my second. I love it. It works, it's completely without thought for me, and it's all taken care of for the next five years,” said one mother of three.

“It was [one of the best] reproductive decisions I’ve ever made,” gushed another woman.

While the IUD users had experienced some of the known side effects, such as heavier periods or pain during insertion, all indicated that they felt it was definitely worth it.

Some people who did not opt for it also cited historical concerns, like the fact that earlier versions in the 1970s had injured women; it seems as if the IUD needs a sustained PR campaign to be sure women know that the risks have been greatly minimized due to new safety measures and design.

The misinformation and sidelining of the IUD extends to the medical community as well—one woman I spoke with said that her doctor didn’t do insertions, and the process of finding one that did made her choice seem like “some kind of aberration.” Another woman shared a horror story: After consulting with one doctor and deciding to get an IUD, a second doctor told her numerous scary statistics about scarring, infection, and infertility. “At this point, I felt so let down (I thought I had finally found a reliable non-hormonal form of birth control) that I started crying. I left, furious and embarrassed. The next time I went to the doctor they simply encouraged me to try another kind of [hormonal] birth control.” The woman later researched the statistics the doctor spouted and found out they were false.

While the removal of the cost barrier can only help the advancement of the IUD, reaching a critical mass of proponents may the most important step. As more women hear positive things about their friends’ experiences, it could encourage them to get past the psychological barriers that exists for some of them. Also, if the IUD is given equal consideration by doctors, that may go a long way toward women getting better educated about the option.

Katherine Goldstein is the editor of Vanity Fair's website, VF.com. Follow her on Twitter.

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