The rise of the IUD
Canadians turning to long-lasting device as precarious job market leaves many uninsured
In the lead-up to the inauguration of U.S. President Donald Trump, American women warned each other their access to birth control under Obamacare was at risk.
On social media, many women advised getting an IUD. The intrauterine device is a small, T-shaped piece of plastic or copper inserted through the cervix into the uterus by a doctor and provides highly reliable birth control for years at a time.
Under Obamacare, women could obtain one without paying out of pocket, along with other forms of FDA-approved birth control. If Congress repeals the Affordable Care Act — something Trump has already begun to set in motion — an IUD could cost American women as much as $1,000, according to Planned Parenthood. Without what’s known as the “birth control mandate,” many women may suddenly find it difficult and expensive to access birth control pills each month.
It seems some of those women turned to the IUD. According to data from 2,500 doctors’ offices across the U.S. compiled by AthenaHealth and published by Vox, clinics in both Democrat and Republican counties saw a 19per-cent spike in IUD procedures from October to December last year. The data suggest no such increase was observed in 2015.
Experts say something similar happens in Canada when women are faced with losing their health insurance or benefits.
The pill and the IUD are covered by some benefits plans — Sun Life, Great-West Life and Morneau Shepell may cover IUDs, depending on the specific financial arrangement with employers — and when women switch jobs or age out of their parents’ coverage they often turn to IUDs, experts say.
“Definitely, definitely, we see that,” said Dr. Erika Feuerstein, clinic physician and education director at the Bay Centre for Birth Control at Women’s College Hospital. “When insurance is about to expire, women ask for an IUD because it was covered under their plan.”
Because Canada lacks a national pharmacare system, about one-quarter to one-third of women — young, precariously employed or new to Canada — do not have access to free birth control because they have neither workplace benefits nor qualify for a drug plan through social assistance, said Sandeep Prasad, executive director of Action Canada for Sexual Health and Rights, formerly the national Planned Parenthood agency, which is not directly linked to the U.S. organization.
That means they often choose less-effective birth control methods, such as condoms, which are about 82-per-cent effective with typical use, rather than a highly effective method such as the IUD, because of its high upfront cost.
The copper IUD costs up to $63 and the hormonal IUD costs up to $380 at Planned Parenthood Toronto. Some women will ask for an IUD prescription just in case they decide later they want to have it inserted by a doctor. (That procedure is covered by OHIP.) The most common form of birth control used by Canadian women remains the pill, but IUD use has been on the rise. The pill is about 90-per-cent effective with typical use and the IUD is 99-per-cent effective.
According to data collected by Canadian health information company QuintilesIMS and obtained by the Star, prescriptions for the hormonal IUD brands Mirena and Jaydess have increased 46 per cent from 116,478 in 2011 to 170,061 in 2015. The copper IUD is not included in the data, which only tracks pharmaceuticals.
Usage varies by patient population: the copper IUD is cheaper and desirable among women who are motivated to avoid synthetic hormones, but can make periods and cramping more intense. The hormonal IUD, which releases a progestin called levonorgestrel, is more expensive and can cause side-effects similar to the pill, but can make periods much lighter.
McMaster University gynecologist Dr. Dustin Costescu estimates up to 5 per cent of Canadian reproductive-age women are now using an IUD, a figure that had hovered around 1 per cent for years. He also notices patients, especially students and young women entering a precarious workforce near the end of their insurance or benefits coverage, seek long-term birth control.
The fact that American women are at risk of losing affordable birth control isn’t ideal, but it may encourage other women to pay more attention to their options, he said.
“Other women might see, when issues of coverage come up, that it may be beneficial to maximize their benefits,” he said. “It wouldn’t surprise me if other women start thinking about, as their coverage expires, an option that (prevents pregnancy) in the long term.”