The rise of the IUD

Cana­di­ans turn­ing to long-last­ing de­vice as pre­car­i­ous job mar­ket leaves many unin­sured

The Hamilton Spectator - - HEALTH - ZOE MCKNIGHT

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.”

RICH PE­DRON­CELLI, THE AS­SO­CI­ATED PRESS

The num­ber of Amer­i­can women want­ing IUDs in­serted in­creased dra­mat­i­cally fol­low­ing the re­cent U.S. elec­tion.

While birth con­trol pills are 90-per-cent ef­fec­tive with typ­i­cal use, the IUD is 99-per-cent ef­fec­tive.

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