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

30 Jun

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.

6 Responses to “IUD insertion immediately after abortion: Time to break down the barriers”

  1. Katie June 30, 2011 at 4:46 pm #

    I had an IUD inserted on the same day that I had my abortion. I was so happy when I found out that they would give it to me for free! I had looked into it before I got pregnant bc the pills were making me sick, but there was no way I could afford them. I almost cried from the counselor at Planned Parenthood told me that I could have one for free. Its been 2 years now with no problems, I love it!

    • Theresa May 21, 2012 at 11:35 pm #

      I had an IUD inserted on the same day I had my abortion as well. I was pretty happy with the thought of not having to worry about getting pregnant for the next 5 years. Unfortunately, 4 days after my abortion and having the IUD inserted, I had a major cramp. I went to the restroom due to the cramping; the IUD expelled itself. I was in disbelief, but my body had a lot of tissue to expel. I don’t know if I want to try to reinsert another IUD later due to its’ high cost and another chance for the IUD to expel itself. Every body reacts differently, but birth control in any form is important and every woman who does not want to get pregnant should explore their birth control options. If I do not get another IUD, I will go back to the Ring, it has worked before and I know it will work again.

      • Sandra September 15, 2012 at 5:44 am #

        I had an IUD inserted immediatetly after the surgical abortion at 9weeks, everything seemed great 3days later I experienced severe cramping, moderate bleeding like a period, not of any concern, the cramping was horrific,(sharp, bloating,constant) this lasted about 2hours, no relief from ibuprofen. my fiance rubbed/deep tissue massage to my lower abdomen below belly botton. Within the hour I went to pee and a clot the size of a walnut came out, it was tissue, dense, fibrous along with the IUD. it almosted looked like a small placenta. It appeared the tissue may have been from the pregnancy. I continued to have scant bleeding that day with occasional cramps lasting just a few minutes at a time. It was horrible and just a site i couldnt explain. I thought I would share this story with you as it is very similar to yours. I am not going to replace the IUD (mirana)due to the thought of a foreign object in my body for months to years. Condoms are working for us. I have worked in an ob clinic in NM and have had 3 incidences in 2yrs where the iud imbeded itself into the uterus. happened to a 35y/o and a 24y/0.

  2. Lilith May 22, 2012 at 6:34 pm #

    Theresa, I have not had an IUD, tho I did want to get a ParaGard IUD.
    I have never been pregnant, and my doctor at planned parenthood recommended against it, after talking some she suggested I try implanon I have my 2 week follow up appointment to make sure it’s in place and working right tomorrow, it was completely painless other than some bruising feeling that occurred the next day for about 4 days, and it was pretty itchy.
    It is as effective as the IUD, but with less of a risk of expulsion. A second random hole showed up (my arm was itching and it looked kind of like a sunburn peeling except it just showed a second hole that hurt) it didn’t expel tho, I can still feel it in my arm.
    So if you are really concerned about a second IUD, you should look into that.

  3. nycprochoicemd May 24, 2012 at 4:53 pm #

    Hi Theresa, how disappointing that your IUD expelled right after you had it inserted! This is the negative of immediate post-abortion insertion. Although for the vast majority of women (in the study I was writing about in this post, 95%) the IUD stays in just fine, there is nearly double the expulsion rate when compared with people who wait 2-6 weeks for the IUD after abortion.

    If you’re game to try the IUD again (if you don’t plan on having children for quite a few years, it’s more cost-effective than than implant because it lasts for longer), your chances of it expelling again are very low. However, the implant is also a great choice, and as Lilith points out expulsion isn’t a problem. If you choose a Mirena IUD it will last for 5-7 years, and if you choose a copper IUD it will last for 12 years. The implant (also known as Nexplanon) is good for 3 years before it must be replaced. For more information try this website: http://www.bedsider.org

    Good luck!

  4. Tara July 25, 2012 at 6:27 am #

    I wish I had been spoken too about birth control when I went into to get an abortion done. I would have said yes to anything offered. They probably just want repeat business.

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