The New (Old) Alternative to the Pill

How public-health experts are rebranding the IUD

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If you're a woman in the U.S., you'd be forgiven for being wary of the intrauterine device. The reversible contraceptive--which is popular globally--has a dark past in the States, after the Dalkon Shield, a '70s-era IUD, was linked to pelvic inflammatory disease and infertility and was subsequently beset by lawsuits. Consumer mistrust has lingered ever since.

But that was then. Although today's IUDs aren't perfect, experts say they're safe and cheaper (in the long term) than the Pill. And usage is rising: roughly 8.5% of American women who use contraceptives use IUDs, up from 5.5% in 2007 and 2.4% in 2002. In order to lift those stats even further, major public-health organizations such as the National Institute of Reproductive Health and the National Campaign to Prevent Teen and Unplanned Pregnancy have started a major push to raise IUD awareness among younger generations and thwart the stigma before it sticks. Here's what the experts are touting in new apps, social-media campaigns, physician-training programs and more.


Unlike traditional oral contraceptives that require taking a daily pill and making public pharmacy pickups, IUDs--typically plastic, T-shaped devices that sit in the uterus and release hormones to stop sperm from reaching an egg--are hidden from view. "The IUD is between a woman and her doctor," says Louise Cohen, vice president of Public Health Programs, a New York City--based nonprofit that's co-leading an IUD task force. "No one else has to know."


Once inserted by a clinician, an IUD can last anywhere from three to 12 years without being replaced, removing the pressure to remember a daily pill dose (although users need to self-check their IUDs each month). And while insertion can be pricey--up to $840 if the patient does not have insurance--it's still cheaper than years of monthly payments for other methods.


Oral contraceptives have an average failure rate of 9% (mainly reflecting skipped doses). But IUDs are about 99% effective, with failure rates as low as 0.2%. To be sure, there are drawbacks: they can sometimes cause heavy or painful periods and in very rare cases can perforate the uterus. Still, the American Congress of Obstetricians and Gynecologists--the authority on all things birth control--has declared IUDs the most effective form of reversible contraception and one of the best tools to fight unwanted pregnancies.