birth control


Birth Control’s Next Frontier? Health Center Aims For Quick And Easy IUDs And Implants

Family Health Center of Worcester. (Jesse Costa/WBUR)

Family Health Center of Worcester. (Jesse Costa/WBUR)

Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:

“Are you planning to become pregnant in the next year?”

If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.

“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education that I got that I’m able to pass on to them.”

That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the health center’s perinatal services manager.

“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”

The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)

The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.

“If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

– Mark Edwards, co-founder of Upstream USA

So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?

For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.

Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.

“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.

“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers. Continue reading


Coming To A Clinic Near You: The $50 IUD With A Fascinating Backstory

The new Liletta intra-uterine device (Courtesy of Medicines360)

The new Liletta intra-uterine device (Courtesy of Medicines360)

Zoe Reiches got her first IUD this August — a new model with the lilting name Liletta.

Reiches, 25 and a human resources specialist in Boston, is now happily set for birth control for at least three years. “It’s convenient, I don’t have to worry about it, and I didn’t have to pay for it because of insurance,” she said. “I’m lucky in that sense.”

Millions more American women share her luck now that Obamacare has mandated birth control coverage with no co-pays for most insurers.

But the Liletta, which is just starting to roll out at clinics and hospitals here in Boston and around the country, is not only a device for the lucky — quite the opposite.

Its whole reason for being is to serve poor and uninsured women, to make IUDs — which can cost $1,000 or more — affordable to all, and available on demand at publicly funded health centers.

“This has never been done before,” said Jessica Grossman, the new CEO of Medicines360, the nonprofit pharmaceutical company behind the Liletta. “Our whole mission is to offer this low-cost product.”

Very low cost, compared to the usual thousand-plus dollars. At least until the end of the year, a special program guarantees that insured women who get a Liletta will pay no more than $75 out of pocket for it, Grossman said. A permanent patient assistance program will also provide Lilettas for free to women who qualify.

‘Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’

And, behind the scenes but even more important, public health clinics can order the Liletta for a mere $50 each.

In Massachusetts, all six Planned Parenthood clinics have begun to stock the Liletta, and it’s starting to enter “formularies” — the approved prescription lists — from major hospitals to cash-strapped community health clinics. Medicines360 reports shipping Liletta to 49 states, with more than half of the devices going to clinics that serve low-income patients.

The idea is to make the devices affordable enough that clinics can stock plenty, Grossman said, so that a woman can come in and say, “’Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’ ”

The Anonymous Donor

The Liletta is the latest chapter in the story of the great resurgence of IUDs in the United States, featuring billionaire investor Warren Buffett in a key cameo.

A New York City subway sign that is part of the new "Maybe the IUD" campaign (Courtesy of Dr. Deborah Kaplan)

A New York City subway sign that is part of the new “Maybe the IUD” campaign (Courtesy of Dr. Deborah Kaplan)

After the 1970s debacle of the Dalkon shield, which caused infections and even a few deaths, IUDs fell almost completely out of use among American women. Then, in 2001, a new, hormone-emitting device came on the market — the Mirena.

IUDs steadily gained popularity as a relatively safe, set-and-forget, long-acting but reversible option for many women. (As a no-complaints Mirena user for a decade, I’m one of them.)

More than 10 percent of American women who use birth control now choose IUDs, the most recent data show — the Mirena or the Skyla, which emit tiny amounts of hormones, or a simpler copper IUD, the Paragard.

The latest evidence of the IUD’s full rehabilitation: New York City’s Health Department this week launched its “Maybe the IUD” campaign to encourage New York women to consider an IUD.

The campaign talks about “reproductive justice,” reflecting in part a troubling trend: Unintended pregnancy is increasingly a poor woman’s problem. Look at the trend in the Guttmacher chart below: Continue reading


Even Without Warren Buffett, IUDs Have Some Upside



Don’t miss this fantastic bit of reporting by Bloomberg’s Karen Weise that uncovered the juicy news that through a charitable foundation, Warren Buffett “has become the most influential supporter of research on IUDs.”

It turns out the Buffett-funded foundation paid for myriad studies of the once-shunned type of contraception that is now undergoing a renaissance of sorts. (Shunned, of course, due to the infamous Dalkon Shield, a type of intrauterine device eventually linked to complications, including infertility, infections, even death.)

Here & Now covered the story this week and posted these details:

First, an anonymous donor funded a multi-year study in St. Louis, finding that when given the choice, 75 percent of women chose IUDs or IUDs and hormonal implants. Further, the study revealed that IUDs had over a 99 percent effectiveness rate — in addition to being extremely safe. That study was written up in 50 medical journals, and was also used to promote extensive initiatives in Colorado and Iowa, where an anonymous donor funded low cost IUDs, as well as training programs for medical professionals on IUD use and counseling. In Colorado, the results showed the teen birth rate dropping by 40 percent. Finally, with the evidence of the IUD’s safety and effectiveness indisputable, the anonymous donor funded the development of a new, low-cost IUD known as Liletta.

Well, it turns out that the anonymous donor, in every case, was the Susan Thompson Buffett Foundation — a philanthropic organization funded by its founder billionaire Warren Buffett.

OK, so Buffett has long been a supporter of expanding access to contraception. Does that mean the IUD should not be given a second look? We’ve written a fair amount on this topic: Carey wrote about her own IUD here, and also offered a thoughtful, news-you-can-use post, “10 Reasons To Get An IUD, And 5 Downsides.” Continue reading

From Pimples To Desire, What Might Happen When You Ditch The Pill

(Becca Schmidt/Flickr via Compfight)

(Becca Schmidt/Flickr via Compfight)

By Veronica Thomas
Guest Contributor

So you’re thinking about going off the pill. Maybe you’ve been feeling depressed, getting headaches, or keep forgetting to pop the tiny tablet. Perhaps you’ve been experiencing some really strange stuff that didn’t happen before you started the pill—like inflamed, bleeding gums or cringing at another person’s touch.

Both personal anecdotes and research studies have linked these and other side effects, such as breast tenderness and nausea, to the pill. (One study suggested it might even make you pick the “wrong” partner by altering your chemical attraction to a man’s scent.)

Most randomized control trials haven’t actually found any real difference in the frequency of side effects among women taking the pill versus those taking a placebo.

“It’s an interesting phenomenon,” says Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. “Clearly some women are sensitive to the pill and experience these things, but when you try to study it scientifically on a population basis, there’s really no difference.”

Still, while four out of five American women have used the pill at some point, 30 percent have discontinued its use due to dissatisfaction—most commonly because of its side effects. The latest federal statistics on contraception use are due this fall, and experts expect trends from recent years to continue: IUD use will continue to rise, while pill use seems to have plateaued.

I tried five different formulations of the pill, but never managed to escape all the annoying symptoms.

The issues a woman experiences—or whether she has any at all—vary greatly based on the specific dosage of hormones and the unique individual swallowing them every day. Personally, along with bloating and mood swings, I got migraines with an aura, or what felt like a laser light show in my left eyeball. Twice I had to retreat to my office’s “Pump and Pray Room”—reserved for new mothers and religious employees—to lie down and recover. (What I did not know at the time was that, because of this symptom, I should not have been on an estrogen-containing pill in the first place. Women with aura migraines, along with other conditions that put them at risk for strokes, blood clots, heart disease or some cancers, should not take combination pills.)

Finally, I gave up on the pill—only to be blindsided by a whole new challenge: the unexpected side effects of going off the pill. To help others avoid similar unpleasant surprises, I spoke with three experts about what to expect when you ditch the pill for another birth control method.

Of course, just as each woman has a unique reaction to the pill, she’ll also have a unique reaction to going off. According to the feminist women’s health organization Our Bodies, Ourselves, there is “enormous variability in any individual’s response to her own hormones or any synthetic hormones she takes.” One woman’s skin may break out in pimples, while another’s clears up completely.

With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:

1. Most of the side effects should disappear in a few days.

First off, while many women decide to have their period before pitching the pack, it’s safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the medical director of a Massachusetts General Hospital outpatient gynecology clinic. Continue reading

Morning-After Pill Disappoints, On To Plan C: More Effective Methods

Morning After Pill

They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.

The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.

But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.

Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.

“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”

Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.

Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.

Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading

Should Parents Stock ‘Plan B’ At Home In Case Teens Need It?

Plan B emergency contraception (AP photo)

Plan B emergency contraception (AP photo)

I’ve been thinking lately about the sexual stupidity of my youth. The foolish chances I took. The silly expectations born of “uncontrollable passion” scenes in bodice-buster books. The deep need for approval as demonstrated by desire.

The trigger for these regretful ruminations was last Friday’s landmark ruling on “Plan B,” also known as “the morning-after pill.” A federal judge ruled that it should be available over the counter to all ages. He not only overruled an Obama administration decision to require prescriptions for girls under 17, he derided that age limit as “scientifically unjustified.”

That ringing endorsement prompted this disconcerting train of thought: “Wow, Plan B sounds amazingly safe. Wish they’d had it when I was young and stupid. Hey, wait. Does this mean that when my kids are old enough to enter the danger zone, I should stock some Plan B for them? If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?”

It felt outlandish and loving at the same time. I could already imagine the speech: “Please, please, please don’t have unprotected sex. But if somehow you do, you don’t even have to face me or talk to me. The Plan B is on the top shelf in the bathroom. Use it as soon as possible. And I hope when you’re ready, we can talk.”

If it’s stocked on store shelves, does that mean we should stock it on our closet shelves?

Could that kind of tactic even make any sense? And mightn’t it encourage irresponsible behavior? And is Plan B really that safe, or does it carry even minor risks?

I called over to the contraception and sexual education experts at the Planned Parenthood League of Massachusetts, who had — unsurprisingly — heartily praised last week’s ruling.

First, their medical reassurance, from Dr. Danielle Roncari, the league’s medical director:

“Emergency contraception, we know, is safe and highly effective. We also know from multiple research studies that it’s safe for women of all ages to use, and that increased access to emergency contraception doesn’t lead to increased sexual activity, it just leads to increased use of contraception.

We also know that it’s a very safe medication. There’s really virtually nobody that this medication isn’t safe for, and we also know that teenagers are able to use it just as easily as adult women. Research backs this up.”

Two additional safety points she mentioned: Plan B will not impact an existing pregnancy, so no pregnancy test is needed; and repeated usage is not unsafe either, though it is a concern because emergency contraception is not as effective as regular contraception – Plan B is up to 89% effective at preventing pregnancy, compared to daily birth control pills, which are up to 99% effective.

So, then, I asked, is this a good idea, to keep Plan B in the house? Continue reading

Pregnancy Prevention Progress: Easier Pills, Plan B At Teen Check-Ups

Birth control pills

This looks like quite a convergence. In a country where roughly half of conceptions are still accidental, we’ve just seen two significant steps toward helping women avoid unwanted pregnancy, both coming from groups of doctors who can rule on safety as well as urgent need.

On WBUR’s Cognoscenti, writer Judy Foreman posts here today:

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.
It’s about time.

And also last week, the American Academy of Pediatrics recommended that doctors routinely counsel teenagers about emergency contraception — better known as Plan B or the morning-after pill — and prescribe it in advance, even if the teen is not sexually active. Currently, girls under 17 need prescriptions for the pills.

WBUR’s Here & Now discusses the issue here, and the segment elicited this cogent comment:

Well how about the boys? Isn’t it time we gave them a script for the morning-after-pill to give to their partners?

Readers? Interesting scenario, isn’t it? How might that dialogue in the steamed-up car go?

Just How Nuts The Akin Rape Remark Was

Rep. Todd Akin of Missouri last week at a state fair (Orlin Wagner/AP)

You could hear the groans from coast to coast. “Welcome to the Middle Ages — or earlier,” said one email in my inbox. You’ve surely heard it all by now: Rep. Todd Akin’s unspeakably (except it wasn’t unspeakable for him) offensive remark about how woman who are the victims of “legitimate rape” can purportedly “shut down” somehow to prevent pregnancy.

Akin has been appropriately bashed and battered all over the media. The Planned Parenthood League of Massachusetts just sent over a statement from its president, Dianne Luby: “Congressman Todd Akin’s misinformed statements on women’s health are astonishing and downright offensive. For an elected U.S. Representative and Senate candidate to be so ill-informed about 51% of the country’s population is alarming and perfectly illustrates why politicians should not be allowed to decide what kind of health care a woman can and can’t have.” There are now calls for him to be removed from the House Science, Space and Technology Committee. (Yes, he was really on a science committee.)

‘There’s no biologic plausibility to that theory.’

But I wanted to hear it from a primary source: Is Akin’s bizarre statement as utterly lacking in factual foundation as it certainly seems to be? I spoke with Dr. Erin Tracy, an obstetrician and gynecologist at Massachusetts General Hospital and an assistant professor at Harvard Medical School. Our conversation, lightly edited, follows, but the short answer to my question is: Yes. Utterly lacking.

Dr. Tracy: I saw that The New York Times quotes a physician who tried to lend some credibility to the theory that there is impaired fertility in the case of extreme stress which is rape, but that is absolutely not the case. There’s no biologic plausibility to that theory and there’s no evidence that there are decreased fertility rates in that setting.

Yes, I saw that your Mass. General colleague, Dr. Michael Greene, said in The Times, “It is just nuts.”

I actually posted that on Facebook. The reality is that if someone has ovulated and the egg is sitting there and the sperm can get to it, then pregnancy is possible. So whether that sperm has arrived via a criminal assault such as a rape or from consensual sex, that woman has a possibility of getting pregnant. There’s no difference.

My one question is: We do hear a lot about how when women are trying to get pregnant, they’re told that they should try to relax and that will help their chances. Wouldn’t the corollary be that high stress hurts fertility? Continue reading

Study: IUD Cuts Risk Of Cervical Cancer In Half

The IUD may offer protection against cervical cancer

IUD’s have gotten a bad rap over the years, due to their checkered history (see: Dalkon Shield) and the fact that many women don’t want a medical device implanted their bodies if they can avoid it. But as my CommonHealth colleague Carey Goldberg has written, a newer, safer version of the IUD is currently enjoying a mini-renaissance.

Now there’s another excellent reason to consider (or reconsider) the IUD for birth control: In a study involving more than 20,000 women from different countries, researchers report that the IUD may offer protection against cervical cancer. Interestingly, they suggest that the annoying process of inserting and removing the device might be the very thing that destroys precancerous lesions or triggers a protective immune response. The study was published in The Lancet Oncology.

Here’s more from the press release:

The results show that women who uses IUD halved the risk of developing cervical cancer compared to those that had not ever used [the device]. These results are contrary to popular belief that IUD could be a risk factor of cervical cancer. Previous studies on possible effects of IUDs use on the development of this cancer have yielded inconsistent results…

IUD use did not affect the risk of HPV infection, but was associated with a significantly lower risk of cervical cancer for both major cervical cancer types —reducing the likelihood of developing squamous-cell carcinoma by 44% and adenocarcinoma or adenosquamous carcinoma by 54%. Continue reading

10 Reasons To Get An IUD, And 5 Downsides

Our recent post on why IUDs are on the rise has been going gangbusters, so for those interested in more bite-sized chunks of information, here’s a distillation:

After being out of style for decades, IUD use has been rising rapidly among American women in recent years, spurred by strong endorsements from birth-control experts. IUDs are by no means for every woman, but top women’s health authorities are saying they’re a good option for most women — unlike the old days when, because of the risk of infection, they were recommended only for women who’d already had children.
This post is not numerically balanced because birth control experts are not balanced: They argue that the IUD is under-used. But let’s start with some downsides:

1. IUDs don’t protect against sexually transmitted infections. A reader who’s happy with her own IUD points out: “An IUD is an effective form of birth control NOT a way to practice safe sex.”

2. Though current IUDs have caused nothing like the 1970s fiasco of the dangerous Dalkon Shield, complications still do arise. As Judy Norsigian of Our Bodies, Ourselves noted: ““Like every method, it has its downsides. There’s a remote risk of embedding and perforation, but it’s small. And some women have a lot of pain, others don’t. Some women expel the IUD, others don’t.”

Two IUDs are in use these days: The copper Paragard and the hormone-emitting Mirena. Each has some minuses:

3. The copper Paragard can lead to heavier periods.

4. The Mirena makes periods diminish or disappear, which some women don’t like.

5. Also, though their levels are very low, the hormones that the Mirena emits can affect some women. A friend of mine just had her Mirena pulled because of nasty, depressive symptoms. It’s a well-trodden path for women to replace the hormonal Mirena with the copper Paragard.

This is not an exhaustive list. But as our IUD-using reader said, “One great thing about needing a procedure to get this type of birth control is that it will allow you to have conversations with your ob-gyn and have an honest discussion about what kind of birth control suits your lifestyle.” That conversation should also include a run-down of the risks. A helpful IUD fact sheet is here.

Now for the upsides:

1. “Just one act“: It takes a doctor’s visit to have an IUD implanted, but then your birth control is likely set for years.

2. Effective: Once that “one act” is done, the device is close to 100% effective.

3. Cost: The IUD is also considered one of the most cost-effective forms of birth control; though it costs several hundreds dollars up front, that cost is spread out over years, and… Continue reading