Eve Espey, M.D., a professor of ob-gyn at the University of New Mexico, in Albuquerque, says doctors in her field have been anxiously awaiting the publication of these findings, which emerged from a broader ongoing study, known as the Contraceptive CHOICE Project, that was developed to promote LARC use in and around St. Louis.
“It definitely confirms what most people in family planning have expected, that the LARC methods are by far the most effective,” says Espey, who was not involved in the study. “We’ve been anticipating this CHOICE data for a while, because it’s such a great way to look at outcomes of different contraceptive methods in real life.”
The CHOICE project, however, differs from real life in key ways that may shed light on why IUDs aren’t more widely used. The project, which is funded in part by the Susan Thompson Buffett Foundation, was purposefully designed to remove all financial barriers to the use of IUDs and implants, which have a high upfront cost—$500 or more—and aren’t always covered by insurance.
All of the study participants, who ranged in age from 14 to 45, received a prescription for their preferred birth control method for two to three years, free of charge. With cost taken out of the equation, more than three-quarters of the participants opted for an IUD or implant—a proportion roughly 10 times higher than in the general population.
In addition, the participants talked with a doctor about the risks and benefits of each birth control method before making a selection. This counseling session also may have helped to encourage IUD and implant use by dispelling many of the misconceptions that surround long-term birth control, Peipert says.
IUDs, for instance, haven’t fully shaken the bad reputation they earned in the 1970s, when an early device known as the Dalkon Shield was pulled from the market after it was found to cause infection and injury. Decades later, some gynecologists still aren’t trained to insert IUDs, and others believe that many women—such as those who have never had children—are not good candidates for the method, Peipert says.
In fact, today’s IUDs and implants have been shown to be safe and effective for a wide range of women, including teenagers, Espey says. Women who are interested in trying one should talk to a gynecologist, or more than one, she adds.
“If you’re told that you’re not a good candidate, you shouldn’t necessarily take that at face value,” she says. “You might need to take an advocacy role for yourself if you really want the best options available to you.”