Women's use of long-acting reversible contraceptives (LARCs), which include IUDs and implants, has shot up sixfold since 2002 — and doubled since 2010.
Only about 2 percent of women who used birth control in the US chose a LARC in 2002. That increased to 6 percent in 2006-'10, and hit 11.6 percent in 2011-'13. A lot more women who choose LARCs use IUDs (10.3 percent of birth control users) than implants (1.3 percent).
There are two key reasons IUD use is rising
IUDs only used to be recommended for women who have already had a child, a recommendation that only recently changed in 2012. Cost was also a big barrier before the Affordable Care Act required health plans to cover all forms of contraception, including LARCs, in 2012. IUDs easily cost hundreds of dollars upfront without insurance.
The dramatic uptick in LARC usage in this latest set of data, which covers 2011-'13, probably reflects these two big 2012 changes — better affordability under Obamacare, and updated recommendations from gynecologists that IUDs are fine for young women and adolescents who haven't had children.
Long-acting contraceptive usage rates may be increasing, but a lot of US women still don't use them. The Pill is still the most popular birth control method, other than female sterilization — and IUDs still lag pretty far behind both, considering their efficacy. The failure rate for LARCs (0.8 percent for the IUD and 0.05 percent for the implant) is astronomically lower than the pill (9 percent) or the male condom (18 percent).
IUDs are much more popular in Europe, and there are reasons US women still use IUDs at such relatively low rates. There was a big health scare in the 1970s around the Dalkon Shield, which caused widespread injuries, infertility, and even death. The scare was a bigger deal in the United States than in other parts of the world, however. While today's IUDs are very safe and nothing like the Dalkon Shield, that scandal gave IUDs a bad name in the US for a long time — including among health care providers, who still sometimes shy away from recommending the devices to their patients.
But as the stigma of that scandal continues to fade, the new IUD recommendations become more established, and insurance coverage continues to expand, it seems likely that the next set of data will find even higher rates of women using reliable, long-acting forms of contraception.