The first time I asked my OB-GYN about whether an intrauterine device (IUD) was right for me was in 2010. The doctor flatly told me, "No."
I was 25 and for years had relied on birth control pills for contraception. I had recently started researching other options, and what I'd read online about IUDs seemed promising. The device, once inserted, would prevent pregnancy for at least five years. I didn't plan to have children anytime soon, so I brought it up with a doctor at a women's health clinic in downtown Washington, DC.
He immediately dismissed the idea. You've never had children, he explained, so it would hurt too much to get the IUD placed. He handed me a prescription for the Pill, and the visit was over.
I didn't know it at the time, but my doctor's medical knowledge was sorely outdated. The American College of Obstetricians and Gynecologists has said for years that IUDs are a great choice for women regardless of childbearing status. Most surveys find that non-childbearing women do experience pain getting the device, possibly more than women who have given birth — but also that they're extremely happy with the contraceptive.
It took me another four years until I had the courage — and the medical knowledge — to ask a second doctor for an IUD.
Why doctors deny women the birth control they want
There are numerous myths that still surround IUDs. Many of those that have been soundly rejected by science — that they're only appropriate for women who have already had children, that patients need to have the devices inserted while on their periods, or that they're inappropriate for teens — still circulate widely in doctors' offices.
Earlier this year I wrote about a nonprofit group, Upstream USA, that is trying increase women's access to IUDs and implants (another long-acting, reversible contraceptive). The group works against numerous barriers to IUDs, including the myths like the ones I encountered but also financial obstacles (the devices often cost $500 or more) and logistical challenges (doctors often ask patients to come back for a second insertion appointment).
In my story, I asked Vox readers to share with me the barriers they had experienced seeking IUDs. I got dozens of responses — some of them similar to my story, and others quite different.
I heard from multiple women who were denied IUDs, became pregnant, and ultimately terminated their pregnancies. Many recounted having to essentially fight their doctors for access — and some gave up, frustrated, and decided to rely on the Pill instead.
The responses are not a representative sample; they don't suggest a high or low rate of obstacles with women seeking IUDs. What they do show, though, are some examples of how difficult it can be to access IUDs in the United States — and the sometimes severe repercussions of those challenges.
"I was told no because I hadn't had a kid so it wouldn't really fit"
The myth I heard — that you can't have an IUD if you haven't already had a child — was also most ubiquitous in the emails I received. Here are a few examples of what women seeking IUDs said their doctors told them:
When I first asked my (male) doctor for one, he told me that I couldn't have one because I hadn't had a baby and "wouldn't I maybe want one one day?"
Before I had a child, my nurse practitioner at a large OB/GYN provider in DC told me she does not insert IUDs on women who have not had children because it was too difficult to get it through the cervix
I was told no because I hadn't had a kid so it wouldn't really fit
An IUD is tiny — a T-shaped device that's maybe an inch or so tall and a few millimeters wide. It will definitely "fit" inside a uterus! But this particular myth appears to pop up again and again. Doctors will often say that it's painful for women who haven't had babies to get IUDs inserted. That is probably true — but is not a good enough reason to set the device off limits.
One study of Swedish women who had never before given birth and had an IUD inserted found that 9 percent experienced "no pain," 72 percent said it was "moderately painful," and 17 percent said it was "severely painful." And, for what it's worth, four months after the insertion, 5 percent said they were dissatisfied with their new method of birth control.
Non-childbearing women are more likely to continue using their birth control than those on the Pill. One study found that within a year, the IUD had a 20 percent discontinuation rate, compared with 27 percent for the Pill.
"I had to go to 4 separate clinics on 6 different days to obtain the IUD"
One of the biggest themes in the emails I received was about logistical hassles — that in the American health care system, doctors will often request multiple appointments for an insertion process that takes five minutes. Sometimes clinics won't keep the devices in stock or just won't budget those extra five minutes for placement into the doctor's schedule.
One woman wrote me about the six appointments it took her to obtain her IUD:
I attended my primary care doctor who had to write me a referral. I then received two consultations on separate occasions from the gynecological clinic. Finally, the clinic planned to insert my IUD on the third day, but they were not able to measure my uterus. I then had to attend another clinic where I could receive ultrasound during the insertion of the IUD. I finally had to have an appointment at a different clinic to check the placement of the IUD via ultrasound. I also had to pay for the ultrasounds, as my insurance would not cover them.
Luckily, I am a student with no children and a flexible schedule, so I was able to attend all of these appointments. But I know that many women do not have that flexibility.
Another woman from Illinois, who is on the state Medicaid program, told me she recently gave up on getting an IUD. The appointments took weeks to schedule and were hard to get to, especially while taking care of her son. Here's what happened after she asked her doctor about an IUD:
The soonest appt I could get was in three weeks and was a 45 minute drive for me. I have a four year old and couldn't find childcare so I ended him dragging him along with me to an area I'm not familiar with.
She had trouble finding the exact clinic, which was part of a large hospital complex. When she arrived 15 minutes late, the front desk told her that her appointment had been canceled.
"My son had a class that afternoon and we had just spent a good three hours on a failed mission," she wrote. "I paid for my parking and cried as I left. I called to see if I could make another appointment and was informed there wasn't another one available for a month and that one was at an office even further away. I just can't do it."
She decided, for the moment being, to continue to rely on birth control pills:
Defeatedly, I called my primary care physician and asked for a refill on my birth control pills. I really loath them. I gained weight didn't feel good, and had a hard time being consistent. I have given up on the iud for the moment. :(
"I gave up and eventually was left to resort to an abortion when I got pregnant"
Most women who weren't able to obtain an IUD told me they turned to other contraceptive methods. Pills and condoms are often much easier to access and less expensive for those who don't have insurance coverage.
But other contraceptives have higher failure rates. Eight of 100 women using the Pill will get pregnant each year, for example, or 18 percent of condom users. I heard multiple stories about unintended pregnancies that happened after women had unsuccessfully sought out IUDs.
One reader told me about her teenage sister, who became pregnant and ultimately had an abortion after two doctors had said that IUDs aren't appropriate for teens. (The organization that represents obstetricians and gynecologists actually recommends IUDs as the first choice for teens.)
Another woman told me about her own accidental pregnancies after she found the IUD to be too expensive:
I’ve never been good at remembering to take a pill, and relied on condoms for many years. In reality, this often meant early withdrawal was my go-to method of contraception in long-term relationships. Predictably, I ended up with two unplanned pregnancies – one that ended in abortion, and one that ended with the birth of my wonderful now-teenaged daughter.
Another women wrote in with a similar story. She was 27, married, and insured but unable to get good information on how much an IUD would actually cost. She got stuck in a mess of calls to her doctors and her insurance, each giving different answers about how much she would have to pay or how to even obtain the device. Her insurance told her it would cost $275 — but her doctor's office said it might cost as much as $900. She didn't want to risk paying that higher price, so she stuck with the Pill.
This is what happened next:
About 8mos later our marriage was almost nothing and I managed to get pregnant probably in a "let's imagine things are fine for one night." I was on the pill but since it'd been months of no contact I was slipping here and there having to take two pills in the morning at least twice a month.
The reader terminated her pregnancy, a fact she kept secret from her family. She says that in her case, it felt like a lack of coordination ultimately failed her.
"I'd have to identify multi-party coordination as the reason [an IUD] was hard to access," she wrote. "Shouldn't there be a website that can help by now? MyChart integration? Simple case working phone call to align us all?"
There are lots of studies out there that show there are barriers standing between women seeking IUDs and actually getting them. These stories show the high costs of resistance, and the serious consequences of asking women to use less effective contraceptives.