By Sandra Basu

WASHINGTON — Although current versions of intrauterine devices (IUDs) are among the most-effective forms of birth control available, they remain underused in both the general population and among military women.

The American College of Obstetricians and Gynecologists noted that fewer than 1 in 100 women using an IUD become pregnant during the first year of typical use.

Furthermore, the CDC states that “women and their clinicians should be aware that today's IUDs are highly effective and safe for long-term contraceptive use for women at low risk for sexually-transmitted diseases.”

A female mechanic worked on an armored vehicle at the Green Falcons motorpool at Camp Ramadi, Iraq in July 2011. Photo by Sgt. Kista Feldner.

Yet, a 2011 study published in Human Reproduction Update noted that injectable and implantable methods are used only by an estimated 3.4% and intrauterine methods by 15.5% of women worldwide.

Mistaken beliefs regarding IUDs, possibly stemming from safety concerns about a very different IUD device pulled from the market more than 35 years ago, might play a role in their underuse, according to a study published in March 2012. It found that 30% of 2,000 U.S. healthcare providers surveyed had misconceptions about the safety of IUDs for women who had never given birth.

That study concluded that “healthcare-provider misconceptions about the safety of IUDs for nulliparous women are prevalent and are associated with infrequent provision. Improved healthcare provider education and IUD availability are needed to increase IUD use among nulliparous women.”

The product which initially caused providers to question use of IUDs, the Dalkon Shield, had a flawed design no longer used in the devices. It was found to cause severe injury to a disproportionately large percentage of its users, leading to lawsuits and millions of dollars in compensatory and punitive damages. Manufacture of the device ended in 1976.

Early IUDs also were thought to increase the risk of infertility and were not recommended for women who had not had children, but more current studies have found the infertility concerns to be unfounded.

IUDs

Like the civilian sector, IUDs appear to be underutilized in the military. A 2011 study published in the American Journal of Obstetrics and Gynecology pointed to research that unintended pregnancy among active-duty servicewomen is largely related to the lack of contraceptive use and that, among servicewomen who use contraception, less-effective methods are commonly used.

“Approximately 30% of sexually-active female military personnel reported condom use during their last sexual encounter, but consistent condom use during each act of intercourse was uncommon. Oral contraceptive pills (OCP) were the method most frequently used, although less than 40% of women at risk for unintended pregnancy used this method. The contraceptive injection was used by less than 15% of sexually-active Navy personnel. Even smaller proportions of servicewomen used highly-effective methods of contraception such as the intrauterine device (IUD), contraceptive implant or male or female sterilization.”

In addition to unwanted side effects, lack of availability of the birth control of choice in the deployed setting, and limited military healthcare provider knowledge of available contraceptives, the study suggested that low rates of contraceptive use among servicewomen may be attributable to “limited reproductive-health education and knowledge prior to joining the military.”

“A qualitative study of 29 sexually experienced Navy servicewomen found that, prior to entering the military, few had used contraception. Furthermore, a survey of 244 Army women revealed that 26%, 44%, and 44% had never heard of the contraceptive implant, IUD or emergency contraception, respectively. In a study to assess reproductive-health knowledge among female Navy personnel, knowledge scores regarding contraceptives (21.2 on a 32 item scale) and IUDs (1.2 on a 4 item scale) were low.”

The study suggested that deployed women might benefit from long-acting reversible methods such as the IUD and contraceptive implant, because “it may not be feasible to stock overseas military-treatment facilities with a variety of daily, weekly and monthly contraceptives.” Further research is needed “on the uptake and ease of use of these methods among deployed servicewomen,” the study stated.

IUDs are inserted and left inside the uterus, and a copper IUD can last as long as 10 years, while a hormonal IUD can last as long as five years. While an IUD can be used for many years, it has the advantage of being reversible, and a woman can try to become pregnant immediately after having it removed. Contraceptive implants are inserted under the skin and also provide long-term protection, lasting as long as three years.