By Margaret Rogers, FNP

Sixteen-year-old Joanna grimaced as the slender applicator entered her uterus, but smiled broadly as she sat up after the intrauterine contraceptive (IUC) was inserted. Sexually active with her boyfriend for over a year, Joanna had tried the pill and the vaginal contraceptive ring without success, so she had been relying on her less-than-dependable partner to use condoms to avoid pregnancy; she had already taken emergency contraception twice in six months. 

New Yorkers broadly support President Obama’s non-partisan goal of reducing abortions and the teen pregnancy rate. IUCs can do both, but only if teens have access to them. Few primary care providers have training in the insertion of intrauterine contraceptives. Many who are trained are unaware of the American College of Obstetrics and Gynecology’s (ACOG) 2007 recommendation to include IUCs as a first-line contraceptive option for adolescents.

As a nurse practitioner in primary care, I have been prescribing contraceptives for adolescents for 25 years, but still diagnose too many unintended pregnancies. The New York State Health Department states that between 2004 and 2006 there were 19,260 pregnancies and 7,485 babies born to 15- to 19-year-old mothers in the Bronx, and over 120,000 teen pregnancies in New York State. One young patient confided that she had forgotten to take a couple of her pills, her partner didn’t have a condom and sex “just happened.” Another had removed her ring because her aunt told her that hormones would mess her up. Yet another had stopped the patch because it left marks on her skin. She had not switched to the three-month shot because her periods would be irregular and her mother would notice. Pregnant at 15, her hand caressing her belly and tears in her eyes, she considered her options. 

IUC is one of the most effective, least expensive and safest contraceptive methods. It is the most popular form of contraception worldwide. Both devices currently on the market, one copper-wrapped and the other containing levonorgestrel, have outstanding safety profiles and 99 percent efficacy in preventing pregnancy. IUCs cost about $40 to $80 per year over five to 10 years as compared to an estimated $6,094 annual public cost per teen pregnancy in New York State. IUCs fell out of favor in the U.S. due to an increased risk of pelvic inflammatory disease (PID) and related infertility associated with the Dalkon Shield, which was pulled from the market in 1974. Recent evidence has found no increase in the risk of PID or infertility for women using IUCs.

Once an IUC is inserted into the uterus, it can remain there, safely preventing pregnancy for up to five years (the hormonal IUC) or10 years (the copper device), long enough for a 15-year-old to graduate high school, go through college and begin a career, long enough for most teenagers to understand consequences. It may be easily removed and a woman can become pregnant soon after it has been withdrawn. Best of all, many adolescents are eager to use a method that does not require them to remember to put it in, take it off or swallow it daily, does not interfere with their menstrual cycles, and will protect them against pregnancy as effectively as sterilization, yet still allow them to get pregnant when they are ready. 

The New York City Department of Health, medical schools, nursing schools and health care institutions must provide more training in IUC insertion for health care providers.  Health care providers must seek training and routinely counsel adolescents about intrauterine contraception. IUCs are not for everyone, but they are an essential tool for reducing abortions and teen pregnancy. 

-Margaret Rogers is a nurse practitioner in the Montefiore School Health Program.