Why do some doctors refuse to give women IUDs?

There are ‘few medical reasons a woman can’t have an IUD’

(iStock/Lily illustration)

Adapted from a story by Erin Blakemore for The Washington Post.

Intrauterine devices are considered safe, and more and more women are asking their doctors for an IUD as a way to prevent pregnancy.

According to the Centers for Disease Control and Prevention, IUD use increased fivefold between 2002 and 2013.

Still, some health-care providers refuse to insert IUDs. Why?

Common misconceptions

IUDs have come a long way. In 1984, a device called Dalkon Shield was pulled from the market after causing serious medical problems, including perforations and scarring infections, in some women.

Some providers refuse to insert IUDs because of lingering memories from that time period. Other providers refuse to insert IUDs because of misconceptions about their safety and function, especially in women who have not had children.

  • A 2012 survey of medical providers found that 30 percent mistakenly thought the devices are not safe for women without children.
  • Another survey conducted in 2014 found that among the 4 percent of providers who didn’t perform any IUD insertions in the past year, almost a quarter were concerned that the IUDs are a method of abortion. (They aren’t.)

Medical reasons

“There are really very few medical reasons a woman can’t have an IUD,” says Jen Gunter, a San Francisco area OB/GYN. However, there are still a few you might hear from doctors:

  • A current pregnancy
  • Significant risks from the anesthesia needed for a tubal ligation
  • A uterine abnormality that might make inserting an IUD dangerous

Are IUDs effective?

Compared with condom use, which fails 18 percent of the time, IUDs fail as little as 0.2 percent of the time. Contraceptive pills — the most popular form of birth control — involve putting hormones in your body and fail about 9 percent of the time, in some cases because women don’t take the pill when they are supposed to do so.

IUDs do not protect against sexually transmitted diseases.

If I don’t want kids, can I get my tubes tied?

Tubal ligations are trickier. Sterilization — usually by tubal ligation — is the second-most-popular form of contraception in the United States. However, some women who get their tubes tied regret their decision, especially those who have the procedure done at a young age.

Concern about those regrets, enthusiasm about IUDs, and the general irreversibility of tubal ligation cause providers such as Gunter to challenge women who think they want the procedure.

“It’s all in how you discuss it with the patient,” she says. “Sometimes surgeries require more thinking beforehand. But I would also expect that people would present this in a kind, non-patriarchal way.” Since tubal ligation involves anesthesia and surgery, it carries a degree of risk. For some women, though, especially those who have had complications with IUDs, the risk is worth it.

Gunter has another suggestion, though.

If you have a long-term male partner, ask him to get a vasectomy. Though far less reversible than an IUD, the procedure is cheaper than tubal ligation and simpler to perform. It’s a minor outpatient surgical procedure that involves no general anesthetic, Gunter says. And it has no side effects for a woman — aside from a serious conversation.

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