By Emma Talley
Stanford doctors are advocating for the insertion of an intrauterine device (IUD) immediately following birth or abortion for young people, who are at high risk for unintended pregnancy and rapid repeat pregnancy, or pregnancy onset within one to two years of the previous one, according to a review article published in the Journal of Pediatric and Adolescent Gynecology late last year.
More than a quarter of pregnancies in the United States are mistimed or unwanted. Adolescents and young adults are at particularly high risk, and the emotional and socioeconomic barriers a pregnancy might impose on women, their families and their communities constitute a public health concern, according to the article. In response, Stanford doctors are advocating for increased access to IUDs and reduced barriers to care in order to provide IUDs immediately post-abortion or postpartum.
Providing IUDs in the same visit as an abortion or birth removes the need for women to return to a clinic for IUD placement later, which can often be difficult.
“There are a number of things that could be a barrier to someone’s ability to come back to a clinic for an IUD placement or being able to have an IUD placed at a separate time: finding an available appointment time, having insurance coverage, transportation to an appointment or finding childcare, ensuring someone is not pregnant by the time they return for a visit,” said Sarah Peterson, an obstetrician and gynecologist at Lucile Packard’s Children’s Hospital and one of the article’s co-authors.
“It’s very hard for even women with the best intentions of coming back for a second appointment … there’s a lot of reasons it’s hard to come back,” added Lisa Goldthwaite, an obstetrician and gynecologist at Stanford Health Care and another one of the article’s co-authors. “Other than just changing their mind, which is also a valid reason not to come back.”
A lack of information can also impede a patient’s access to contraceptive care. Only 24 states mandate sex education, and 34 states mandate HIV education, according to Planned Parenthood — statistics that raise red flags for Goldthwaite.
“I think that teenagers and young adult women often have trouble figuring out where to go for health care,” she said. “We don’t make it really clear what their access points are for contraception and for care outside of really major organizations like Planned Parenthood with a lot of name recognition.”
Especially in light of the ongoing pandemic, she said, the immediate placement of an IUD following a birth or abortion can decrease the number of times a person must go into the doctor’s office by avoiding the possibility of another pregnancy.
“Especially in the context of COVID, and the pandemic, we’re really trying to minimize the number of times patients have to interface with the healthcare system,” Goldthwaite said. “And so anytime we have evidence-based interventions that can be initiated immediately, there’s no reason we should not be doing that.”
Concerns of inadequate insurance coverage and misinformation are only heightened due to the pandemic, when patients might experience new barriers to receiving healthcare due to losing their job or taking on increased responsibilities at home.
“[One] concern is loss of insurance coverage for patients in the postpartum period, which can also be a barrier for women returning for a delayed IUD placement,” Peterson said. “With the high unemployment rate due to the pandemic, the loss of healthcare coverage is a rising concern and this will disproportionately impact more vulnerable populations.”
Goldthwaite said contraception is considered an essential service.
“Most healthcare systems are trying to continue that type of access [to contraceptive care],” she said. “Obviously, there’s a few states in our country that are doing the opposite, trying to be more restrictive in this context and using the pandemic as an excuse. But we feel at Stanford that reproductive health care is an essential service, including contraception, and our doors are open for business.”
Peterson and Goldthwaite’s article also highlights the fact that a person’s ability to consent to reproductive healthcare if they are under 18 years old varies by state. Healthcare providers and patients must be aware of the specific rules in their area, they write. However, both doctors maintain that IUDs are safe and effective, including for postpartum or post-abortion use.
“Postpartum and post-abortion IUD placement is both safe and effective and should be offered to eligible patients during these times when they’re already interfacing with the healthcare system,” Peterson said.
Goldthwaite said IUDs are safe “regardless of age, regardless of whether or not you’ve been pregnant, regardless of medical conditions.”
“It’s really important for women to know that our historical barriers, including doctors saying that a young woman who’s never been pregnant before can’t get an IUD, that’s just a thing of the past,” she said. “So women who are interested in birth control should know they have access to any type of birth control out there and that basically, most methods are going to be safe for them.”
Contact Emma Talley at emmat332 ‘at’ stanford.edu.