For Informed Consent, Don’t Forget the IUD as EC

Congratulations to the American Academy of Pediatrics (AAP) for the November 26 policy statement, “Emergency Contraception.” The AAP deserves praise for following science and promoting public health. However, the policy statement omits a critical point: the copper intrauterine device (IUD) is considerably more effective than emergency contraception pills (EC)–99% effective versus 90% effective. Shouldn’t pediatricians be encouraged to talk to their patients about the most efficacious method of EC?

Part of the goal of the updated AAP policy statement is to “educate pediatricians and other physicians on available EC methods.” In order to reach this important goal, physicians and their patients need to know two key things:

1. Using a copper IUD as EC is a safe and effective option for adolescents (and older women as well) and that it is considerably more effective than EC pills; and

2. Offering the copper IUD as EC can address not only the patient’s immediate need for EC, but also the underlying and ongoing need for a highly effective contraceptive method.

The policy statement says that the copper IUD is not discussed because it is not “available to most pediatricians in their offices.” That may be true, but in order for patients to give informed consent to receive EC pills, physicians must inform their clients about the more effective alternative, the copper IUD as EC. Imagine you went to see your primary care doctor about a recently discovered cancer. Even though your primary care doctor probably does not perform surgery, he/she would still tell you that surgery is one of the treatment options for cancer. Doctors cannot restrict the treatments they mention to only those that they themselves offer.

Some may worry that providing adolescents with highly effective contraceptive method will lead to promiscuity and thus more teen births. However, the AAP policy statement notes that a 2010 review of seven randomized trials of emergency contraception that included teenagers found that advanced prescription did not increase sexual activity. Furthermore, a recent large study in St. Louis documented a teen birth rate of only 6.3 per 1,000 girls enrolled in the study, far below the U.S. rate of 34.3 per 1,000 for girls the same age. The reason for the lower birth rate? Adolescent girls in the study were given access to free contraception and a majority chose IUDs or Implants, the most effective methods.

Encouraging routine counseling about emergency contraception and advanced provision of prescriptions for adolescents, as AAP has done, is an important step forward. But without making providers and patients aware of the advantages of the copper IUD—both as a more effective EC method and one that prevents future unplanned pregnancies—it is an incomplete step.

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  • michelle-mesick

    This is a great article. It’s definitely important for physicians to discuss the full range of options with their patients. My only caveat is that no sane person is going to think IUDs will increase the pregnancy rate. Especially since the article focuses on offering the IUD to teens who already have a pregnancy risk. If somebody is already having sex, the IUD brings the pregnancy risk down and there is no way any amount of “promiscuity” could raise the risk of pregnancy to pre-IUD levels. It would have been nice if the study had included STD rates among teen IUD users, but I think we can extrapolate from current studies that STDs will not increase from using this method of EC. Hopefully the AAP will revise their policy to remind doctors to fully inform their patients of all options.