Intra-uterine devices, or IUDs, have been slow to shed their stigma after faulty models in the 1970s and 1980s led to massive lawsuits. Today, fewer than 10 percent of women on contraceptives use them. Now, New York is part of a concerted effort to increase access to IUDs, especially among poor women.
Since 2010, Bellevue Hospital has given away nearly 1,000 IUDs at childbirth. Many women receiving them have been on Medicaid, but until recently Medicaid insisted doctors and midwives implant IUDs in an outpatient setting — and it refused to pay for them in the Bellevue delivery room.
IUDs are a cheap form of contraception over time because they last for years, but the upfront costs are high. Most places would not give away a $300 device that would not be reimbursed, but the city hospital system, which operates Bellevue, felt childbirth presents such a unique and important moment for family planning, it was worth taking the loss.
“We want to insure that our patients obtain the best care and receive all options for birth control, when they’re here with us,” said Dr. Amita Murthy, the director of Reproductive Choice at Bellevue and a professor at NYU medical school. “So, we have been eating that cost.”
Now, they won’t have to.
Last week, New York's Medicaid system cut the red tape and agreed to pay for IUDs in the labor and delivery ward, not just at other times in a woman's life.
That means a lot more women will have access to an IUD, according to Joan Malin, President of Planned Parenthood of New York.
“Making it available through this revised Medicaid policy is great, because it reduces the cost issues,” Malin said.“ It makes it so a woman does not have to come up for a follow-up visit and more care. It just takes care of it all at one time.”
But the window of opportunity is short. Doctors or midwives need to either implant IUDs within ten minutes of delivering the placenta, or wait for several weeks.
Dr. Murthy said that given the sensitivity of doing another procedure right after childbirth, it is crucial to have the family planning discussion well before delivery day. During that conversation, Dr. Murthy gives a patient all the options, and if the patient decides she wants an IUD after childbirth, she signs a consent form to authorize it. Then, when the patient comes to the hospital for her delivery, among the many part of her labor assessment is reconfirming her wish for the IUD.
“Some patients change their mind,” Dr. Murthy said. “Most don’t.”
Dr. Arthur Caplan, Director of Medical Ethics at NYU, agreed it is imperative to discuss IUDs far in advance, when patients are clear-headed. But he said it is also important for policy-makers to insure the IUD option is not just something for Medicaid, given what he said is a long history of the government pressuring poor women to have fewer babies.
“If it’s just one group of Medicaid recipients, and they’re the only ones for whom a program has developed, it just looks prejudiced against that group,” he said. “I think it’s something that you do your best to encourage the private sector, the insurance market that they do the same thing.”