Thanks to a determined nonprofit, those defiant IUD purchases in the U.S. are helping African women get modern birth control, safeguarding their lives and families as Trump administration restrictions and cuts in foreign aid drive down global access to safe abortion.
Many OB-GYNs think of hormonal IUDs as the best birth control technology to date. You get it and forget it—no need to do something every day or every time you have sex. It releases only a micro-dose of hormone, right where it’s needed rather than through the whole body. It’s 20+ times as good as the pill at preventing unwanted pregnancy. It has bonus health benefits. It cuts menstrual cramps and bleeding by on average 90 percent or more by the end of the first year. And it’s immediately reversible when a woman wants to get pregnant. Though each person is different, and no method is right for every body, most IUD users love them.
Until recently, monopoly pricing and lack of insurance coverage meant IUDs and contraceptive implants were luxuries many American women couldn’t afford. The up-front cost could be over $1000. That has changed because of Obamacare and a non-profit called Medicines360, which deliberately broke the monopoly by developing a competing hormonal IUD now available at low cost to clinics serving low-income women. Liletta, as the device is called in the U.S., is functionally equivalent to the more familiar Mirena, and is stocked at Planned Parenthood and other family practice and women’s health clinics. The lower cost has made it possible for even uninsured and undocumented women to have a modern contraceptive option; and among middle class young women, long-acting contraceptive devices are becoming the norm.
Some people think women in developing countries should have the same array of options we have, and they are working to make that happen.
Taking it Global
As the religious right rolls out anti-abortion legislation across conservative states, the Trump administration has taken the battle global, tightening a “gag rule” that strips funding from any health clinics that even discuss or refer for abortion. In the past, similar waves of Republican control over international aid have resulted in clinic closures and more poor women dying from unwanted pregnancies and self-induced abortions. Together with other international family planning donors and nonprofits, Medicines360, which developed Liletta, is fighting back. They receive a small royalty for each Liletta sold in the U.S. and are using that money to fund several African countries to provide affordable hormonal IUDs to women who want them.
In the U.S., a woman with a hormonal IUD may appreciate not having to think about birth control pills every day or worry about messing up and facing a surprise pregnancy. A young athlete or mother in particular may appreciate lighter periods and less intense cramps. A student may be grateful to know that she likely won’t have to face a difficult abortion decision.
But when medical or food resources are scarce, being able to manage reproductive health takes on a different level of significance. Pregnancy and childbirth—or even just monthly cramps and bleeding— without modern medical care can be fraught. A woman who wants a child may assume the complications and risks willingly, but menstrual health problems and unwanted fertility can reduce education, employment and family wellbeing:
A woman with heavy menstrual bleeding may become anaemic; a young woman may miss school or drop out due to lack of sanitary facilities. A mistimed pregnancy may pull a woman out of the workforce or stretch a family’s economic resources to the breaking point. Each day eight hundred women die from complications of pregnancy or childbirth, which together are the leading cause of death for girls between the ages of 15 and 19.
By contrast, women who are able to choose whether and when to have a child do better, and so do their families. Family planning access improves maternal and child health, allows girls and women to continue education, and fosters family economic security. All over the world women know this, and when birth control isn’t available or doesn’t work, desperate women seek abortions. Restrictions like those promoted by the Trump administration force many of them toward methods that are unsanitary and unsafe.
When access to safe abortion is scarce, there are two ways to reduce unmet need. One is to increase access. Non-profits like IPAS and Marie Stopes International are doing just that—working in the global south, conflict zones and refugee camps to increase availability of safe abortion pills. The other way to reduce unmet need for safe abortion is to reduce need itself, by enabling women to better manage their fertility and get pregnant only when they feel ready.
Any family planning method helps in this regard, but long-acting IUDs and implants are real game changers, removing the factors that make pills and condoms so hard to use consistently: forgetting, fights, fatigue, financial fluctuations and more. Women who get Liletta IUDs to defy Republican misogyny or prepare for disappearing contraceptive coverage and abortion rights—or simply because they want top-tier contraception—can take some small satisfaction from the fact that they are protecting not only themselves, but also women in distant villages they may never see.
She writes about religion, reproductive health, and the role of women in society.