The first time I needed emergency contraception, I was home from college and spending the summer with my family in rural Texas.
I had just gotten off birth control a few weeks earlier and was not expecting to have sex. After an unplanned fling, I knew I would have to come up with some excuse to sneak away and drive an hour and a half to the closest Planned Parenthood in order to get Plan B. It was a holiday weekend, I felt like I was up against a clock, and the logistics gave me a headache.
When I needed emergency contraception again a few years later, Plan B was easier to come by, as it was available over the counter. It was still expensive, and my insurance didn’t cover it.
While I was grateful that I didn’t have to drive as far to get it, I felt the pharmacist’s judgement burning a hole in my head. I remember thinking, “I wish there was a better option.”
Roe has collapsed and Texas is in chaos.
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This experience is one of the reasons I am grateful to do research that aims to increase access to methods of birth control. A recent study published in the New England Journal of Medicine, which my colleagues and I authored, found that Liletta—a hormonal intrauterine device—can also be a very effective form of emergency contraception. A person can have the hormonal IUD placed within five days of unprotected sex for the purpose of emergency contraception, and they can continue to use it as an ongoing method of contraception for up to seven years.
Research and practice guidelines have supported using the copper IUD for emergency contraception for decades, but prior to this study, the hormonal IUD hadn’t been adequately tested for this special indication. This research was important because each IUD has unique attributes that are more (or less) attractive to different users. While the copper IUD is the only reversible, long-acting method that is hormone free, the hormonal IUD can reduce or eliminate menstrual bleeding and cramping.
Our research found that the hormonal IUD had similar emergency contraception efficacy to the copper IUD. While our study did not directly compare IUDs to either oral emergency contraception pill, we found that the pregnancy risk in the first month after hormonal IUD placement following unprotected sex was less than 1 in 300 users—significantly more effective than oral emergency contraception options, which range from 1 to 3 pregnancies per 100 users.
These novel findings provide people with another option for emergency contraception—one that could potentially better meet their needs in the long term. Not only does the hormonal IUD work at preventing pregnancy for one (or two or more) episodes of unprotected sex in the previous five days, but people who use this option can also use it to prevent pregnancy for up to seven years.
It’s been over a decade since I’ve needed to navigate the economic, logistical, and stigmatizing barriers to access emergency contraception. Today, a better option is finally available—one that I wished for when I was in my 20s. It is my hope that this new information will reach the people who might need it and empower them to ask about the hormonal IUD for emergency contraception.
Additionally, states need to support coverage of the full range of emergency contraception, through contraceptive equity acts. These laws can affirm the federal contraceptive mandate in individual states and ensure that insurance covers all contraceptive options, including the hormonal IUD for emergency contraception, without cost-sharing and without preauthorization. This is crucial so that people who want to use IUDs for emergency contraception are able to access it where they want it, when they want it.