Changes in IUD uptake with the availability of a low-cost levonorgestrel IUD — a retrospective review of Title X clinics

Abstract

Objectives: US demand for long-acting reversible contraceptive (LARC) methods is increasing despite persistent cost barriers to obtaining these devices. In February 2015, the FDA approved a low-cost 52-mg levonorgestrel (LNG) IUD. This study assesses the difference in copper IUD, LNG-IUD and overall IUD uptake in Utah’s Title X clinics before and after introduction of the low-cost LNG-IUD. Methods: We conducted a retrospective review of IUD uptake via the electronic medical records at Utah’s Title X clinics (n=8) for the 11 months before and after introduction (Period 1 and Period 2, respectively). We assessed IUD uptake stratified by IUD type for these two periods. Results: There were a total of 1221 IUD insertions in Period 1 and 1758 insertions in Period 2. After the introduction of the low-cost LNG-IUD, we observed increases from baseline for copper IUD, LNG-IUD and all IUDs: 30%, 55% and 44%, respectively. Of women who received IUDs, the proportion who selected the LNG-IUD in Period 1 was 56% and 61% in Period 2 (p<.001). Fee type differed between the two periods as well (68% full fee vs. 32% reduced fee in Period 1 and 60% full fee vs. 40% reduced fee in Period 2). Conclusions: IUD use at these clinics increased overall after the introduction of the low-cost LNG-IUD. The increase observed in LNG-IUD use was significantly greater than the increase in copper IUD use. Fee types for the insertions during these two periods were also different.