Why Are Australians So Freaked Out by IUDs?

In the United States, intrauterine devices (IUD) are now as popular with teenagers as condoms. For those who haven't sat through a female health class, IUDs are tiny T-shaped contraceptives containing copper or a hormone called progesterone. When inserted into the uterus they prevent pregnancy 99 percent of the time, and for many women eliminate all period pain and often reduce or stop bleeding. They're cheap, safe, effective, and if you have no idea what I'm talking about, you're probably Australian.

Two-thirds of Australian women of reproductive age (measured as 15 to 49 years old) regularly use contraception. But only 1.2 to 2.1 percent of them use IUDs, with the rest mostly favoring the pill or condoms. At a glance this isn't surprising; taking an afternoon off work to have something surgically inserted is less appealing than popping a pill or pulling out a condom. But to put that number in perspective, the rate of IUD use is lower than vasectomies (8.6 to 11 percent), and tubal ligation (4.8 to 8.6 percent)—both far more invasive and expensive procedures.

Speaking to VICE, Dr. Kathleen McNamee, Medical Director at Family Planning Victoria, explained that compared with the pill, IUDs are more reliable, longer-lasting, and often safer. While women using the copper version may experience heavier and more painful periods, the hormonal option (called Mirena) results in a much lighter flow, or no bleeding at all. She does note there may be initial hormonal side effects from Mirena—like breast tenderness and pimples—but they tend to subside soon after insertion.

So considering all the upsides of IUDs, why is Australia lagging so far behind American teens in embracing them?

McNamee says that although she has seen an increase in women using IUDs, our preference for the pill and condoms is cultural. "In Australia you become sexually active, you go on the pill," McNamee says, "You know, it's what everybody does."

Interestingly she adds that when training doctors and nurses, IUDs are taught as the first and best method of female contraception. But when teens are learning about birth control in high school the devices are left as a passing footnote.

Siobhan Luck, a 22-year-old law student from Melbourne, echoes McNamee's observation. Speaking to VICE she remembers that in her high school sex-ed classes the pill and condoms were the only methods discussed. And even later in life, alternatives were rarely talked about. "I don't know anyone else who has an IUD or even considered having them," she says.

It was only after a hormonal reaction to the pill and Implanon—a contraceptive rod implant—caused excessive bleeding that her GP suggested she try an IUD. On her 22nd birthday, she went to the Royal Women's Hospital to have the procedure done. While it was a success, she admits she was nervous going into it. "I had a few nurses and a gynecologist there and they pretty much said, 'This is gonna hurt, just hold onto my hand,'" she remembers, "She sort of instilled fear in me."

Although her experience was less painful than expected, it highlights the device's lingering reputation as a painful choice. For all the recommendations by doctors, IUDs have a murky reputation they've struggled to shake. Reddit is full of chains detailing horror stories about bleeding vaginas, blinding pain, dodgy doctors, and unplanned pregnancies.

Stephanie McLean is a 31-year-old communications student from Melbourne who has had a hormonal IUD for four and a half years. She learned about the device in her former job as a flight attendant. Surrounded by women who were open about their experiences with the IUD, she decided to try it for herself. Unlike Luck, her experience wasn't easy. She had a non-hormonal copper IUD inserted without a general anesthetic during a layover in Sydney, but after six months the pain and heavy periods were too much and she had it removed.

Not put off, she tried again with the hormonal IUD. This time she describes the insertion as "uncomfortable" rather than painful, and has had hardly any bleeding for the entire time she used the IUD.

But the devices do have downsides beyond bleeding and requiring a small surgical procedure. While condoms break and the pill's effectiveness can be impacted by vomiting, antibiotics, and diarrhea, the user is often aware that their contraception has been compromised and can take other precautions. If an IUD isn't inserted properly, or slips out of place, the first sign of trouble may be a punctured uterus or an unplanned pregnancy.

Also, presently the copper form of the IUD—which is more popular with women concerned about manipulating their hormones—is not subsidized by the Pharmaceutical Benefits Scheme. As a result, it will cost about $120 [$84 US] outside a public hospital setting. Although the hormonal IUD is covered by the PBS and costs range from $6 to $37 [$4 to $26 USD]—making it cheaper than most brands of the pill.

But despite these detractions, McNamee reiterates that there has been a slow shift in our attitudes towards the device. Horror stories aside, she marks this up to increased reporting on complications related to the pill, such as hormonal side effects, blood clots, deep vein thrombosis, heart attacks, and strokes.

She also points out that while schools focus on other forms of birth control, women are speaking more openly about their reproductive health with their friends. "I think part of it is word of mouth. They hear that their friends had it and it was really good, all that sort of stuff comes into it too."

Stephanie heard about the device through friends, and was encouraged to try it again following her negative experience because of their positive ones. And although Luck was the first person she knew to have it inserted, she has encouraged others to try it.

"The whole concept seems terrifying to have something inserted up inside you. I remember when I first went on the pill, my doctor said, 'There's all these other options, would you consider having something inserted inside you?' and I went, 'Nope' straight away," Luck remembers. But after having it for a year she reflects, "The concept just seems crazy and daunting. I think that's what really puts people off… but I think it is a good option for those who are willing to consider it."

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