​Pulling Out, the Pill and Us: Why Aren’t Australian Women Using IUDs?

A recent survey found that in the US unplanned pregnancies are at their lowest levels ever. At the same time, the use of intrauterine devices (IUDs) has tripled. It's no coincidence. So maybe it's time to start asking why the pill is still the default choice in Australia: especially when there is a simple, effective alternative.

Dr Kathy McNamee, medical director at Family Planning Victoria, says about nine percent of Australian women have an IUD—too few in her books. "It's long acting, it's great at protecting from unwanted pregnancy and it's cheap. With a health care card you're looking at about €4.1," she says. Actually, according to my exhaustive research at Chemist Warehouse, five years of no worries sex will set you back just €3.5 for a Mirena IUD. Compare that with around €215 per year for some pill brands.

Speaking to women in their 20s though, VICE found for those who actually know about IUDs, the decision to get one was not so simple. And after being burned by various contraceptive methods, some are ditching hormones altogether for more risky options.

"To be honest, I sort of don't really know much about IUDs," says Lucy, 25. "I've been on the pill on and off for 16 years, and each time I've gone to my doctor I haven't been asked about alternatives." Both Dr McNamee and Melbourne gynaecologist Sneha Parghi said they recommended IUDs to women looking for options, but it might take a while for all GPs to catch on.

Lou, 23, says her doctor advised against an IUD because the pill helped her skin problems, but she also says she's been scared off by horror stories of girls getting "butchered" when they get them inserted.

Despite the impressively high success rate of IUDs (close to 100 percent), these stories of botched insertions aren't doing much for the Mirena's rep. So many of the women we spoke to mentioned the word "invasive," and it's a fair choice of word.

The procedure, which involves getting into the same position as a pap smear, can at the very least be described as uncomfortable. For some women the thought of having your cervix opened by a doctor means taking the pill remains the better option.

Then again, some of us are shunning hormonal options entirely. "It doesn't really make sense to me to go shop for groceries at an organic food store, and then take a bunch of hormones," Kitty, 24 tells VICE, saying her and her longterm partner use condoms. Maya, 26, also finds the idea of the device creepy. "I think I would feel uncomfortable with the idea of something inside of me—especially releasing hormones," she says.

Of course, another route for the anti-hormone among us is the "pullout" or "withdrawal" method. Don't baulk when you hear it—for women in their 20s, it's more common than you would think. Nor is it just uninformed women doing it. Even Dr McNamee admits that for some women "it can feel like there's nothing left to try."

Lenny, 27, and her boyfriend have been pulling out for years with no mishaps: "But we don't live in the same state, so it's not like we're having sex every night," she qualifies, while Eliza, 29, said her and her boyfriend have started pulling out after hormonal changes on the pill drove her "crazy."

Dr McNamee says "natural family planning can be great if taught well," while Melbourne gynaecologist Dr Sneha Parghi shuts it down pragmatically: "If you don't mind getting pregnant, it's fine."

For those who don't want a small, harpoon-shaped device inserted up there, there's also Implanon—a long acting reversible contraception (LARC) that's inserted just under the skin in your upper arm and slowly releases hormones for three years. "It's pretty good but can cause problematic spotting and irregular unpredictable bleeding in some women (about 40 percent), which can be very annoying," Dr Parghi says. There's also the Depot Provera: An injection that lasts three months, but its link to osteoporosis makes that one off-putting in the long run.

Dr McNamee says there will always be a place for the pill, but she and many other doctors are keen to see more women using IUDs. The best part? "Most women report no problems at all and if they have lighter periods, may even end up with no periods at all," she says.

Of course, there are possible downsides, including a small chance the device could perforate the wall of your womb when being inserted, or that it could fall out. Woman are told to pull on the string once a month to make sure it's still secure.

Risks aside, Dr Parghi speaks so highly of the Mirena IUD that she feels she needs to clarify she has no financial incentive to do so. "I'm honest when I say I think it has revolutionised gynaecology," she says. "We do fewer hysterectomies now for heavy bleeding, and it can even take care of precancerous cells in the uterus. It's a pretty amazing invention."