December 18, 2015

The Levonorgestrel Intrauterine System: A Pragmatic View of an Excellent Contraceptive

Written by Roy Jacobstein and James D Shelton

This post originally appeared on the GHSP website here.

In this issue of Global Health: Science and Practice, Hubacher makes a good case for the levonorgestrel intrauterine system (LNG IUS) and why donors should purchase it for provision in African family planning programs.1 The LNG IUS is indeed an excellent contraceptive. It is highly effective, with only 2 pregnancies per 1,000 women in 1 year of typical use,2 a level of effectiveness 4 times that of the copper-containing IUD, and 35 and 70 times that of the injectable and pill, respectively. The LNG IUS also has very high satisfaction and continuation rates, and it confers important non-contraceptive—even therapeutic—benefits. And, like other long-acting reversible contraceptives (LARCs), it is suitable for all reproductive intentions (delaying, spacing, or limiting births). Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have endorsed LARCs as “first-line” method choices for adolescents and young women.3,4 No wonder the LNG IUS is fueling a rise in IUD use in Europe and the United States. (Prevalence of IUD use is now over 6% in the United States, representing 9% of all modern method use among women aged 15–44.5)

Hubacher cites 3 obstacles to greater donor interest in the LNG IUS: high commodity cost; the belief that currently available method options are sufficient; and doubt about overcoming the barriers that the copper T 380A IUD (Cu T) often faces. He then advances 6 reasons why international donors should buy the LNG IUS: (1) it is on the World Health Organization’s (WHO’s) Essential Medicines List; (2) it is well accepted worldwide; (3) it has a “unique/advantageous delivery system” and important non-contraceptive benefits; (4) it will “activate” some countries; (5) many women in sub-Saharan Africa want to use intrauterine contraception; and (6) more highly effective options are needed.

To more fully consider Hubacher’s arguments, we address 5 somewhat overlapping aspects:

Read the full article here.