Women Want an IUD After Childbirth—But Many Can't Get Access

Long-lasting contraception right after delivery might actually be a good idea—but if you want it, you might be out of luck. Here's what you can do.

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The last thing you're probably thinking about when you give birth is having another baby (or even having sex, right?). But while you're in the hospital could be the perfect time to have an IUD or implant placed, since you're with your doctor anyway (and you might have an epidural to make placement pain-free). A new study, though, shows that women who want long-acting contraception after delivery are having a hard time getting it.

Why aren't they available?

The University of Michigan study, published in the journal Obstetrics & Gynecology, finds that available long-acting reversible contraception (LARC) after birth is lagging far behind the demand. Although the rate of IUDs and implants like Nexplanon increased in the last five years, over 96 percent of those placed were at urban teaching hospitals, which means women in other areas aren't getting access.

The reason why IUDs aren't available after birth for so many women is largely due to insurance not covering them while you're in the hospital. "The major access barrier is uneven reimbursement for immediate postpartum LARC service," lead study author Michelle H. Moniz, MD, tells Fit Pregnancy. "Hospitals often do not receive specific additional payment for it, but would receive payment if LARC services are provided in the outpatient postpartum setting. This is a serious disincentive to providing this care."

Another problem, Moniz says, is logistics. "Even for hospitals that want to provide this care, it can be very difficult to set up these services," she says. The hospital pharmacy has to get order and stock the devices, the billing department has to learn how to charge for them, and providers have to figure out when and how to insert them into patients. "Initiating inpatient postpartum LARC services is a heavy lift for hospitals!" Moniz says.

If you want an IUD after birth, ask

What's the big deal about getting an IUD after delivery anyway? IUDs and implants are very effective at preventing another pregnancy too soon after giving birth, which is associated with lots of risks for moms and babies including miscarriage, preterm labor and stillbirth. LARC is also completely safe to get after you've delivered, Moniz says. And if women don't get it in the hospital when it's convenient, those who want an IUD or implant are less likely to make a follow-up office appointment to have it inserted, because it's not so easy to get out while caring for a newborn.

If you want one, what should you do? Definitely talk to your doctor or midwife about it ahead of time, Moniz says, and request it if it's not suggested. "If their provider doesn't offer this service, they can ask if other hospitals in the area do provide this care," she says. "Some women who are highly interested in initiating contraception immediately after childbirth might choose their obstetric provider based on the availability of this service."

An IUD or implant after birth might not be right for everybody, but it's an option you should have, Moniz says. Whether you have one inserted in the hospital or later on, both choices are safe and effective. "The goal in making both options available is to help an individual woman pick the option that best meets her personal family planning needs after childbirth," she says. If you want it after birth, ask. The more women who speak up, the greater chance doctors and hospitals will listen.

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