Bill & Melinda Gates Foundation

The IUD: A Tiny Device With a Huge Impact

February 22, 2013

This is not your mother’s IUD.

The world of intrauterine devices (IUDs), like so much in the 21st century, has progressed rapidly. With a wide variety of size, configurations and mechanics of action, the IUD now offers one of the most effective (99% efficacy), cost-effective and reversible family planning options. Indeed, the tiny IUD is worth a long second look by family planning programs that are trying to provide a low-cost, easy-to-use method with up to 12 years of protection from pregnancy.

The IUD is the second most popular contraceptive method in the world (after sterilization).  DKT International has been marketing IUDs for more than 10 years but, in the last five years, has seen a dramatic increase in uptake, with nearly 1.6 million units sold in 2012. There are several reasons behind that surge.

IUD product variety and multiple benefits

There is a lot of new variety and benefits for both consumers and providers. In addition to the popular Copper T (TCu380A) and Multi-load (Cu375) models, there is a range of IUD technologies that allows programs to segment the market and cater to more specific needs of clients and providers. The Cu375 “Sleek” IUD is smaller and can be marketed for “smaller-hipped” clients.  There are a couple of IUDs that contain a silver core, reducing fragmentation of the copper and, therefore, side effects. Pre-loaded IUDs make it easier for providers to insert, reducing mistakes and problems.  A generic hormonal intra-uterine system (IUS) should be available at lower prices later this year. The Intra Uterine Ball device is currently in clinical trials.

 IUDs have come a long way and will play an increasingly important role in international family planning given their advantages in cost and efficacy.

IUD boasts benefits of long efficacy and immediate return to fertility. In places like Indonesia, DKT’s research showed that midwives promoted IUDs as a method with less weight gain than other methods.  IUDs are safe for breast-feeding mothers and are one of the most effective forms of emergency contraception available.

This range and associated benefits of the product make it more responsive to the needs of women and health providers.

IUD marketing works

We’ve seen that direct-to-consumer marketing for IUDs can help educate women.  DKT India’s new IUD commercial, for example, addresses a number of common myths and concerns regarding IUDs.

Such marketing efforts change behavior. Over a four-year period in Indonesia, we aired TV messages addressing women’s concerns about the size of the IUD. One advertisement highlighted the affordability and long-term effectiveness of IUDs. Media analyses indicate that tens of millions of women viewed these advertisements along with similar messaging through radio, print and live events.

These marketing efforts boosted the IUD uptake of DKT’s program as well as the government and other family planning programs. Over four years, the number of IUD clients increased, according to government data. Bottom line: IUD advertising works.

New IUD clients in Indonesia

2008

2009

2010

2011

299,316

334,135

516,279

627,980

Government of Indonesia and private sources

Highly cost-effective

IUDs may provide the best bang for the buck in the world of family planning. The popular Copper T costs around $0.50 per unit, although the up front, out-of-pocket cost to the client is usually more because providers charge for their service. However, over the long term, the cost-effectiveness of IUDs is hard to beat. This carries great appeal for customers who can afford the initial cash outlay and will save over subsequent years, and also for donors and administrators who seek cost-effective strategies to maximize impact. 

Creating a conducive environment through training and advocacy

However, we recognize that the choice is not always in the hands of the consumer. This is especially true if providers are not comfortable or well-trained in the insertion and removal of IUDs or if they are legally not allowed to provide such services.  Training providers and ensuring that lower level providers like midwives and nurses are allowed to insert IUDs can make a world of difference when it comes time for a woman to choose her method.  If the provider won’t insert or is nervous about removal, what the client wants may be a moot point.

IUDs have come a long way and will play an increasingly important role in international family planning given their advantages in cost and efficacy.
 
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