Wellness

Military Women Face Serious Challenges When It Comes To Birth Control

A new initiative to bring more IUDs to the armed forces could change that.
The pharmaceutical company Allergan is providing the IUD Liletta to the military at a deep discount in order to increase access to the birth control method. 
The pharmaceutical company Allergan is providing the IUD Liletta to the military at a deep discount in order to increase access to the birth control method. 

Before deploying to the Black Sea in 2014, Navy servicewoman Malia Mason was on a very specific mission: to obtain birth control that could stand up to the rigors of deployed life. It wasn’t her first deployment, and Mason knew that the erratic work and sleep schedules on her ship, combined with the monotony and boredom that can warp time, would make for a tricky environment in which to take a contraceptive pill at the same time every day.

Because deployments can be unexpectedly extended, Mason also knew that birth control methods that run out after three to six months were not ideal. She wanted birth control that was immune to forgetfulness, sleepiness, deployment extensions or any other barriers that would get in the way of consistently taking the correct dose of hormones.

So Mason, 26 at the time, did her research and settled on the intrauterine device, a type of long-acting reversible contraceptive that is implanted in a woman's uterus. The IUD is over 99 percent effective, making it one of the most effective forms of birth control available. But three weeks before deployment, when Mason was finally able to get off duty and see a doctor at the military hospital -- it had taken her six months to get the leave approved -- the gynecologist denied her request, stating that she was too young and had not had any children. Due to outdated notions about IUD risk, and despite the fact that they can be removed if a woman wants to become pregnant, some doctors won't prescribe such a long-term solution to women who are under 25, unmarried, and haven't had a child before. Mason's doctors were among them; a second doctor, and then a third, told her the same thing.

"I was denied because I hadn’t had children, and the doctor was more concerned about me having kids in the next five years than me going on deployment,” Mason said. “I was like, this is ridiculous."

Finally, a week later, a fourth doctor who was up to date on all the latest research about IUDs agreed to insert one. Mason had been granted a second leave day as an emergency measure, and by then she was only two weeks away from deployment.

It’s unclear whether Mason’s struggle to access the birth control she wanted is typical for all U.S. servicewomen. Officially, Tricare, the military’s healthcare program for service members, veterans and their families, covers most forms of birth control like diaphragms, pills, patches, rings, injectables and yes, IUDs. But military clinics aren't required to stock them all, notes Vox.

Despite this access to comprehensive medical care, women in the military have higher unplanned pregnancy rates than the general population. And one study shows that one-third of deployed servicewomen were unable to access the birth control they wanted for deployment. Fifty-nine percent did not speak to a military provider about birth control before deployment, and 41 percent of servicewomen who needed medication refills thought they were difficult to obtain.

Allergan, the pharmaceutical company that manufactures the hormone-based IUD Liletta, has created a program with the goal of changing that. Through a partnership with Medicines360, the non-profit global pharmaceutical company that developed Liletta, Allergan began offering the IUDs to 700 U.S. military bases at a cost of $55.83 per device back in March. The Medicines360-Allergan partnership already offers the Liletta device to public clinics for just $50.

Liletta's new low price for military healthcare providers is not an exclusive contract, but instead a deep discount from the $625 price the device debuted at in 2015. It will still be up to healthcare providers if they want to stock the device at their clinics, but Medicines360 and Allergan hope that the low cost is enticing enough to make Liletta available across as many military clinics as possible. Allergan notes that other IUDs cost the military anywhere from $330 to $650. In the civilian world, IUDs can cost up to $1,000 to buy and insert.

Because IUDs must be inserted by a healthcare provider, clinics have to buy the product and have it on hand for when a woman requests one. This can be an expensive endeavor, considering the cost of most IUDs.

"What we’ve found over the years for IUDs, both in the military and in the public sector, is that it's really expensive for the doctors or the clinics to buy and keep on the shelves,” said Dr. Jessica Grossman, CEO of Medicines360. "What’s important to both [Allergan and Medicines360] is to provide them at a low cost to different groups of the population, so that the clinic can afford it and the doctors can insert the IUD on the same day the patient comes in."

Part of this "Liletta Access on the Front Line" initiative also involves defeating the myths around IUD use that stem from American women’s experience with an earlier, flawed IUD model called the Dalkon Shield, which resulted in permanent infertility and even some deaths among women who used it in the 1970s. Because of this history, doctors today may still be hesitant to insert any kind of IUD into young women, or women who have not yet given birth, like Mason.

“We want to provide women and providers with information and access so they can make educated, cost effective health care choices that are best for them,” said Aimee Lenar, vice-president of women’s healthcare at Allergan.

“If you’re standing on duty, think about how awkward it is to pull your birth control out and take a pill really quick while you’re in your dress blues.”

Allergan’s efforts could have a tremendous benefit for servicewomen, and especially those about to go on deployment, says Kate Grindlay, a researcher for the non-profit organization Ibis Reproductive Health who published the aforementioned study on birth control access and unplanned pregnancy in the military. She is not connected to Allergan or Liletta in any way, but said more access to birth control of all kinds would help women not only avoid pregnancy in precarious or unpredictable situations, but could also put a pause on menstruation, which can be an inconvenience while on deployment. (Not all IUDs pause a woman’s period, and Liletta specifically is only indicated for contraception).

Indeed, Mason found that with her IUD, her periods were light to non-existent during her eight-month Black Sea deployment. She said her female colleagues, on the other hand, struggled to obtain birth control pill refills, and those who used a contraceptive patch found that humidity below decks made the stickers peel off.

Her IUD "made a world of difference when on deployment,” said Mason. “If you’re standing on duty, think about how awkward it is to pull your birth control out and take a pill really quick while you’re in your dress blues. I fought for [the IUD], eventually got it, and it ended up being really great."

Jessica Alexander, a spokeswoman for Navy Medicine, acknowledged that the types of delays that Mason experienced may still be affecting sailors, depending on where they are and the range of health care services available at that facility. But she also says that Mason’s case is not typical, and that both the Navy and Marines are being more proactive in recent years about raising awareness about IUDs and LARCs, a category that includes a hormonal implant placed under the skin.

For instance, Navy Medicine collaborated with other military health programs to sponsor LARC awareness and insertion training events for staff at 11 Navy medical facilities from 2014 to 2016. The goal of these sessions was to "increase the capacity of Navy Medicine to provide LARC-first family planning counseling and contraception services.” These in-person trainings have also been supplemented with webinars, briefings and military medical courses.

That effort seems to be working. In 2009, LARCs made up 14 percent of all contraceptive methods delivered to Navy and Marine Corps women, but jumped to 32 percent by 2015. IUD use rose from 11.4 to 12.2 percent during the same time.

Of course, all women have different individual needs that require different methods, and Grindlay pointed out that no one type of birth control should ever be encouraged over another.

"We see that in a lot of settings, people aren’t counseled effectively and given the full information about [IUDs’] safety and effectiveness, so I think there's a real need to improve that,” said Grindlay. “With that said, I don’t think any method should be pushed over any other method because that could be coercive and not necessarily in the person’s best interest."

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