Don’t recoil from the coil

Contraception in America

The teenage pregnancy rate is strikingly higher in America than in many other rich countries. So are unplanned pregnancies in general: over half of American conceptions are accidental, compared with a third in France. One reason is that Americans have been slow to embrace the use of long-acting contraceptives such as the intrauterine device (IUD) and the hormonal implant. Only 6% of American women of childbearing age use an IUD; more than 20% of Norwegians do. Implants and IUDs have the advantage that, once fitted, they last for years. Unlike the Pill, you don’t need to remember to take one every day. Unlike condoms, you don’t have to summon the willpower to stop and put one on.

All modern contraceptives are highly effective, if they are used properly. But in the real world, they often aren’t. In America the IUD is 40 times as effective as the Pill and 90 times as effective as condoms in preventing unwanted pregnancies each year. This matters for several reasons. Four in ten unplanned pregnancies in America are the result of poorly used contraception. Poor women are four times more likely to have unplanned babies than rich women are, and less able to cope with the consequences. And regardless of other factors, babies born to mothers who did not intend to get pregnant are more likely to grow up poor: their parents are more likely to split up, and their mothers are more likely to drop out of school to care for them. If long-acting contraceptives were more widely used, they might accelerate social mobility. So why aren’t they?

Two reasons stand out. First, many Americans have strong views, often religiously inspired, about sex and abortion. Some consider IUDs to be abortifacients because they could prevent a fertilised egg from implanting in the uterus. Some also object to schools teaching about contraception.

Second, America is a litigious place. The penalties for doing something wrong are immense. The maker of Dalkon Shield, a defective IUD sold in the 1970s, was bankrupted by hundreds of thousands of lawsuits. Modern long-acting contraceptives are extremely safe, but manufacturers have been slow to market them in America and doctors have been hesitant to recommend them. Many women who would benefit from them do not know they exist, or imagine that they are dangerous.

Implanting ideas

The use of implants and IUDs in America is starting to inch up, and as more women get them, their friends may follow. But more can be done. States should try to curb excessive damages in medical lawsuits, as California has done. (This is an essential step towards curbing health-care costs more generally.) The government should respect people’s religious views, but that need not stop schools from teaching about contraception more thoroughly. And when a woman walks into a clinic and asks for the Pill, she should be told about IUDs, too—not to be coerced into anything, but to be informed.

Official guidelines already state that IUDs and implants should be the first contraceptives recommended to teenagers. Health workers should be reminded of this. For casual sex, condoms should be recommended as well, since they guard against sexually transmitted diseases. The most vulnerable women typically qualify for public health care, so they ought to be reachable. Long-acting contraceptives are cheap and make it easier for the poor to plan their escape from poverty. America should not recoil from the coil.