For seven years in Mexico, one 39-year-old mother used an intrauterine device (IUD) as an effective contraceptive, until she removed it when she wanted to get pregnant after immigrating to the United States.
The IUD has been a common method of birth control in Mexico — so common, in fact, that the Mexican government enacted a law that all women, insured or not, were to be offered the contraceptive immediately after giving birth in the hospital, according to a recent Texas Policy Evaluation Project study for which this unidentified woman was interviewed. Intended to encourage effective family planning, Mexico's nationwide policy went into effect in 1973, then finally picked up steam in practice in the 1980s after years of comprehensive training among physicians and providers across the country.
The 39-year-old woman expected that, after giving birth in the U.S., she would be able to have an IUD reinserted, since she did not want to have any additional children. But she was confused to find that was not the case, after her prenatal doctor told her she would have to go elsewhere, that it was too expensive and not offered here.
That’s because, according to the Texas Policy Evaluation Project (TxPEP) study, Mexico is three decades ahead of the United States in finding a way to curb unintended pregnancies with IUD contraceptives. More than 30 years after Mexico began comprehensively offering IUDs to all women, by 2014, 19 percent of all new Mexican mothers chose to immediately have an IUD inserted after giving birth, and 26 percent had one inserted within 18 months.
By contrast, in the United States, less than 0.1 percent of American women chose to have an IUD inserted after giving birth in 2014 and only 9 percent received one within 18 months. The TxPEP study suggests that the United States. start following Mexico’s lead.
“One of the important aspects of the Mexican model is it really was a national initiative,” said Kari White, a TxPEP investigator and assistant professor in healthcare organization and policy at the University of Alabama at Birmingham. “It began with government support behind it, and so it was really a nationwide effort to try to make contraception available to women across the country, not only in urban centers, but also in rural areas.”
White said barriers to IUD access in the United States have included the failure of hospitals to stock them routinely, a lack of training among healthcare providers who may not even know how to insert them and insurance challenges some women may face, making the IUD too costly for them.
Recently, however, various states across the country have amended their Medicaid pregnancy policies to allow women to receive an IUD for free immediately after giving birth — and that includes Texas.
The new Medicaid policy became effective in January, but White said that just because there's a policy does not mean women will start routinely asking for IUDs in practice, and so Texas and other states are going to have to come up with a game plan if they want to be half as successful as Mexico.
“Clearly this policy change indicates some receptivity among people involved in public health in Texas, recognizing that this is really an important aspect of women’s reproductive health, and that the state should try to make changes that enable women to use some of the most effective methods of contraceptives, space their pregnancies and prevent any unintended pregnancies,” White said. “So I think that legislative change really is a positive step.”
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And demand for the contraceptive, particularly among Texas women who immigrated from Mexico, appears to be particularly high, according to the TxPEP study. Survey results showed that, despite 47 percent of Mexican women living in Austin preferring to have an IUD insertion and 57 percent wanting one in El Paso, only 9 percent and 7 percent respectively had actually received one. White said that, through interviews, it was apparent that the women not only preferred IUDs, but expected them.
To finally receive her IUD, the woman whose story TxPEP used as a case study said that she simply went back to Mexico. She went to a clinic, where they told her yes, it was still available for free, and to simply come back in the morning, since that was the time clinicians inserted them.
The TxPEP interviewer asked her, somewhat incredulously, “You just get there and they immediately put you in line?”?
“Yes,” the woman said, “You get there, they’re like, ‘What are you here for?’ ‘I’m here to get an IUD.’ ‘Great. Get in line.' And that's it."