The copper IUD: safe and effective. The international experience of Family Health International.
Family Health Intenational (FHI) has promoted and tested the new copper releasing IUD, TCu 380A, in 23 developing countries. The leading obstacle for IUD use is its poor image for example, people still blame it for pelvic infections, yet when trained health workers insert an IUD properly, the risk of pelvic infection is almost nil. Thus prophylactic antibiotic therapy is not cost effective. Research shows that the IUD tail neither causes nor enhances development of pelvic infection which refutes beliefs, held by many. The risk is increased, however in women with multiple sex partners and those with sexually transmitted diseases. Other misconceptions are it is an abortifacient and is not effective as other contraceptives. Yet the accidental pregnancy rat for TCu 380A is lower than that of other IUDs (e.g., 0.3% vs 2.3% for TCu 200) and of other contraceptives including oral contraceptives. The 1-year continuation rate among TCu 380A users in FHI studies is 86.4%. The major reason women discontinue IUD use is irregular bleeding or excessive bleeding during the menstrual period. This side effect tends to wane after the 1st few months of use, however. Another significant reason is pain. A possible risk factor of the IUD is partial or complete expulsion and the risk if highest after the 1st 3-4 months following insertion. Correct placement of the IUD reduces the expulsion risk. Another concern is preformation of the uterus which tends to occur during insertion. IUDs do place women at greater risk of ectopic pregnancy than intrauterine pregnancy. IUD insertion is easiest and most convenient in postpartum women shortly after delivery of the placenta. This is especially true with copper releasing IUDs. Insertion during cesarean delivery has a lower expulsion rate than a vaginal insertion. The IUD does not interfere with breast feeding.