Just Do It: The When and How of IUD Insertion

Intrauterine devices (IUDs) are safe and highly effective methods of long-acting reversible contraception. While increased use of these methods has been associated with decreased rates of unintended pregnancy and abortion in adolescents and young adults, these methods require provider visits for method initiation (and often for discontinuation) that can be significant rate-limiting steps for method use. When adolescents and young adults choose an IUD for their contraceptive method, it is crucial that providers work to remove barriers to both initiation and discontinuation of these methods. For IUD insertions, proposing clinic and medical system policies that support same-day insertion of IUDs, immediate postpartum insertion, and immediate postabortion insertion can help reduce these barriers. Importantly, at time of insertion, and throughout use, it is essential to ensure that patients can choose to discontinue the method at any time—without question—in order to fully support their bodily and reproductive autonomy. This chapter will discuss the timing of IUD insertion, including insertion at any time during the menstrual cycle as long as pregnancy can be reasonably excluded—and insertion following vaginal delivery, cesarean section, and abortion. We will also review use of the copper IUD as a highly effective form of emergency contraception. Lastly, this chapter will address the importance of framing these conversations using reproductive justice principles of non-coercive counseling methods, and creating clinical spaces for shared decision-making with IUDs in order to ensure contraception free of reproductive coercion.