New contraceptive device for broader access to long-acting contraception in developing countries

June 20, 2018 by Hanae Armitage, Stanford University Medical Center
Paul Blumenthal holds an IUD inserter he helped develop as a means of providing postpartum contraception in developing countries. Credit: Norbert von der Groeben

In the past 10 years, the percentage of women who use intrauterine devices in the United States has leapt from less than 1 percent to nearly 20 percent. But at the international level, those figures are much lower.

Paul Blumenthal, MD, MPH, professor of obstetrics and gynecology at the School of Medicine, focuses much of his work on family planning in developing countries, many of which do not have broad access to long-acting contraception. Blumenthal's latest paper, published in collaboration with Population Services International, describes the implementation of a new device used to insert IUDs in women immediately after they give birth, and he hopes it will help in developing countries provide broader access to long-acting contraceptives.

The idea behind Blumenthal's postpartum IUD inserter, which comes with the IUD packaged inside it, is to simplify and streamline the process of providing women with birth control. In a clinical trial with 500 participants, in India used either Blumenthal's IUD inserter or the traditional forceps method to place the contraceptive, comparing their efficacy, ease and safety.

A paper detailing the clinical trial was published online May 8 in Contraception. Blumenthal is the senior author.

Blumenthal's goal is to bring simple, affordable contraception to the masses—particularly in developing countries. Establishing the inserter's legitimacy in this trial, Blumenthal said, is a step in that direction. Recently, he spoke with science writer Hanae Armitage about the details of this work, the drivers behind it and how he hopes to see it pan out on an international scale.

Q: What motivated your team to create this device? Why opt to support IUD usage as opposed to a different contraceptive option?

Blumenthal: IUDs are an excellent method of contraception, and that's increasingly recognized by both providers and patients around the world. They're extremely effective. They're a "forgettable" form of contraception—that is, they're inserted and they don't need tending to or replacement for somewhere between five and 12 years, which also makes them very cost-effective.

In a postpartum setting, there are actually a lot of serendipities that make it an optimal time for IUD insertion. Since the woman has just delivered her baby, both she and her provider  are already in the same place at the same time; no one has to make a special trip to have the IUD inserted. Studies have shown that, among women who want an IUD for contraception, the number of individuals who have an IUD one year after delivering a baby are higher if the woman gets the IUD postpartum, rather than if they wait to have it inserted later.

So, we thought if we can make this convenient, simple and intuitive, then maybe we could reduce barriers for providers, who could then have better access to providing postpartum IUDs. Furthermore, in some developing countries, the special forceps often recommended to insert IUDs right after birth can be hard to come by. With the dedicated inserter, the IUD is already packaged in the instrument, and it's just a "grab-and-go" process.

Q: Why did you decide to conduct this study in India and how did the health care providers react to your new device?

Blumenthal: India has one of the most well-developed programs for postpartum IUDs. For example, in obstetrics and gynecology, physicians are required to learn how to insert IUDs postpartum because the Indian government and the community of OB-GYNs in India feel that it's an important part of provision of contraception. So, we thought, "OK, if you're going to do a lot of something, then why wouldn't you have something specifically designed to do it?" One analogy we often use is, if you're going press garlic, you don't smash it with a hammer, you want to use a garlic press. It's the same idea here: We want to make it precise, and we want to simplify the process.

When we introduced the inserter, in general the feedback was very positive. Most who used the inserter said that it was easy to use. Now, they also said that it was easy to use the traditional forceps—but that doesn't take away from the success of the inserter. This study is a win for broad dissemination of the tool in India. And now, it's even been approved by the Drug Controller General of India for broad public and private use.

Q: With the Drug Controller General of India approval for commercial use, how will you scale up the process in India, and do you plan to bring this option to women in other developing countries as well?

Blumenthal: We're working with a third-party company called Pregna International. They're based in India, and they manufacture IUDs used in programs worldwide. Now with commercial approval, Pregna can market this inserter to the public and private sector in India and reach potentially millions of women. At the same time, other nongovernmental organizations that are working in the family planning area can also recommend this to their programs in India, and that will likely enhance the public-sector programs as well. Currently, the IUD inserter is under review by the United Nations Family Planning Assistance Program, and we hope that this publication will serve to help the UNFPA in its deliberation. Hopefully, that will allow for prequalification of the device, so that it can be used in UNFPA publicly-funded programs that reach other developing countries in sub-Saharan Africa and South Asia.

Q: Do you have plans to integrate the device into developed countries like the United States, too?

Blumenthal: We don't have plans at present, specifically because Pregna doesn't market its IUDs in the U.S. For a company like Pregna, it's likely too costly to have their device approved by the Food and Drug Administration, which requires a significant amount of capital to achieve. However, I'm sure that Pregna would be open to working with a U.S. company or any other company to adapt the technology of this relatively simple inserter to IUDs that are very similar.

Q: Are you working on other projects that likewise empower contraceptive options?

Blumenthal: We're always working on these kinds of projects. One of our fellows is looking at a unique combination of an emergency contraceptive product and another available drug in the U.S. to see if it's possible to make an "on-demand" contraception. So for example, if a woman has intercourse infrequently, she may not feel like she needs to take a pill every day, or might not need to have an IUD, but she may want to have a contraception method she can use when she wants. So, theoretically, a woman could take this pill once during the course of a cycle, at any time during the cycle, and that would effectively act as . Our tagline here could really be "simplicity and precision." We want to empower women with options, access and the ability to choose what's right for their lives and body, at the exact time that they want it.

Explore further: Study finds benefits of device for inserting IUDs after birth

More information: Paul D. Blumenthal et al. Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial, Contraception (2018). DOI: 10.1016/j.contraception.2018.04.019

Related Stories

Study finds benefits of device for inserting IUDs after birth

March 23, 2016
A simple tool designed for inserting an intrauterine device may offer women in the developing world a convenient, low-cost option for long-term contraception.

New ACOG guidance on long-acting reversible contraceptives

October 27, 2017
(HealthDay)—Long-acting reversible contraceptives (LARC), including implants and intrauterine devices (IUDs), are a safe and effective contraception option for many women, according to a practice bulletin published online ...

Study: Access to long-lasting contraception after childbirth lags behind demand

May 10, 2017
Before leaving the hospital after childbirth, more women are opting to check one thing off their list: birth control.

Study identifies ways to increase IUD use in developing countries

February 15, 2013
Boosting demand for intrauterine devices, commonly referred to as IUDs, and improving access to them can significantly increase their use in developing countries, where they have traditionally been an unpopular method of ...

Put birth control in place right after childbirth

July 26, 2016
(HealthDay)—Obstetrician-gynecologists should counsel pregnant women about use of long-acting reversible contraception, such as implants and IUDs, immediately after they give birth, a leading group of U.S. doctors says.

Long-acting reversible contraceptives (LARCs) are safe, effective option

December 20, 2016
Long-acting reversible contraceptives are the most effective form of reversible birth control but not the most commonly used. Misconceptions and outdated misinformation prevent many people from realizing the benefits of intrauterine ...

Recommended for you

Lowering hospitals' Medicare costs proves difficult

July 18, 2018
A payment system that provides financial incentives for hospitals that reduce health-care costs for Medicare patients did not lower costs as intended, according to a new study led by Washington University School of Medicine ...

Eating iron-fortified grain improves students' attention, memory

July 18, 2018
Adolescent students in a rural school in India who consumed an iron-biofortified version of the grain pearl millet exhibited improved attention and memory compared to those who consumed conventional pearl millet, according ...

Vaping tied to blood clots—in mice

July 18, 2018
A new study involving mice raises another concern about the danger of e-cigarettes in humans after experiments showed that short-term exposure to the device's vapors appeared to increase the risk of clot formation.

Sugar improves memory in over-60s, helping them work smarter

July 18, 2018
Sugar improves memory in older adults – and makes them more motivated to perform difficult tasks at full capacity – according to new research by the University of Warwick.

People who tan in gyms tan more often, and more addictively, than others, new research shows

July 18, 2018
Gyms are places people go to get healthier. But nearly half the gyms in the U.S. contain a potentially addictive carcinogen—tanning beds, report UConn researchers in the July 18 issue of JAMA Dermatology.

Omega 3 supplements have little or no heart or vascular health benefit: review

July 17, 2018
New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.