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Date of Award

Spring 2024

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Lisa Akselrad PA-C, MSPAS

Abstract

America falls behind other countries in IUD use and development despite updated safety profiles and recommendations as the gold standard in birth control from trusted medical societies. This American “lag” can be attributed to a complex culture of peer and provider bias, misconceptions among adolescents, and low accessibility. These barriers partly stem from apprehension after the monumental failure of an IUD called the Dalkon Shield in the 1970’s. This led to extensive FDA approval policy contributing to a US market that offers far less IUD options than other countries. Experts suggest that today’s lack of options may fail to address natural uterine variability leading to the exclusion of many women, most notably, the young and nulliparous. Low IUD use is most consequential for this demographic who are at the greatest risk of unplanned pregnancy and abortion. Some suggest US rates are significantly higher than in parts of Europe that offer more diverse IUD design. These are only some of the barriers unique to the US that directly hinder contraceptive R & D. This special topic review includes information from historical articles, opinions from experts in the field, literature reviews, clinical trials, and data from well known medical bulletins with the hope of launching a new era of much needed research and consideration.

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Misconception, Government Policy, and Lack of Options: Why America Lags Behind in IUD Use and Development

America falls behind other countries in IUD use and development despite updated safety profiles and recommendations as the gold standard in birth control from trusted medical societies. This American “lag” can be attributed to a complex culture of peer and provider bias, misconceptions among adolescents, and low accessibility. These barriers partly stem from apprehension after the monumental failure of an IUD called the Dalkon Shield in the 1970’s. This led to extensive FDA approval policy contributing to a US market that offers far less IUD options than other countries. Experts suggest that today’s lack of options may fail to address natural uterine variability leading to the exclusion of many women, most notably, the young and nulliparous. Low IUD use is most consequential for this demographic who are at the greatest risk of unplanned pregnancy and abortion. Some suggest US rates are significantly higher than in parts of Europe that offer more diverse IUD design. These are only some of the barriers unique to the US that directly hinder contraceptive R & D. This special topic review includes information from historical articles, opinions from experts in the field, literature reviews, clinical trials, and data from well known medical bulletins with the hope of launching a new era of much needed research and consideration.