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Why don't American women use IUDs?

They're the most effective form of birth control, yet only five percent of women use them

The contemporary American woman has more birth control options at her disposal than ever before. From pills to sponges to rings to copper crosses, there's a whole wealth of ways to keep babies from happening inside our bellies. And as more women choose to delay having kids until their 30s or later, contraception becomes an integral, consistent part of our lives. Why, then, are we opting for the less effective methods?

New research indicates that IUDs are far and beyond the most effective form of birth control ever invented, ever. They outdo the pill and the NuvaRing by a whopping 20 percent. Yet only about 1 in 20 American women use them at any point during their lives. IUDs of all forms are catching on among women in the rest of the world, but here in the states, women largely forego them in favor of hormonal or physical alternatives. 

The statistic certainly seems counterintuitive. Why would anyone choose the product that only kind of works some of the time when a nearly foolproof alternative is available? But when you look into the culture of contraception and women's health in this country, the IUD avoidance starts to make sense.

When it comes to birth control, your options fall into two basic categories. You've got your basic over-the-counter barrier devices--your condoms, sponges, films, et cetera--the things you apply yourself and whose mechanics are obvious, even if they're a far cry from 100 percent effective. Then you've got the high-powered prescription stuff--your hormonal supplements (the pill and the patch and the ring) and your IUDs. The contraception you need a doctor to get is much more effective than any kind of barrier method, and although it seems pricier at first glance, actually saves you money compared with buying condoms on a regular basis. So why do we teach our kids in sex education that condoms are your best bet?

Part of the reason condoms have become the go-to for pregnancy prevention is that their mechanics are so accessible. If you take one off and there's no leak, you pretty much know that you're good to go. Plus, they prevent disease--something IUDs and the pill can't do. Our nationwide condom-peddling habit may very well be a vestigial precaution from the '80s when AIDS ran rampant. Now, it may be doing more harm than good. 

Despite its unparalleled effectiveness, the IUD comes with its own baggage. It's notoriously uncomfortable to implant, with many users reporting cramps and pain for weeks after getting their uteruses outfitted with one. And it's expensive up-front, even unaffordable if you don't have insurance or if contraception isn't covered under your plan. And if the religious right has their say, it won't be--which is really the crux of the issue here. Any country whose leaders stigmatize birth control isn't going to make widespread use of a longterm contraceptive device. Women may feel that getting an IUD is like saying, 'hey, I'm planning on having lots of condom-free sex for the next five years. Who's with me?'

More so than any other form of birth control, an IUD is a commitment. And while that may be a good thing in places like Scandinavia, where 20 percent of women have IUDs implanted, it doesn't fly quite so well here in the States. Which is a shame--we already have too many babies, and we're not encouraging our women to make use of the most foolproof methods of not having more.