Sharon was 16 years old when she became pregnant. After discussion with her foster parents, her boyfriend and his family, and her case manager, she decided to terminate the pregnancy. Afterwards, she opted for the most effective contraceptive method, a hormonal IUD that would also help with her menstrual cramps and bleeding. However, she had no insurance coverage for this type of IUD and resorted to condoms instead. She came back one month later with Medicaid insurance, which her case manager helped her obtain. Her Medicaid would not cover an IUD for contraception, only for medical problems that threatened her life. Faced with the inability to obtain the IUD she wanted, she opted to receive the non-hormonal IUD we could give her for free through a reproductive health grant.

This IUD, unfortunately, would do nothing for her menstrual cramping or bleeding. One month after her IUD insertion, she came back with complaints of daily bleeding. We attempted to use birth control pills to help stop her bleeding, but she continued to bleed despite the medication. Finally, two months after the IUD was initially placed, she came back requesting its removal. At that point, the provision in the Affordable Care Act requiring comprehensive contraceptive coverage was in force, so we made another call to her Medicaid insurer. They still denied her the hormonal IUD, with an exception to save her life. At that point in time, she decided to have the IUD removed and agreed to the contraceptive patch.

I was amazed at the tenacity of this young girl in her attempts to get a hormonal IUD—and flabbergasted that, despite the ACA, her insurance still did not cover it. And unfortunately, the real-life failure rate of the contraceptive patch is 9% at one year—compared to the 0.2% failure rate of the hormonal IUD.