The copper IUD for emergency contraception, a neglected option.

It can be argued that the most important failing of modern family planning is the persistent epidemic of unintended pregnancy. In developing countries, about 75 million pregnancies annually are unintended, a number close to the 80 million growth of world population each year [1]. In the United States, about half of pregnancies are unintended [2]. By the age of 45 years, about half of women in the United States will have experienced an unintended pregnancy, and one third will have had an abortion [3]. The fact that 47% of the 1.2 million annual abortions in the United States are repeat procedures is additional evidence of ineffective or nonuse of contraception [3]. Reducing unintended pregnancy requires a multifaceted approach that includes better education about sexuality and contraception, improved access to higher-quality family planning counseling and services, and more affordable methods and services. A transition from contraceptive methods that require continuing motivation and conscientious use to long-acting reversible contraceptives (LARC) would markedly reduce unintended pregnancies. One neglected gateway to LARC use is to offer women seeking emergency contraception (EC) or after experiencing “pregnancy scares” the copper intrauterine device (IUD) — a safe and effective method of EC [4,5]. The copper IUD is more than 99% effective as EC, whereas that of oral levonorgestrel pills or ulipristal acetate is less than 90% [4–8]. Although a few large studies in China and a small pilot study in the United States have demonstrated acceptability and continuation rates of the copper IUD as EC, additional research is needed [4,5,9]. Sustained efforts of the reproductive health community have resulted in the availability of levonorgestrel EC at pharmacies to women aged 17 years or older, and most contraceptive providers currently offer EC pills at their practices. However, a California study of contraceptive providers showed that only 14.5% offered the copper IUD as EC to their clients at least once [10]. The overwhelming majority of women seeking EC in the United States are not being offered the most effective method of EC. Two studies in the United States found that more than 10% of women seeking EC in a family planning clinic were interested in the copper IUD [11,12]. While it is neither practical nor desirable for providers to discuss every method