Intrauterine devices (IUDs)—contraceptives that prevent the fertilization of an egg or implantation of the egg in the uterus—have come under attack by the Supreme Court and the Ohio legislature recently. In the Hobby Lobby case, the Court ruled that a for-profit organization can use religious beliefs as an excuse to not cover certain contraceptives including IUDs, and an Ohio bill would ban insurance coverage of “drugs or devices used to prevent the implantation of a fertilized ovum.”

Hobby Lobby and the Ohio legislature suggest IUDs are abortifacients, or devices that induce abortion; however, this belief ignores the long-standing definition of abortion—the ending of an established pregnancy—and flies in the face of evidence from medical professionals and researchers that IUDs do not disturb an already implanted embryos and are thus not abortifacients.

Unfortunately, the villainization of IUDs significantly impairs a woman’s sexual agency. IUDs are nine times more effective than the pill and almost 20 times more effective than most condoms. Depending on the model, IUDs can be placed inside the uterus and remain there for up to 10 years—a significantly more reliable method than attempting to remember to take a pill each day.

IUDs are also important in mitigating the impact of hormone-based contraceptives on the female body. Hormones released by birth control pills have a number of emotional and physical side effects, but one IUD model does not use hormones and another only uses hormones in a targeted manner, allowing many users to escape the mood swings, headaches and even more serious effects of the pill. Moreover, a 2009 study conducted by the Bixby Center for Global Reproductive Health found that, in terms of pregnancies prevented, IUDs saved more money than did condoms and oral contraceptives.

Despite the provable economic and social benefits of increasing access to IUDs, only about nine percent of women use IUDs in the United States—the lowest rate of IUD use among all developed countries. Their unpopularity is partly due to a poor reputation based on largely inaccurate representations, a checkered history and high up-front costs. The recent judicial activity and legislation will only heighten these issues by continuing misguided conceptions of birth control and by hindering women’s ability to pay for the device using health insurance.

While the IUD may still be the least popular kid in the cafeteria, female condoms may soon be lucky enough to sit at the cool kids’ table thanks to new research funding awarded by the Bill & Melinda Gates Foundation. Four recipients of the Grand Challenges Exploration grant in early June proposed employing inflation devices, balloons, tampon applicators and other innovative materials to design more effective and usable female condoms.

Despite support from HIV-prevention advocates, the female condom has had a difficult time gaining traction within many consumer markets. Female Health Co.’s first female condom (FC1) was approved by the FDA in 1993, and an updated version (FC2) was approved in 2009. Yet a 2009 article by the International Women’s Health Coalition estimated that “only one female condom is distributed for every 700 male condoms.” Outside of the U.S., countries such as Malawi have reported low popularity for the female condom, and a previous Gates foundation study found that distributing female condoms was not as cost-effective as distributing male condoms, in part due to the lack of social acceptance of female condoms.

A frequent critique of female condoms focuses on the difficulty users face in inserting the devices, but some of the grant recipients are working to mitigate that issue. HealthRock, LLC announced an “air-infused female condom,” which would use air pressure to inflate and position the condom within a woman’s vagina. Similarly, QX System in California is testing a female condom that would be inserted using a reusable tampon applicator surrounded by a balloon.

The lead researcher for the grant recipients at Indiana University, Debby Herbenick, also noted, “Current [female] condoms are big and baggy and really don’t match a female’s anatomy.” Recognizing this issue, Herbenick and her colleagues plan to give the condom an elliptical rather than circular opening, as well as include ribbing on the outside of the condom to increase pleasure for female users.

Another grant recipient, Origami Healthcare Products, proposed an internal, silicone condom that could be used during both vaginal and anal intercourse and could become the first condom approved by the Food & Drug Administration (FDA) for anal intercourse.

Such a design could slow HIV transmission, as female condoms have been effective at doing in the past. In 2010, HIV/AIDS-prevention organizations in Chicago and in Washington, D.C. began campaigning for the female condom using the slogans “Put a Ring on It” and “Get Turned On To It,” respectively. In the first year, D.C.’s campaign is estimated to have prevented 23 HIV transmissions and saved $8 million in medical costs, significantly exceeding the $500,000 grant that funded the program.

Additionally, female-focused contraceptives serve as a safe alternative in a situation where a woman’s partner rejects the use of a male condom, which is especially important in countries where gender inequity impairs a woman’s ability to negotiate condom use.

Female condoms are widely used in other countries such as Cameroon, and perhaps the work of these researchers will generate wider consumer popularity in the U.S.

Photo of an IUD, courtesy of Hic et nunc via Wikimedia Commons.

Infographic of the importance of female condoms in increasing a woman’s sexual agency, courtesy of Debby Herbenick via Indiana Public Media.