Although IUDs are one of the most cost-effective contraceptive options over time, the high initial cost can be a major hurdle. Making matters worse, there are few IUDs available in public clinics, and misconceptions about them impact how many women use them. But with the launch of South Africa’s first generic hormone-releasing IUD, women in South Africa finally have access to a long-lasting, affordable generic IUD. The program launched by Pharma Dynamics could finally break down the price barriers that have stopped many women from using them and make it much easier for people in both the private and public sectors to get the care they need.
Meet the experts: Ingrid Singelsis is deputy director of the scientific department at Pharma Dynamics and has expertise in women’s health. Dr. Malikah van der Schyff is an obstetrician and gynecologist working at Mediclinic Constantiaberg in Cape Town.
Long-term contraception has been available for women for many years. There is the implant (Implanon), which lasts three years, and the IUD, which lasts between five and eight years and can be non-hormonal or progestin-based. According to available statistics, around nine million women use contraceptives, but mostly rely on short-acting means such as condoms, the injection or the pill. The effectiveness of these methods is great – but they require daily or monthly maintenance.
Why long-acting contraceptives are more practical
In contrast, only 2% of women use long-acting contraceptives such as the IUD. That’s because it’s expensive – prices start at around R1,500 and can go up to R5,000 – and requires a doctor’s consultation, the actual device and an insertion procedure, causing fees to skyrocket very quickly.
The cost of an IUD, previously offered by various brands that have patented certain materials and shapes, can reach R4,000 for the device alone. There is now a generic drug from Pharma Dynamics on the South African market that will make the cost of the IUD significantly cheaper and therefore more accessible.
How does an IUD work?
There are two types of IUDs: hormonal IUDs, which release levonorgestrel (progestogen), and non-hormonal copper IUDs. Typically, IUDs are T-shaped devices that sit in the uterus and prevent pregnancy. However, there are differences between hormonal and non-hormonal devices.
Hormonal IUD
Example of a hormonal IUD
Mirena and Kyleena – and now the generic – are hormonal T-shaped devices that slowly release progestin, known as levonorgestrel. This synthetic hormone binds to progesterone receptors in the body and thickens cervical mucus (making it difficult for sperm to penetrate), thins the uterine lining (so fertilized eggs cannot implant), and suppresses ovulation.
Copper spiral
Example of a non-hormonal copper IUD
A non-hormonal option, this copper device uses the natural element to prevent pregnancy. It has a negative effect on sperm and thus prevents pregnancy. It also affects the ability of the fallopian tubes to transport an egg. Although this method is 99% effective, it is not suitable for women with abnormal bleeding.
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What are the benefits of using an IUD?
South Africa is struggling with a high rate of unplanned pregnancies. It is estimated that 64% of all pregnancies are unplanned – a significant number. Health experts believe that improving access to long-term contraception is essential and that the introduction of cheaper long-term contraception is a positive step.
They have no effect on fertility
Research shows that more than 85% of women who want to have children become pregnant within a year of IUD removal, regardless of age, previous pregnancies, or length of IUD use.
They can help with heavy menstrual bleeding
The hormonal IUD can also reduce the stress of your period, says Dr. van der Skyff: “As it acts locally on the lining of the uterus, it becomes thinner over time. As a result, menstrual bleeding usually becomes lighter and for some women, periods may stop altogether. Clinical studies show that they can reduce menstrual blood loss by more than 80% after several months, and many guidelines recommend them as a treatment option for heavy menstrual bleeding.”
IUDs do not contain estrogen
For a variety of reasons, some women should not use estrogen contraceptives. Hormonal IUDs like this generic contain only progestin, making them a safe option for many women.
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What does South Africa’s generic IUD offer?
“The generic option is currently up to 22% cheaper than the original product available on the market,” explains Singels. “It is also important to note that it has been registered with SAHPRA (South African Health Products Regulatory Authority) in South Africa for use up to six years after launch, compared to five years for the original product.” This offers added value and an additional year of protection.
Most patients experience moderate to severe discomfort when an IUD is inserted – and most doctors avoid painkillers. On a scale of 0 to 10, average scores range from 5 to 7. Studies show that about 50 to 78% of people report moderate to severe pain. The new generic IUD helps with insertion pain. “The device was designed with a slimmer insertion tool that makes placement easier for healthcare providers and more comfortable for patients,” says Singels. “Its clinical program, including the ACCESS-IUS trial, demonstrated high insertion success rates and improved tolerability compared to older IUD designs.”
Additionally, Singelsis says Pharma Dynamics has invested in training for healthcare professionals to update insertion techniques and reduce discomfort. “While approaches to pain management are at the discretion of the healthcare professional and personal preference, the combination of improved device design and physician support is intended to make the experience more manageable for women,” says Singels.
Where to go for an IUD?
The first port of call should be your doctor, who can help you find the best option for you. The IUD is only available with a prescription, says Dr. van der Skyff. “The insertion must always be performed by a trained professional in a clinic, hospital or private practice. Typically the prescription is taken to a pharmacy, the device is picked up and then taken to the insertion appointment. In some cases it may be provided directly by a doctor, but this is less common,” she says.
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