LARCs as a Three-Legged Stool: The Growing Importance of the LNG-IUS

Long-Acting Reversible Contraceptives

Kate Rademacher, MHA

FHI 360 | Technical Advisor, Contraceptive Technology Innovation
In addition to being one of the most effective forms of contraception available, the LNG-IUS has important non-contraceptive benefits.

In addition to being one of the most effective forms of contraception available, the LNG-IUS has important non-contraceptive benefits. Photo courtesy of FHI 360.

Over the past several months, K4Health has been shining a spotlight on LARCs, which stands for long-acting reversible contraceptives. While LARCs offer multiple advantages—they are highly effective, long-acting and cost-effective, and fertility returns quickly after removal—the term is actually a bit misleading. The acronym implies that a multitude of family planning methods fit within that broad category. But the truth is that that only two general types of methods meet the LARC definition: contraceptive implants and intrauterine devices (IUDs).

Yet we often forget that there are two distinct types of IUDs: copper IUDs and hormonal IUDs, also known as levonogestrel intrauterine systems or “the LNG-IUS.” The LNG-IUS represents a third, distinct LARC option. In addition to being one of the most effective forms of contraception available, the LNG-IUS has important non-contraceptive benefits, including that it can be a treatment for heavy menstrual bleeding and may help alleviate anemia. While popular in many high-income countries, the LNG-IUS is often overlooked in the world of international family planning. This is because the product has been out of reach for most women in low-resource settings, largely due to its high price.

But the landscape is changing. In 2015, a new LNG-IUS supplied by Medicines360 (a nonprofit pharmaceutical company) and Allergan was approved by the U.S. Food and Drug Administration for three years of use. Clinical trials are ongoing that will evaluate its effectiveness for up to seven years. Medicines360 has exclusive distribution rights in 61 countries in Africa and South Asia, and the LNG-IUS will be priced to facilitate affordable access in the public sector.

Also, the ICA Foundation, a public-private partnership between the Population Council and Bayer Healthcare, offers donations of Bayer’s LNG-IUS in low-resource settings. More than 70,000 units have been donated in 28 countries since 2003.

Participants listen to an instructor during a training sponsored by NURHI on using the post partum intrauterine contraceptive device (PPIUD) at Nyanya general hospital in Nigeria’s capital Abuja.

Participants listen to an instructor during a training sponsored by NURHI on using the post partum intrauterine contraceptive device (PPIUD) at Nyanya general hospital in Nigeria’s capital Abuja. © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

I recently traveled to Kenya, where I spoke to a variety of stakeholders about the potential they see for wider introduction and scale-up of the LNG-IUS there. Here are some of their reflections:

  • “I want people to know three things about this product,” said Dr. Anne Kihara, Chairperson of the Kenya Obstetrical & Gynaecological Society (KOGS). “First, its benefit to women as a highly effective contraceptive. Second, the medical benefits it can bring to women. And third, the critical importance that the LNG-IUS and other LARCs can play in helping achieve broader development goals.”
  • “The LNG-IUS is one of the most exciting innovations we can bring to Kenya. I am passionate about this method,” said Faustina Fynne-Nyame, director of Marie Stopes Kenya. “As we work to increase choice, our introduction strategy has been designed to build the pathway to ensuring sustainable access to the product over the long term.”
  • “The non-contraceptive health benefits of the LNG-IUS make this a particularly important product for health programs. Many regions in Kenya have a high burden of anemia,” said Dr. Marsden Solomon, Reproductive Health Advisor for FHI 360 in Kenya. “If we can demonstrate the potential of the LNG-IUS as an effective treatment and prevention for anemia, we could amplify the impact even more.”
  • “We are excited about the potential to reach key populations with the LNG-IUS,” said Dr. Gathari Ndirangu, Technical Director of the Maternal and Child Survival Program (MCSP) at Jhpiego in Kenya. “We need to better understand what demand will be and make sure that we address myths and misconceptions that have impacted uptake of the copper IUD.”

Similar perspectives were reflected in a market assessment that FHI 360 and Marie Stopes International (MSI) conducted in Kenya last year to assess the potential to introduce and scale up Medicine360’s product there. In addition, there are ongoing efforts among a variety of partners, including FHI 360, Jhpiego, MSI, PSI, and WomanCare Global, to prepare for wider introduction of the LNG-IUS in a number of countries across Africa.

Last year, the LNG-IUS was added to the World Health Organization’s Essential Medicines List, yet the product is still not available in most low-resource settings. When we talk about the benefits and importance of LARCs, we can no longer afford to downplay the potential role of the LNG-IUS. Would we use a kitchen stool that was missing its third leg? Likewise, we must ensure that women around the world have equitable and affordable access to all three of the available LARCs—implants, copper IUDs, and the LNG-IUS.