South Africa has made steady progress in expanding access to contraception, with an estimated nine million women using modern contraceptive methods. Yet despite this relatively high uptake, most women still rely on short-acting options, such as pills, injectables and condoms.
Long-acting reversible contraception (LARC) methods, like intrauterine devices (IUDs), account for less than 2% of the country’s contraceptive method mix – a strikingly low figure given their safety, effectiveness and convenience.
According to Ingrid Singels, associate director for Pharma Dynamics’ scientific division, among the most significant barriers to wider IUD uptake has been cost.
“While IUDs are among the most cost-effective contraceptive options over time, the initial expense places them out of reach for many women. Additional challenges include limited availability in public facilities, gaps in healthcare provider training and persistent misconceptions about IUDs.
Against this backdrop, Pharma Dynamics’ entry into the medical device space through the introduction of the country’s first generic hormone-releasing (levonorgestrel 52 mg) IUD this month marks a potentially important turning point. By offering a lower-cost, clinically equivalent alternative, the generic IUD substantially reduces the price barrier that has historically limited access – opening the door to broader uptake across both public and private sectors.
IUDs and access issues
Hormone-releasing IUDs may work for contraception in several ways including thickening of the cervical mucus, inhibiting sperm movement, reducing sperm survival and thinning the uterine lining. The 52 mg levonorgestrel IUD also treats heavy menstrual bleeding (HMB) by thinning the uterine lining so that there is less bleeding every month.
Globally, IUDs are among the most widely used reversible methods of contraception, with over 150 million users. In contrast, SA’s reliance on injectables remains high, with 47% of women using contraception, opting for either the two-month or three-month injection.
“Although highly effective, long-acting methods like IUDs have remained out of reach for many South African women,” says Singels. “Lower-cost options can make these choices more realistic, helping both providers and patients embrace long-acting contraception more widely.”
High efficacy and quick return to fertility after removal
Hormone-releasing IUDs have efficacy rates comparable to permanent sterilisation. International clinical studies following women using the 52 mg levonorgestrel IUD of six years show efficacy rates of ~99%.
Equally important for many women is what happens after removal. Fertility returns quickly, with research showing that more than 85% of women desiring pregnancy conceive within a year of IUD removal, regardless of age, previous pregnancies or duration of IUD use.
“For women who want reliable contraception without compromising future fertility, IUDs offer reassurance,” says Singels.
Helps control menstrual bleeding
Beyond pregnancy prevention, hormone-releasing IUDs are also widely used to treat heavy menstrual bleeding (HMB) (≥ 80 mL per menstrual cycle), a condition that affects up to one in three women at some point in their lives. Clinical studies show that menstrual blood loss can be reduced by over 80% within 12 months of insertion, with many women experiencing lighter periods, spotting only, or no bleeding at all over time.
“These outcomes can be life changing. Heavy bleeding doesn’t just affect physical health – it impacts work, relationships and emotional wellbeing,” explains Singels.
What women should weigh up before choosing
Like all contraceptive methods, hormonal IUDs are not a one-size-fits-all. Women should talk to their doctors about contraindications to IUD use and the potential risks before deciding if the method is right for them.
Benefits of the 52 mg levonorgestrel IUD include:
• Long-term protection against pregnancy
• Effective treatment of HMB
• No need to remember daily pills or clinic visits for injections
• Reduced menstrual bleeding or no bleeding
• Return to fertility after removal
Possible drawbacks include:
• Side effects, including initial cramping or irregular bleeding after insertion
• The need for a trained provider for insertion and removal
• Higher upfront cost compared with other contraceptive methods
A changing contraceptive conversation
As South Africa grapples with high rates of unplanned pregnancy – estimated at 64% of all pregnancies – health experts believe improving access to long-acting contraception is essential.
“Ultimately, the goal is not to steer women toward one method, but to ensure they have accurate information, real choices and affordable options,” says Singels. “When women are empowered with knowledge and access, they can choose what truly works for their bodies and their lives.”