How a Billionaire-Backed IUD Is Fighting Back Against the GOP War on Women's Bodies

If you’re looking for empirical evidence that the GOP and its “pro-life” boosters are less anti-abortion than they are anti-sex, look no further than the case of Liletta. The new intrauterine device became available in April, and family planning clinics around the country began stocking it, often in bulk, this summer.

Liletta is everything a contraceptive should be: affordable, safe, effective, and for now—thanks to the backing of a well-known billionaire—widely accessible. Studies prove the IUD reduces rates of unplanned pregnancies, and it’s been shown to decrease the number of teen abortions. Yet the conservative response has been to obstruct the use and availability of Liletta and similar contraceptive methods at every opportunity. Like the Republican crusade to defund Planned Parenthood, the pushback suggests that anti-choice advocates are on a misguided and ultimately futile mission. One less focused on protecting the sanctity of human life than it is penalizing and stigmatizing women for having non-reproductive sex.

Liletta is more than 99 percent effective, making it more trustworthy than any other form of contraception save for permanent sterilization, according to the Centers for Disease Control. As with other long-acting reversible contraceptives (LARCs), once Liletta is inserted by a healthcare professional, it can remain in place for up to three years without any patient intervention, effectively eliminating the kinds of user errors that lead to pregnancy, from forgetting to take a daily pill to incorrectly putting on a condom. In trials, including one involving more than 1,000 women aged 16 to 46, researchers found that Liletta can be used throughout a woman’s childbearing years. And in multiple studies, Liletta has been proven safe, placing it far outside the troubled history of IUDs.

But what makes Liletta truly stand out from other LARCs is its affordability. The average cost of an IUD, including the price of the device itself and the additional fee for insertion, can run anywhere from $800 to $1,200. That’s far beyond the economic reach of most low-income and uninsured women. It’s also prohibitively priced for most family planning clinics, many of which are already severely underfunded. In Liletta’s case, Medicines360, which developed the IUD, has capped out-of-pocket expenditures for insured women at $75, and in cases where patients qualify financially, even that cost can be subsidized. For struggling health clinics around the country facing ever-shrinking budgets, there’s also good news. Medicines360 has made it a priority that public health care centers can purchase the IUD at just $50 a pop, allowing them to keep plenty in stock. Clinics around the country have placed orders, and batches of Liletta recently shipped to “49 states, with more than half of the devices going to clinics that serve low-income patients,” according to the CommonHealth blog.

If Liletta is a revelation, so too is the story of how it came to be. At the center of it is the Susan Thompson Buffett Foundation, the philanthropic organization co-founded by Warren Buffett and his late wife, its namesake. As Karen Weise notes in a comprehensive recent piece in Bloomberg Businessweek, the foundation has a long history of supporting women’s reproductive justice, “including helping to fund Planned Parenthood as well as the development of RU-486, the so-called abortion pill.” In addition to its pro-choice efforts, the foundation has more recently focused on funding family planning work, spending an estimated $200 million to determine the best and most effective contraceptive methods, underwriting costs for product development, conducting clinical trials, and creating distribution channels that ensure affordability. The Buffett Foundation has done this work—which promises to lower the number of unwanted pregnancies, and thus abortion rates —anonymously and without fanfare. All because its benefactor is dedicated to ensuring women have choice over their bodies and lives.

“For Warren, it’s economic,” said Judith DeSarno, the former head of domestic programs for the Buffett Foundation, in a 2008 interview quoted in Weise’s Bloomberg piece. “He thinks that unless women can control their fertility—and that it’s basically their right to control their fertility—that you are sort of wasting more than half of the brainpower in the United States.”

In 2007, the Buffett Foundation gave approximately $20 million to fund the Contraceptive Choice Project, a three-year study involving more than 9,000 women of childbearing age in St. Louis, Missouri. Participants were given information about various types of birth control, with particular insights on IUDs, and offered the method of their choice for free. The majority, 56 percent, ultimately opted for an IUD, proving women would be interested in the devices when armed with the right information. Between 2008 and 2013, the Buffett Foundation spent over $50 million in Colorado on a project that offered free and reduced-cost IUDs to some 30,000 women through 68 family planning clinics statewide. A recent New York Times piece enumerates the results of the Colorado Initiative to Reduce Unintended Pregnancies, which were unprecedented:

The birth rate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school. “Our demographer came into my office with a chart and said, ‘Greta, look at this, we’ve never seen this before,’” said Greta Klingler, the family planning supervisor for the public health department. “The numbers were plummeting.”

A message from from Colorado governor John Hickenlooper states that “Colorado moved from the 29th lowest teenage birth rate in the nation before the initiative began in 2008 to 19th lowest in 2012.” The project saved the state “$42.5 million in public funds in 2010 alone.”

While those findings suggested incredible promise for IUD usage in states around the country, the Buffett Foundation recognized that there remained an issue of expense. Research and development of IUDs had essentially been at a standstill for decades, a consequence of the birth control form’s fraught history. For many women who came of sexual age in the 1970s and '80s, IUDs are synonymous with the Dalkon Shield, a brand that was recalled for causing septic abortions, infertility, and in rare cases, death. The birth control method consequently became unpopular with both women and clinicians, and largely disappeared for two decades. In 2000, the FDA-approved Mirena hit the market, followed in 2013 by pharmaceutical giant Bayer's Skyla, both of which helped revive interest in the IUD for a generation of women less familiar with its history. But with only a handful of IUDs on the market, a lack of competition kept prices sky-high.

To remedy this, the Buffett Foundation spent $74 million to launch Medicines360, a nonprofit pharma (even the pairing of those words seems oxymoronic) that immediately set about creating a generic IUD. Liletta was the result. Following a multi-year clinical trial, the device received FDA approval in February. Medicines360’s commercial partner, the European pharma company Allergan, handles sales of the IUD and charges insurance companies a retail premium. Those funds essentially allow the company to keep rates low for family planning clinics, which in turn keeps prices manageable for the women who rely on public health centers.

This should be good news for everyone, regardless of where one stands on the reproductive justice divide. According to the Guttmacher Institute, there are nearly 3.4 million unintended pregnancies each year in America; these pregnancies, obviously, are those most likely to end in abortion. Family planning is the clear first step to prevention. Poor and low-income women, more specifically, are five times more likely than wealthier women to experience both unplanned pregnancies and unintended births, according to a Brookings Institute study released this year. Researchers note that, “[s]ince unintended childbearing is associated with higher rates of poverty, less family stability, and worse outcomes for children, these gaps further entrench inequality.”

Although conservatives often discuss the birth rate among women in underserved communities as if it points to some innate, class-based moral failing, Brookings notes that rates of premarital sex are not socioeconomically determined. “There is no 'sex gap' by income,” researchers write. There are, however, clear variances in contraceptive use that correlate with income, class and the cost of birth control. The Wilson Quarterly illuminates the problems that exist for poor, uninsured and underinsured women:  

[A] study by the Guttmacher Institute of women aged 18-34 with household incomes below $75,000 found that cost led many women to cut corners with their birth control, skipping pills, delaying prescriptions, or adopting a one-month-on, one-month-off approach to taking the pill. One in four women who struggle financially are forced to take such measures; among women with financial stability, the rate is roughly one in seventeen...Beyond inconsistent oral contraceptive use, low-income women are less likely to access the most effective forms of birth control. Hormonal implants and intrauterine devices (IUDs) have success rates of 99 percent in preventing pregnancy — far more effective than birth control pills or condoms...But the front-loaded cost of these methods restricts their availability to women with low incomes; the most effective forms of birth control are used mostly by affluent women.

Access to birth control gives women agency, and can have a genuinely life-changing impact. Another Guttmacher Institute survey of nearly 2,100 women served by family planning clinics around the U.S. finds that a “majority of respondents reported that birth control use had allowed them to take better care of themselves or their families (63%), support themselves financially (56%), complete their education (51%), or keep or get a job (50%). Young women, unmarried women, and those without children reported more reasons for using contraception than others. Not being able to afford a baby, not being ready for children, feeling that having a baby would interrupt their goals, and wanting to maintain control in their lives were the most commonly reported very important reasons for using birth control.”

Many conservatives might not be interested in the self-determination birth control provides for women. But as a measure that helps reduce unplanned pregnancies—and therefore, abortions and unwanted births—they should be all for it. Not only does access to birth control like Liletta help stop the cycle of poverty, conservatives surely recognize the public funds that might be saved when contraception is affordable and accessible. In 2010, nearly 70 percent of unintended births were paid for by public insurance programs, especially Medicaid. Guttmacher reports that same year, “[t]otal public expenditures on unintended pregnancies nationwide were estimated to be $21.0 billion.” The GOP, which supposedly values dollars and cents above all else, should be trumpeting any solution likely to send those numbers downward. Instead, Republicans and other anti-choicers seem to be trying their damndest to keep the numbers right where they are—or perhaps, to send them higher.

Examples abound. Early this summer, House Republicans voted to eliminate funding for Title X, the only federal program which specifically funds family planning and reproductive-health services, including birth control, for low-income women. Yet Title X funds cannot be used for abortions; federal law explicitly forbids it. Republicans in Congress are currently making a big dumb show of trying to defund Planned Parenthood, which provides a long list of family planning services to millions of women. Abortions represent just three percent of the services Planned Parenthood offers, a figure Republicans might care about if any of this was actually about abortion.

In related news, conservative legislators in Texas, Kansas, Utah, Arkansas, Louisiana and Alabama are trying to defund Planned Parenthood at the local level, leading to legal challenges in each of those states. (New York Magazine points out that Louisiana Planned Parenthood clinics don’t even provide abortion services, “so defunding it would only keep low-income patients...from accessing cancer screenings and other preventative health-care.”) And it’s not just Planned Parenthood that’s under attack. Across the country, health care clinics have been disappearing at a clip, thanks to Republican efforts. Those organizations prevent millions of unplanned pregnancies and hundreds of thousands of abortions each year, and the GOP is doing its very best to force them all to close their doors.

Remember the 2014 Hobby Lobby decision? The Supreme Court ruled in favor of the arts and crafts company in a case that decided closely held religious organizations can opt not to provide women insurance that covers the cost of IUDs and some morning-after pills. (Hobby Lobby says IUDs are abortifacients; doctors and elementary school-level reproductive science say that’s not true.) In a piece for the Cut, Ann Friedman does a beautiful job of explaining why it’s just another way of trying to prevent women from having sex for pleasure:

The Supreme Court’s decision—and most reproductive-health restrictions passed by lawmakers across America over the past several decades—expresses the view that women make their choice when they choose sex, and it's up to them to figure it out after that. That there is no social or moral or governmental obligation to make it easier for them to make choices that follow from a perfectly human impulse to want sex but not babies. For women, sex is an option, an inessential luxury like LASIK eye surgery. Hey, the Court is saying, we’re not telling you not to have sex! We’re just telling you that if you do, you’ll find it difficult to maintain a career, gain financial footing, or live a healthy life.

If you aren’t convinced yet that the GOP war on family planning is a war on female sexuality, that the Republican party is its own worst enemy, and that conservatives are perhaps the most obstructionist force against the very "family values" they claim to support, let’s revisit that Colorado initiative. After the Buffett money ran out on the family planning project—the one that was nothing short of record-breaking in the results it delivered, including a massive drop in teen pregnancies and abortions across the board—the Colorado Department of Public Health & Environment requested state funds to keep it going. Conservatives in the legislature said no. One local anti-choice group said giving teens access to contraception “does not help them understand the risks that come with sexual activities."

In other words, anti-choicers want no part of a program that teaches young women how to be sexually responsible, or that doesn’t scare them into believing the only way sex can end is badly. Just like they refuse to support an incredibly effective program that gives women options in their sex lives. The same conservatives who refuse to fund anything that benefits children once they leave the uterus, who vilify single mothers, who bemoan “entitlement programs” for the most vulnerable families and children, and who pour money into defeating initiatives that offer even the tiniest aid to poor families, won’t give a dime to a program we know would help mitigate the need for any of those things. In voting against those measures, conservatives are voting for teen pregnancy, unplanned births and abortion. That, incredibly, is how invested they are in making teenage girls and grown women feel bad for having sex.

In some way, Liletta’s proliferation is continuing to achieve progress in reproductive justice even as the GOP pulls out the stops trying to drag our society backward. As more clinics introduce Liletta to their clients, and more health care plans offer it as a choice (mine does!), the 10 percent of women who rely on IUDs for birth control will only continue to grow. Republicans will keep pushing for policies that attempt to stop women from having sex, instead of plans that actually benefit women’s reproductive health and offer real choice. Thankfully, organizations like the Buffett Foundation are innovating practical solutions. Which seems like the best way to fight a right wing that’s out of ideas and behind the times.   


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