Why the IUD Can’t Beat Its Bad Reputation

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Bad reputations are hard to come back from, and that’s true whether you’re talking about a kid in high school battling an unfair rap, a celebrity with an image crisis — or a teensy, T-shaped birth control device called the IUD. It’s something worth considering today, as the Supreme Court ruled in the Hobby Lobby case that companies can’t be required to provide contraception coverage if it doesn’t jive with their religious beliefs. The decision won’t affect the most common birth control methods, like condoms or the pill, USA Today reports, but it will affect what the Guttmacher Institute calls the most effective birth control method available: the IUD. 

But even women — and their doctors — who aren’t religious may still be wary about the device. It’s much less popular than the pill, condoms, and even sterilization, according to Guttmacher estimates, and that’s likely at least in part because the IUD is facing a double whammy here in terms of a bad rap. In the 1970s, an early version of the device was recalled after reports of nasty infections, and even some cases of infertility. It also comes down to disagreement over what the IUD actually does; as today’s Supreme Court ruling over religious beliefs and contraceptives  demonstrates, science and religion don’t always agree over what counts as “conception,” as The Atlantic’s Olga Khazan wrote in March.

That’s a lot of negativity for a little device to overcome. Here, some psychological findings that help explain why the IUD can be a hard-sell:

We remember negative information more clearly. Our brains may have evolved to cling to the bad, scary stuff in life more tightly than the good. For example, research shown that the psychological hangover you get from one bad day can last well into the following day; the same isn’t true for a good day. And, as Florida State University psychologist Roy F. Baumeister (and others) argues in a 2005 paper, the same is true for sexual experiences — research has shown that the psychic pain of one bad romp can last for years, but no matter how great any single sexual experience is, it won’t have the same lingering effect as the deleterious one. Applying this logic to the IUD, it seems the threat of risk is something our minds take more seriously than its potential reward.

Inaccurate information may be stickier than accuracy. Rejecting inaccurate information requires more cognitive effort than just accepting the truthiness at face value, a recent paper in Psychological Science in the Public Interest argues. In the context of the IUD, what these researchers are essentially arguing is this: If all you’ve heard about the device is that it’s dangerous, even immoral — who has the time or energy it would take to change your mind? We’ve got stuff to do.

Attempts to correct misinformation often backfire. In that same paper, the authors write that research has consistently found that retractions rarely, if ever, work. Even when people understand and can later recall the corrected information, it’s unlikely to change their beliefs. It’s not fun to be wrong, about a medical device or otherwise, and an attempt to rectify false information can make people dig even more deeply into their inaccurate beliefs, they argue. 

One factor that might help the IUD catch a break? It could be as simple as time. Recent research is showing that younger American women, who of course weren’t alive during the 1970s, are increasingly using the device. Plus, the IUD has long been among the most expensive birth control options, but the Affordable Care Act offers full coverage for birth control, including the IUD; as the Daily Intelligencer post notes, this is likely to hold true despite the Supreme Court ruling today. Hang on, little IUD. Your day may be coming yet.