TY - JOUR T1 - The Levonorgestrel Intrauterine System: A Pragmatic View of an Excellent Contraceptive JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 538 LP - 543 DO - 10.9745/GHSP-D-15-00330 VL - 3 IS - 4 AU - Roy Jacobstein AU - James D Shelton Y1 - 2015/12/01 UR - http://www.ghspjournal.org/content/3/4/538.abstract N2 - The levonorgestrel intrauterine system (LNG IUS) has major advantages and could be a “game-changer” in improving contraceptive choice and use. It faces important challenges, however, including: (1) high commodity cost; (2) often-strong provider resistance to IUDs and difficult programmatic requirements; (3) need for demand creation, including assessing if markedly reduced menstrual bleeding is attractive to clients; and (4) the many requirements for introducing any new contraceptive. A good next step would be a well-focused and multifaceted “learning introduction” to assess the LNG IUS’s potential in several low-income countries, with rapid scale-up if results are promising.See related article by Hubacher.In this issue of Global Health: Science and Practice, Hubacher makes a good case for the levonorgestrel intrauterine system (LNG IUS) and why donors should purchase it for provision in African family planning programs.1 The LNG IUS is indeed an excellent contraceptive. It is highly effective, with only 2 pregnancies per 1,000 women in 1 year of typical use,2 a level of effectiveness 4 times that of the copper-containing IUD, and 35 and 70 times that of the injectable and pill, respectively. The LNG IUS also has very high satisfaction and continuation rates, and it confers important non-contraceptive—even therapeutic—benefits. And, like other long-acting reversible contraceptives (LARCs), it is suitable for all reproductive intentions (delaying, spacing, or limiting births). Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have endorsed LARCs as “first-line” method choices for adolescents and young women.3,4 No wonder the LNG IUS is fueling a rise in IUD use in Europe and the United States. (Prevalence of IUD use is now over 6% in the United States, representing 9% of all modern method use among women aged 15–44.5)The LNG IUS is fueling a … ER -