I Got Birth Control in Three Different Countries—Here’s How the U.S. Stacks Up

Republicans want Americans to have more babies. But in practice, more people than ever are trying to prevent pregnancy by seeking out long-acting birth control. Requests for intrauterine devices (IUDs) and sterilization, in particular, surged among women after President Donald Trump was elected to a second term in 2024.

Around the world, about 1 in 5 women of reproductive age use either a hormonal or copper IUD, which can prevent pregnancy for 8-to-12 years, depending on the device. This birth control method has become quite popular in the U.S. in recent years. In one 2022 study, participants were more likely to pick long-acting contraception like IUDs over options like pills when cost and access weren’t barriers. 

Still, many people associate IUDs with pain. For years, medical providers have underestimated the pain of forcibly dilating the cervix and sticking a T-shaped device into the uterus. 

This has translated into insufficient pain management. As of 2025, roughly 5 percent of patients get any type of anesthetic or other medication during IUD insertion. That’s up from about 2 percent in 2018, but it still means pain is part of the process for many people.

I didn’t even know I could ask for pain management when I got my first IUD at age 20 in Florida. Ten years later, I’ve had three IUDs put in, each in a different country, and I’ve learned that it doesn’t have to hurt—or be filled with anxiety.

In hopes of helping other IUD patients advocate for themselves, I talked to two patients, a researcher, and an OB-GYN about what makes for a successful IUD insertion. They all agree: The provider’s attitude towards the patient is essential—and research backs this up.

The U.S. in 2014: $50 and some mild cramping

I remember my mom shushing me in embarrassment when, at age 17, I told her in a restaurant that I wanted to go on birth control. The gynecologist she eventually sent me to didn’t inform me that there were different options I could choose from. Instead, I was given a prescription for hormonal birth control pills.

Three years later, a classmate in college told me the IUD was better at preventing pregnancy; it’s over 99 percent effective, whereas birth control pills are about 93 percent effective. I decided to make the switch.

Again, I didn’t choose from a menu of options here: I was offered the Mirena, a plastic IUD that releases a very low level of progesterone into the body to prevent pregnancy. My gynecologist said the copper IUD was for people who had already had kids. (This is a common misconception, and, for what it’s worth, it’s a false one. Anyone can get a copper IUD, which prevents pregnancy without hormones.)

I went to a clinic in Florida, where my family lived, and paid $50. Thanks to the Affordable Care Act, I was still on my mother’s insurance. Without coverage, the procedure can cost up to about $2,000.

I had mild cramping during the procedure, and for three days after. I wasn’t given any pain management, nor was I counseled on pain relief. I was just told someone should drive me home after, and that I should rest. I couldn’t take ibuprofen, a medication commonly recommended to ease IUD insertion pain, because I’m allergic. I stayed on the couch with a heating pad for the rest of the day.

My experience of mild, manageable pain is hardly universal. I spoke with two women whose IUD stories reveal how much patient care can vary.

Katie, 32, had her IUD placed in Illinois this past summer. Katie does not want to use her last name because she fears sharing her reproductive health information (in September, the Trump administration referred to IUDs as “abortifacient birth control”—falsely claiming that these devices cause abortions—and a South Carolina Senate bill could outlaw most contraception, including IUDs).

Katie’s procedure was scheduled after the Centers for Disease Control (CDC) echoed May 2025 guidance issued by the American College of Obstetricians and Gynecologists recommending local anesthetic as an option for IUD insertion.

She said the new guidelines didn’t noticeably affect her care. She described the process as largely physician-directed, with little discussion of the differences between hormonal and copper devices.

Anxiety about pain led her to cancel her first appointment.

“I’ve seen so many women and girls online expressing a very serious, very real fear of going to a gynecologist,” she said, adding, ”I find it very disturbing that nothing is being done to address the fear.”

Katie eventually had her IUD placed while undergoing another gynecological procedure under general anesthesia.

Costa Rica in 2020: $400 and pinching pain

I got my second IUD in Costa Rica during the COVID-19 pandemic. As a university student there, I had access to national health insurance.

Theoretically, that would make birth control free. But a school nurse told me that the public health system would only cover birth control pills. If I wanted another IUD, I’d have to pay 200,000 colones, or about $400.

That’s still true in Costa Rica today. Dr. Adam Paer, a gynecologist in San José, Costa Rica’s capital city, confirmed that the national health insurance only covers IUDs for certain health reasons, like heavy bleeding.

Back in 2020, I wanted an IUD no matter the cost. I made an appointment with an English-speaking doctor at a Catholic hospital. I asked for the Mirena again, and the consultation took less than ten minutes before I was up on the plastic table with my legs spread.

Yet again, the gynecologist didn’t explore whether other IUDs would have been more appropriate or talk about the possible side effects.

This second Mirena experience was a bit more intense than my first. My current IUD was “stuck” and wouldn’t come out the normal way—by pulling on the strings with forceps. The doctor brought in a scarier-looking metal device, called grasping forceps, and those thankfully worked.

Again, after this procedure, I had a few days of moderate cramping and bed rest. I also felt intense mood swings in the following weeks from hormonal shifts. None of my gynecologists have talked to me about this potential side effect, but dozens of IUD patients have documented similar symptoms online.

And, again, I wasn’t offered any pain management in Costa Rica—even when things got complicated. And I felt dismissed when I asked questions. For example, I asked what I could do if the pain got worse, and the doctor told me that most women don’t even need painkillers. (Maybe that’s because he never thought to offer them.)

Paer told me he provides pain management for IUD insertions—ranging from an anti-inflammatory like ibuprofen to local anesthesia, and will even consider sedation “in extreme cases,” though he said the anesthesia fees lead to an increased cost. Paer finds that the main barrier to getting an IUD for private patients is affordability: roughly $500 in Costa Rica, all told. But pain is an issue, too.

“A lot of women come in for the IUD and they’re really scared of the pain,” he said, adding, “Some doctors don’t take that into account.”

Research shows that fear can make the experience worse.

Belgium in 2023: $0 and a breeze

At age 29, I decided to get off the hormones and switch to a copper IUD. Again, I was living abroad, in Belgium, while pursuing my studies in global health at Ghent University. My university hospital was doing a study on IUD placement, so I enrolled and got the device for free.

That doesn’t make me particularly lucky in Belgium. As of 2025, the copper IUD is free for all patients under 25; for patients above that age, with most Belgian private health insurances, it costs up to €150, or about $173.

Before my IUD insertion was scheduled, I got an ultrasound, and my uterine cavity was measured. That’s standard procedure in Belgium, and it should be everywhere else, too, said Rina Wildemeersch, a Belgian IUD researcher.

“It’s all about the size of the cavity and getting the right device,” she explained.

This time, too, I was given misoprostol—the same cervix-softening drug that is frequently used in medication abortions—to help dilate my cervix, as well as local anesthesia.

The whole process was efficient. For the first time, I felt like I was properly prepared—both mentally and emotionally. If there was going to be pain or discomfort, there was a plan in place.

I was told I could ask for anesthesia at any time. I remember digging my nails into the side of the exam table while I rated my pain a seven out of ten, at the gynecologist’s request. He quickly stopped and came back with a needle.

I don’t know how much the local anesthesia helped with the pain, but I felt empowered by asking for help and receiving it. I remember thinking I could scream in pain if I wanted to, and I did. I could communicate how I felt while a piece of metal was thrust inside of me as medical students observed.

The Belgium procedure epitomizes what’s called “patient-centered care”—that is, health care that prioritizes the patient’s particular needs, preferences, values, and experiences.

This is the kind of care that seems to be largely missing in the U.S.

Aria Bercovich, a 44-year-old mother in California, has had two IUDs, one in 2005 and another in 2010. Both experiences went badly. The first, a copper device, was removed after three years because Bercovich experienced extreme pain when it became twisted.

“It was so painful,” she recalled. “It was awful.”

She tried a hormonal IUD five years after the first insertion. The insertion, she said, was “far worse than giving birth.”

In the days that followed, Bercovich experienced intense cramping, vomiting, and fatigue. She went to the hospital multiple times.

“I kept saying something was wrong, but they told me to just take ibuprofen,” she said.

After ten days of severe pain and repeated visits, the device was finally removed.

IUDS in the news

As a group, IUD users do not need either zero pain management or complete sedation.

Most of us fall somewhere in between: A Dutch study from 2025 found that half of all respondents felt “unbearable” or “severe” pain with IUD insertion; about one-quarter had “average” pain; and the rest reported minimal or no pain.

In addition to pain-management recommendations, the new CDC guidelines also promote individualizing the informed consent conversation.

Many American OB-GYNs, in other words, could learn a lot just by asking IUD patients what they want—and then listening. Because there are better and worse ways to feel “just a pinch.”

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