Obstetrician–Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations



      Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined obstetrician–gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception.


      A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership.


      After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all obstetrician–gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among obstetrician–gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs.


      Although most obstetrician–gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations.


      This study shows that obstetrician–gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.


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        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105-1113
      1. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 121. American College of Obstetricians and Gynecologists.
        Obstet Gynecol. 2011; 118: 184-196
        • Cheng L.
        • Che Y.
        • Gulmezoglu A.M.
        Interventions for emergency contraception.
        Cochrane Database of Systematic Reviews. 2012; (Issue 8. Art. No: CD001324.
      2. Access to emergency contraception. Committee Opinion No. 542. American College of Obstetricians and Gynecologists.
        Obstet Gynecol. 2012; 120: 1250-1253
        • Wu S.
        • Godfrey E.M.
        • Wojdyla D.
        • Dong J.
        • et al.
        Copper T380A intrauterine device for emergency contraception: a prospective, multicenter, cohort clinical trial.
        BJOG. 2010; 117: 1205-1210
        • Wright R.L.
        • Frost C.J.
        • Turok D.K.
        A qualitative exploration of emergency contraception users' willingness to select the copper IUD.
        Contraception. 2012; 85: 32-35
        • Turok D.K.
        • Gurtcheff S.E.
        • Handley E.
        • Simonsen S.E.
        • et al.
        A survey of women obtaining emergency contraception: are they interested in using the copper IUD?.
        Contraception. 2011; 83: 441-446
      3. Adolescents and long-acting reversible contraception: implants and intrauterine devices. ACOG Committee Opinion No. 539. American College of Obstetricians and Gynecologists.
        Obstet Gynecol. 2012; 120: 983-988
        • Harper C.C.
        • Henderson J.T.
        • Raine T.R.
        • Goodman S.
        • Darney P.D.
        • Thompson K.M.
        • Dehlendorf C.
        • Speidel J.J.
        Evidence-based IUD practice: family physicians and obstetrician-gynecologists.
        Fam Med. 2012; 44: 637-645
        • Harper C.C.
        • Speidel J.J.
        • Drey E.A.
        • Trussell J.
        • Blum M.
        • Darney P.D.
        Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.
        Obstet Gynecol. 2012; 119: 220-226
      4. Luchowski A, Anderson BL, Power ML, Raglan GB, Espey E, Schulkin J. Obstetrician–Gynecologists and contraception: long-acting reversible contraception practices and education (in press).

        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • Buckel C.
        • Madden T.
        • Allsworth J.E.
        • Secura G.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998-2007
        • Thompson K.M.
        • Speidel J.J.
        • Saporta V.
        • Waxman N.J.
        • Harper C.C.
        Contraceptive policies affect post-abortion provision of long-acting reversible contraception.
        Contraception. 2011; 83: 41-47
        • Kavanaugh M.L.
        • Carlin E.E.
        • Jones R.K.
        Patients' attitudes and experiences related to receiving contraception during abortion care.
        Contraception. 2011; 84: 585-593
        • Rose S.B.
        • Lawton B.A.
        • Brown S.A.
        Uptake and adherence to long-acting reversible contraception post-abortion.
        Contraception. 2010; 82: 345-353