Abstract
Objectives
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.
Design
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.
Results
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.
Conclusions
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.
Implications
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Continuation and satisfaction of reversible contraception.Obstet Gynecol. 2011; 117: 1105-1113
- Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No. 121. American College of Obstetricians and Gynecologists.Obstet Gynecol. 2011; 118: 184-196
- Interventions for emergency contraception.Cochrane Database of Systematic Reviews. 2012; (Issue 8. Art. No: CD001324. http://dx.doi.org/10.1002/14651858.CD001324.pub4)
- Access to emergency contraception. Committee Opinion No. 542. American College of Obstetricians and Gynecologists.Obstet Gynecol. 2012; 120: 1250-1253
- Copper T380A intrauterine device for emergency contraception: a prospective, multicenter, cohort clinical trial.BJOG. 2010; 117: 1205-1210
- A qualitative exploration of emergency contraception users' willingness to select the copper IUD.Contraception. 2012; 85: 32-35
- A survey of women obtaining emergency contraception: are they interested in using the copper IUD?.Contraception. 2011; 83: 441-446
- 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
- Evidence-based IUD practice: family physicians and obstetrician-gynecologists.Fam Med. 2012; 44: 637-645
- Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.Obstet Gynecol. 2012; 119: 220-226
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).
- Unintended pregnancy in the United States: incidence and disparities, 2006.Contraception. 2011; 84: 478-485
- Effectiveness of long-acting reversible contraception.N Engl J Med. 2012; 366: 1998-2007
- Contraceptive policies affect post-abortion provision of long-acting reversible contraception.Contraception. 2011; 83: 41-47
- Patients' attitudes and experiences related to receiving contraception during abortion care.Contraception. 2011; 84: 585-593
- Uptake and adherence to long-acting reversible contraception post-abortion.Contraception. 2010; 82: 345-353
Article info
Publication history
Published online: March 03, 2014
Accepted:
February 13,
2014
Received in revised form:
February 10,
2014
Received:
December 16,
2013
Footnotes
☆Disclosure: The authors report no conflict of interest.
☆☆Funding: This study is funded in part by grant, UA6MC19010, through the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program and a grant from an anonymous foundation.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
