Abstract
Background
Unprotected intercourse is common, especially among teens and young women. Access
to intrauterine device (IUD) as emergency contraception (EC) can help interested patients
more effectively prevent unintended pregnancy and can also offer ongoing contraception.
This study evaluated young women's awareness of IUD as EC and interest in case of
need.
Study design
We conducted a secondary analysis of data from young women aged 18–25 years, not desiring
pregnancy within 12 months, and receiving contraceptive counseling within a cluster-randomized
trial in 40 US Planned Parenthood health centers in 2011–2013 (n=1500). Heath centers were randomized to receive enhanced training on contraceptive
counseling and IUD placement, or to provide standard care. The intervention did not
focus specifically on IUD as EC. We assessed awareness of IUD as EC, desire to learn
more about EC and most trusted source of information of EC among women in both intervention
and control groups completing baseline and 3- or 6-month follow-up questionnaires
(n=1138).
Results
At follow-up, very few young women overall (7.5%) visiting health centers had heard
of IUD as EC. However, if they needed EC, most (68%) reported that they would want
to learn about IUDs in addition to EC pills, especially those who would be very unhappy
to become pregnant (adjusted odds ratio [aOR], 1.3; 95% confidence interval, 1.0–1.6,
p<.05). Most (91%) reported a doctor or nurse as their most trusted source of EC information,
over Internet (6%) or friends (2%), highlighting providers' essential role.
Conclusion
Most young women at risk of unintended pregnancy are not aware of IUD as EC and look
to their providers for trusted information. Contraceptive education should explicitly
address IUD as EC.
Implications
Few young women know that the IUD can be used for EC or about its effectiveness. However,
if they needed EC, most reported that they would want to learn about IUDs in addition
to EC pills, especially those very unhappy to become pregnant. Contraceptive education
should explicitly address IUD as EC.
Keywords
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References
- Declines in unintended pregnancy in the United States, 2008–2011.N Engl J Med. 2016; 374: 843-852
- Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates.Contraception. 2014; 89: 222-228
- Sexual activity and contraceptive use among teenagers in the US, 2011–2015.Ntl Health Stat Rep. 2017; 104
- Knowledge and awareness of emergency contraception in adolescents.J Pediatr Adolesc Gynecol. 2010; 23: 273-278
- Emergency contraception pill awareness and knowledge in uninsured adolescents: high rates of misconceptions concerning indications for use, side effects, and access.J Pediatr Adolesc Gynecol. 2015; 28: 337-342
- Attitudes and beliefs about the intrauterine device among teenagers and young women.Contraception. 2010; 82: 178-82.12
- Adolescent and young adult women's knowledge of and attitudes toward the intrauterine device.Contraception. 2008; 78: 211-217
- The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.Hum Reprod. 2012; 27: 1994-2000
- Interventions for emergency contraception.Cochrane Database Syst Rev. 2012; 15
- Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.Contraception. 2011; 84: 363
- Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.Obstet Gynecol. 2012; 119: 220-226
- Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.Contraception. 2014; 89: 572-577
- Emergency contraception: a multispecialty survey of clinician knowledge and practices.Contraception. 2016; 93: 145-15
- Access to the copper IUD as post-coital contraception: results from a mystery caller study.Contraception. 2016; 94: 561-566
- Knowledge of and interest in the copper intrauterine device among women seeking emergency contraception.J Obstet Gynaecol Can. 2017; 40 ([pii: S1701–2163(17)30441–3]): 41-47
- A survey of women obtaining emergency contraception: are they interested in using copper IUD?.Contraception. 2011; 83: 441-446
- Interest in intrauterine contraception among seekers of emergency contraception and pregnancy testing.Obstet Gynecol. 2009; 113: 833-839
- Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial.Lancet. 2015; 386: 562-568
- An over-the-counter simulation study of a single tablet emergency contraceptive in young females.Obstet Gynecol. 2012; 119: 1-8
- Choice of emergency contraceptive and decision making regarding subsequent unintended pregnancy.J Womens Health (Larchmt). 2016; 25: 1038-1043
- Use of effective contraception 6 months after emergency contraception with a copper intrauterine device or ulipristal acetate—a prospective observational cohort study.Acta Obstet Gynecol Scand. 2016; 95: 887-893
- ACOG Practice Bulletin, Number 152. 2015 ([Emergency Contraception])
- MMWR Recomm Rep. 2016; 65: 1-66
- Improving uptake of the copper intrauterine device for emergency contraception by educating pharmacists in the community.J Fam Plann Reprod Health Care. 2014; 40: 41-45
- EC4U: results from a pilot project integrating the copper IUC into emergency contraceptive care.Contraception. 2016; 94: 48-51
- EC4U Toolkit. Planned Parenthood Federation of America, 2014
- Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study.Contraception. 2016; 93: 526-532
- One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception.Contraception. 2017; 96: 99-105
- Racial and ethnic differences in women's preferences for features of contraceptive methods.Contraception. 2016; 93: 406-411
- What matters most? The content and concordance of patients' and providers' information priorities for contraceptive decision making.Contraception. 2014; 90: 280-287
- Association of the quality of interpersonal care during family planning counseling with contraceptive use.Am J Obstet Gynecol. 2016; 215: 78.e1-78.e9
- Contraceptive features preferred by women at high risk of unintended pregnancy.Perspect Sex Reprod Health. 2012; 44: 194-200
- “I wish they could hold on a little longer”: physicians' experiences with requests for early IUD removal.Contraception. 2017; 96: 106-110
- Interest in and experience with IUD self-removal.Contraception. 2014; 90: 54-59
- PPFA Annual Report 2015–2016.
- Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use.Clin Obstet Gynecol. 2014; 57: 659-673
Article info
Publication history
Published online: April 18, 2018
Accepted:
April 11,
2018
Received in revised form:
April 10,
2018
Received:
February 6,
2018
Footnotes
☆Disclosure: Julia Kohn and Courtney Benedict declare that their institution, Planned Parenthood Federation of America, participates in studies sponsored by HRA Pharma that are unrelated to this study. All other authors report no conflict of interest.
☆☆Funding: This study was funded by the William and Flora Hewlett Foundation. Support was also received from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Office of Research on Women's Health, Building Interdisciplinary Research Careers in Women's Health (Grant K12 HD052163 and the NICHD (Grant K99HD086232). These entities had no role in study design, interpretation, decision to submit or writing.
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