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Contraception. 2014 Jun;89(6):572-7. doi: 10.1016/j.contraception.2014.02.008. Epub 2014 Feb 26.

Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.

Author information

  • 1Long-Acting Reversible Contraception Program, The American College of Obstetricians and Gynecologists, Washington, DC. Electronic address: ALuchowski@acog.org.
  • 2Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024.
  • 3Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.
  • 4Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024; Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, WA.

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.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Adolescents; Emergency contraception; Intrauterine contraceptive device (IUD); Long-acting reversible contraception; Nulliparous; Obstetrician–Gynecologists; Postabortion; Postpartum

PMID:
24679477
[PubMed - indexed for MEDLINE]
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