Interventions Overcome Obstacles to IUD Use

LA JOLLA, CALIF. — Specific interventions to increase the availability of intrauterine devices hold considerable potential for improving the use of these convenient and highly effective contraceptive tools, Dr. Suzan Goodman said at the annual meeting of the Association of Reproductive Health Professionals.

The interventions studied include immediate postabortal insertion, simplified screening criteria, allowed insertion on initial visit, staff training that includes clinician instruction on intrauterine device (IUD) counseling and insertion, and reevaluation and improvement of IUD educational materials.

While IUDs are a highly effective form of birth control equal to tubal sterilization, only 1% of reproductive age women in the United States use them, compared with over 20% in many other countries, said Dr. Goodman, director of medical education at Planned Parenthood Golden Gate in San Francisco.

“We hypothesized that barriers to insertion of IUDs are central to low utilization in the U.S. Postabortal IUD insertion can be a rapid, effective form of contraception, and studies show that complication rates do not increase when IUDs are inserted immediately post abortion,” she explained.

The researchers obtained data on eight clinics' IUD utilization during three periods: an 18-month control group period, a 14-month period after initiation of postabortal insertion, and a 6-month period with all interventions, including the addition of same-day insertion with simplified screening criteria.

During the 3-year study a total of 2,184 IUDs were inserted, including 1,503 interval insertions and 681 postabortion insertions. About half the IUDs were nonhormonal ParaGuard devices and half were Mirena devices, which release a low dose of levonorgestrel. From period 1 to period 3, the average monthly ParaGuard insertions increased fourfold and Mirena insertions increased eightfold.

In the control period, 31 IUDs were inserted per month, on average, compared with 74 per month during the postabortal insertion period and 123 per month in the period with all interventions.

While the abortion rate in the clinics involved in the interventions increased 10%, IUD utilization increased 330%, showing that the observed IUD insertion trend was not just due to increasing abortions, Dr. Goodman said. A nearby Planned Parenthood affiliate that did not undertake these interventions had an increase in IUD utilization over the same period of 20%, she said.

A demographic analysis revealed that each progressive study period had more women using IUDs who were young, single, and of smaller mean family size. The number of white and black women using IUDs increased over the progressive study periods.

Over 90% of IUD users met Medicaid eligibility requirements.

Among the complications encountered were IUD expulsion, infection, pregnancy with the IUD in place, continuing viable pregnancy, and abortion. Dr. Goodman had no financial disclosures.

LA JOLLA, CALIF. — Specific interventions to increase the availability of intrauterine devices hold considerable potential for improving the use of these convenient and highly effective contraceptive tools, Dr. Suzan Goodman said at the annual meeting of the Association of Reproductive Health Professionals.

The interventions studied include immediate postabortal insertion, simplified screening criteria, allowed insertion on initial visit, staff training that includes clinician instruction on intrauterine device (IUD) counseling and insertion, and reevaluation and improvement of IUD educational materials.

While IUDs are a highly effective form of birth control equal to tubal sterilization, only 1% of reproductive age women in the United States use them, compared with over 20% in many other countries, said Dr. Goodman, director of medical education at Planned Parenthood Golden Gate in San Francisco.

“We hypothesized that barriers to insertion of IUDs are central to low utilization in the U.S. Postabortal IUD insertion can be a rapid, effective form of contraception, and studies show that complication rates do not increase when IUDs are inserted immediately post abortion,” she explained.

The researchers obtained data on eight clinics' IUD utilization during three periods: an 18-month control group period, a 14-month period after initiation of postabortal insertion, and a 6-month period with all interventions, including the addition of same-day insertion with simplified screening criteria.

During the 3-year study a total of 2,184 IUDs were inserted, including 1,503 interval insertions and 681 postabortion insertions. About half the IUDs were nonhormonal ParaGuard devices and half were Mirena devices, which release a low dose of levonorgestrel. From period 1 to period 3, the average monthly ParaGuard insertions increased fourfold and Mirena insertions increased eightfold.

In the control period, 31 IUDs were inserted per month, on average, compared with 74 per month during the postabortal insertion period and 123 per month in the period with all interventions.

While the abortion rate in the clinics involved in the interventions increased 10%, IUD utilization increased 330%, showing that the observed IUD insertion trend was not just due to increasing abortions, Dr. Goodman said. A nearby Planned Parenthood affiliate that did not undertake these interventions had an increase in IUD utilization over the same period of 20%, she said.

A demographic analysis revealed that each progressive study period had more women using IUDs who were young, single, and of smaller mean family size. The number of white and black women using IUDs increased over the progressive study periods.

Over 90% of IUD users met Medicaid eligibility requirements.

Among the complications encountered were IUD expulsion, infection, pregnancy with the IUD in place, continuing viable pregnancy, and abortion. Dr. Goodman had no financial disclosures.

LA JOLLA, CALIF. — Specific interventions to increase the availability of intrauterine devices hold considerable potential for improving the use of these convenient and highly effective contraceptive tools, Dr. Suzan Goodman said at the annual meeting of the Association of Reproductive Health Professionals.

The interventions studied include immediate postabortal insertion, simplified screening criteria, allowed insertion on initial visit, staff training that includes clinician instruction on intrauterine device (IUD) counseling and insertion, and reevaluation and improvement of IUD educational materials.

While IUDs are a highly effective form of birth control equal to tubal sterilization, only 1% of reproductive age women in the United States use them, compared with over 20% in many other countries, said Dr. Goodman, director of medical education at Planned Parenthood Golden Gate in San Francisco.

“We hypothesized that barriers to insertion of IUDs are central to low utilization in the U.S. Postabortal IUD insertion can be a rapid, effective form of contraception, and studies show that complication rates do not increase when IUDs are inserted immediately post abortion,” she explained.

The researchers obtained data on eight clinics' IUD utilization during three periods: an 18-month control group period, a 14-month period after initiation of postabortal insertion, and a 6-month period with all interventions, including the addition of same-day insertion with simplified screening criteria.

During the 3-year study a total of 2,184 IUDs were inserted, including 1,503 interval insertions and 681 postabortion insertions. About half the IUDs were nonhormonal ParaGuard devices and half were Mirena devices, which release a low dose of levonorgestrel. From period 1 to period 3, the average monthly ParaGuard insertions increased fourfold and Mirena insertions increased eightfold.

In the control period, 31 IUDs were inserted per month, on average, compared with 74 per month during the postabortal insertion period and 123 per month in the period with all interventions.

While the abortion rate in the clinics involved in the interventions increased 10%, IUD utilization increased 330%, showing that the observed IUD insertion trend was not just due to increasing abortions, Dr. Goodman said. A nearby Planned Parenthood affiliate that did not undertake these interventions had an increase in IUD utilization over the same period of 20%, she said.

A demographic analysis revealed that each progressive study period had more women using IUDs who were young, single, and of smaller mean family size. The number of white and black women using IUDs increased over the progressive study periods.

Over 90% of IUD users met Medicaid eligibility requirements.

Among the complications encountered were IUD expulsion, infection, pregnancy with the IUD in place, continuing viable pregnancy, and abortion. Dr. Goodman had no financial disclosures.