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Abstract #153187

Cynthia C. Harper, PhD¹, Maya Blum, MPH², Heike Thiel de Bocanegra, PhD³, Phillip Darney, MD, MSc⁴, Michael Policar, MD³, and Eleanor Drey, MD, EdM⁵. (1) OB-GYN, University of California, San Francisco, 3333 California Street, Ste. 335, San Francisco, CA 94115, 415-502-4092, harperc@obgyn.ucsf.edu, (2) Center for Reproductive Health Research & Policy, University of California, San Francisco, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, (3) Dept. OB/GYN, University of California, San Francisco, UCSF Box 0744, San Francisco, CA 94115, (4) Bixby Center for Reproductive Health Research & Policy, University of California, San Francisco, 1001 Portero Ave, Ward 6D, San Francisco, CA 94110, (5) Department of Obstetrics, Gynecology and Reproductive Health, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Ave., Ward 6D, San Francisco, CA 94110

Intrauterine contraception (IUC) is used by many women worldwide, from 25% in Europe to 35% in other regions. In the U.S., use is 2%, and in California, where it is available at no cost from the state family planning program, only 1.3% of female clients obtain IUCs. This study hypothesized that clinician awareness about current guidelines and devices increases IUC use. We conducted a mail survey among physicians and midlevel providers (n=1,246) serving 100 or more contraceptive clients per year in the California Family PACT program. The response rate was 65% (n=816). We used multivariate logistic regression analysis to measure the association of knowledge with clinical practice. Only 60% of contraceptive providers offered IUCs and 36% rarely gave counseling, although 92% thought their clients were receptive to learning about the method. Multivariate results showed younger clinicians were more likely to offer insertions, and those who received training in residency (OR 1.9***). Only half of clinicians, in accordance with current evidence, considered nulliparous and post-abortion women as appropriate IUC candidates; evidence-based views were associated with more counseling (OR=2.3***) and insertions (OR 1.8***). Accurate knowledge was also associated with counseling (OR 1.9***) and insertions (OR 3.4***), although over 20% attributed hormonal side effects, including headaches and acne, to ParaGard, a non-hormonal method. Prescribing practices reflected erroneous beliefs that IUCs have limited use and are for a small segment of contraceptive clients. Results show the need for provider training on updated IUC insertion guidelines and on important differences between hormonal and non-hormonal devices.

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