Background: The modern intrauterine device (IUD) is safe, effective and used by 12% of married women worldwide. In America, only 0.8% of contracepting women use the IUD. Reproductive health experts propose that lack of training, fear of litigation, and belief that the IUD causes PID are key reasons for physicians' reluctance to recommend the IUD.
Methods: We performed a national mailed survey of 400 practicing obstetrician-gynecologists to assess their use of and attitudes toward the IUD, their selection of IUD candidates, and to test hypotheses about why it is underused.
Results: Most (80%) obstetrician-gynecologists reported inserting IUDs, but most reported inserting 10 or less in the last year. The large majority agreed that the modern copper IUD is safe (97%) and effective (95%). Respondents were most conservative about patient monogamy when selecting IUD candidates. The number of IUDs inserted during residency was not associated with IUD use in practice. Fear of litigation and a belief in a causal relationship between the IUD and PID were associated with lower IUD use in practice. Having less conservative criteria for selecting IUD candidates was associated with higher IUD use.
Conclusions: Since most obstetrician-gynecologists are inserting low numbers of IUD, educational programs should target this majority to expand their IUD use. Such programs should highlight the evidence for IUD safety and the rarity of litigation. The number of IUDs inserted in residency may be less important than the development of less conservative, evidence-based criteria for selecting IUD candidates.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1. Describe obstetrician-gynecologists' reported use of the IUD in practice and their attitudes toward it. 2. Discuss three reasons for underuse of the IUD in America. 3. Develop educational programs to promote IUD use.
Keywords: Contraception, Reproductive Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.