IUD Use in Adolescents: Contradictions between Provider Knowledge and Likelihood to Recommend

Intrauterine devices (IUDs) are safe and highly effective contraceptives for adolescents as recommended by ACOG and WHO. Nevertheless, many U.S. providers do not recommend or provide IUDs to adolescents—a population at high risk of unintended pregnancy. Little is known about barriers to provision. A 36-item self-administered survey of knowledge and attitudes regarding IUDs was completed by 162 school-based healthcare providers in New York City, including 77 clinicians and 85 non-clinicians (e.g., social workers, health educators). Respondents averaged 41 years of age, and 91% were female. Among respondents, misconceptions included 48% incorrectly reporting that IUDs increase the long-term risk of pelvic inflammatory disease and 22% that IUDs increase the risk of infertility. Whereas 77% responded that IUDs are safe for teens, 26% would be unlikely to recommend an IUD to a patient under age 20. While 86% knew that IUDs can be used in nulliparous women, 29% would be unlikely to recommend an IUD to a patient who has never been pregnant. Furthermore, 61% of respondents believed that counseling patients about IUDs would take more time than other methods. On a 7-point scale, clinicians had significantly greater overall knowledge about IUDs than non-clinicians (5.5 vs. 4.9). Clinicians were more likely to report that they would recommend IUDs to adolescents (65% vs. 47%). Misinformation about the risks associated with IUDs and the belief that counseling about IUDs will take more time than other methods may present barriers to provision. Apparent contradictions between knowledge and likelihood to recommend IUDs warrant further study.