Low IUC insertion rates: Role of providers' candidate selection

Intrauterine contraception (IUC) offers women convenient, highly effective, and reversible contraception. However, IUC insertion rates at Family PACT, California's publicly funded family planning program, are under 2% annually. We reviewed 240 randomly selected medical charts of IUC insertion visits to Family PACT clients occurring in 2005 to assess whether providers' IUC candidate eligibility criteria might limit the candidate pool and hence women's access to this contraceptive method. Demographic variables and medical history of women receiving IUC insertions differed considerably from the general female Family PACT population. Women who received IUCs were primarily Latina (78%). The average age of women who received an IUC insertion was 28.5 years, higher than the average age of female Family PACT clients (26.5 years). The proportion of women receiving an IUC who were younger than age 20 years was low (6%). Only a small number of women receiving an IUC were nulliparous (8%) and the remainder had either one child (23%) or two or more children (69%). Only 2% of women had a history of an STI, suggesting that clinicians refrained from recommending IUC insertions to women with an STI history. These data suggest that providers seem to have unnecessarily conservative eligibility criteria for IUC which discourages wider promotion of IUC utilization. Provider education encouraging insertion in nulliparous women, adolescent females, and women with past history of an STI might increase IUC insertion rates. These 2005 baseline data will help to evaluate Family PACT interventions implemented as a result of these findings.