Perceived contraindications to IUD and implant use among family planning providers: Misalignment with ACOG guidelines and implications for training

In 2010, 159 clinicians in 47 family planning agencies across Colorado and Iowa were surveyed as part of statewide initiatives to reduce unintended pregnancy. The initiatives particularly focused on the promotion of intrauterine devices and implants. Surveys of these physicians, physicians' assistants, nurse practitioners, certified nurse midwives, and registered nurses, asked if they considered intrauterine devices and implants safe and reliable for various groups of women. The resultant data are compared with guidelines for use of these methods provided in July of 2011 by the American College of Obstetrics and Gynecology (ACOG). Specifically, these clinicians' views are not entirely in alignment with ACOG recommendations, particularly in their beliefs that these methods should not be used immediately post-partum or post-abortion or when there are issues of menorrhagia or dysmenorrhea. Notable percentages of these clinicians were also hesitant to recommend these effective methods for other groups of patients, approved for use by ACOG. While it has been repeatedly recognized that the cost of these methods is a barrier to their adoption, these data suggest that there are continuing provider barriers to their use as well. The paper concludes with suggestions of specific topics that might be included in professional and in-service training for family planning providers.