Impact of Years of Clinical Experience on Perceived Contraindications and Barriers to the Use of LARC: A Survey of Family Planning Providers



      Despite their efficacy in preventing unintended pregnancies, intrauterine devices (IUDs) are still relatively underutilized by American women. Although cost of these methods is clearly a barrier to use, IUDs have had a long and sometimes controversial history, and earlier versions were removed from the market.


      This study explores the degree to which the length of licensure for providers is related to their attitudes toward or fears about these methods. Data come from a 2012 survey of 114 clinicians in Colorado and Iowa, collected as part of two, statewide initiatives to reduce unintended pregnancy. Providers were asked about service barriers to prescribing these methods and for which patients they perceived them to be suitable and safe.


      The most experienced clinicians were the least concerned about uterine perforation and history of the Dalkon Shield, but were more likely to fear a lawsuit over complications. More experienced clinicians were also less approving of Copper T IUDs for all 11 subgroups of women, including nulliparous women and those with histories of sexually transmitted infections. They were also less approving of hormonal IUDs for 10 groups of women, including those with histories of ectopic pregnancies. However, clinicians with the most recent licensure were more conservative in their approval of single rod implants than were the providers with the most years since licensure.


      This paper explores potential reasons for these findings and suggests trainings to recognize and overcome these barriers so as to promote consistent and accurate practice across clinicians, regardless of years of experience.
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        • Bartz D.
        • Tang J.
        • Maure R.
        • Janiak E.
        Medical student intrauterine device knowledge and attitudes: An assessment of clerkship training.
        Contraception. 2013; 88: 257-262
        • Diaz V.A.
        • Hughes N.
        • Dickerson L.M.
        • Wessell A.M.
        • Carek P.J.
        Clinician knowledge about use of intrauterine devices in adolescents in South Carolina AHEC.
        Family Medicine. 2011; 3: 407-411
        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspectives on Sexual and Reproductive Health. 2006; 38: 90-96
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the U.S., 2007-2009.
        Fertility and Sterility. 2012; 98: 893-897
        • Goodman S.
        • Shih G.
        • Hawkins M.
        • Feierabend S.
        • Lossy P.
        • Waxman N.J.
        • et al.
        A long-term evaluation of a required reproductive health training rotation with opt-out provisions for family medicine residents.
        Family Medicine. 2013; 45: 180-186
        • Harper C.C.
        • Blum M.
        • De Bocanegra H.T.
        • Darney P.D.
        • Speidel J.J.
        • Policar M.
        • et al.
        Challenges in translating evidence to practice: The provision of intrauterine contraception.
        Obstetrics and Gynecology. 2008; 111: 1359-1369
        • Harper C.C.
        • Henderson J.T.
        • Raine T.R.
        • Goodman S.
        • Darney P.D.
        • Thompson K.M.
        • et al.
        Evidence-based IUD practice: Family physicians and obstetrician-gynecologists.
        Family Medicine. 2012; 44: 637-645
        • Hubacher D.
        The checkered history and bright future of intrauterine contraception in the United States.
        Perspectives on Sexual and Reproductive Health. 2002; 34: 98-103
        • Peipert J.F.
        • Madden T.
        • Allsworth J.
        • Secura G.
        Preventing unintended pregnancies by providing no-cost contraception.
        Obstetrics & Gynecology. 2012; 120: 1291-1297
        • Russo J.A.
        • Miller E.
        • Gold M.A.
        Myths and misconceptions about long-acting reversible contraception (LARC).
        Journal of Adolescent Health. 2013; 52: S14-21
        • Sonfield A.
        Popularity disparity: Attitudes about the IUD in Europe and the United States.
        Guttmacher Policy Review. 2007; 10
        • Spinelli A.
        • Talamanca I.F.
        • Lauria L.
        • The European Study Group on Infertility and Subfecundity
        Patterns of contraceptive use in 5 European countries.
        American Journal of Public Health. 2000; 90: 1403-1408
        • Steinauer J.E.
        • DePineres T.
        • Robert A.M.
        • Westfall J.
        • Darney P.
        Training family practice residents in abortion and other reproductive health care: A nationwide survey.
        Family Planning Perspectives. 1997; 29: 222-227
        • Tang J.
        • Maurer R.
        • Bartz D.
        Intrauterine device knowledge and practices: A national survey of obstetrics and gynecology residents.
        Southern Medical Journal. 2013; 106: 500-505
        • Tyler C.P.
        • Whiteman M.K.
        • Zapata L.B.
        • Curtis K.M.
        • Hillis S.D.
        • Marchbanks P.A.
        Health care provider attitudes and practices related to intrauterine devices for nulliparous women.
        Obstetrics & Gynecology. 2012; 119: 762-771
        • United Nations Department of Economic and Social Information and Policy Analysis
        World contraceptive use 2011.
        United Nations, New York2011


      Ashley E. Philliber, MS, has a Master's in Human Services and is an Evaluation Coordinator at Philliber Research Associates. She has worked on a wide variety of programs, including those in unplanned and teen pregnancy prevention, journalism, employment, and community engagement.


      Heather Hirsch, MS, has a Master's of Science in Criminal Justice and is an Evaluation Coordinator at Philliber Research Associates.


      Louis Mortillaro, MA, has a Master's of Arts in Sociology and is support staff at Philliber Research Associates.


      Rita Turner, MS, has a Master's of Science in Educational Administration and is an Analyst at Philliber Research Associates.


      Abigail Arons, MPH, is a Senior Research Associate for the Bixby Center for Global Reproductive Health and has an Master's in Public Health.


      Susan Philliber, PhD, one of the founders and senior partners of Philliber Research Associates, has more than 30 years of experience in evaluation and basic research. She has her PhD in sociology and demography.