Reproductive Health| Volume 28, ISSUE 1, P68-74, January 2018

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Effect of Knowledge of Self-removability of Intrauterine Contraceptives on Uptake, Continuation, and Satisfaction

Published:September 04, 2017DOI:



      Preference for control over use is a consideration in choosing a contraceptive method. Counseling women on the possibility of intrauterine device (IUD) self-removal may increase interest in the method. This study tests whether counseling on self-removability as a stated feature of IUDs affects uptake, satisfaction, and continuation.

      Study Design

      We monitored clinic-level data on IUD uptake at clinics in Michigan, Missouri, New Jersey, and Utah over 6 months. During the first 3 months, counselors provided standard contraceptive counseling. During the second 3 months, they added information about IUD self-removal. Women who initiated IUD use in both periods were recruited and asked to complete baseline and follow up surveys at 3 and 6 months after insertion. Among 361 women who had IUDs inserted during the study, we compared outcomes for women who did and did not receive information about self-removability during contraceptive counseling. We conducted descriptive analyses to test for differences by group and used logistic regression and survival analysis to assess discontinuation.


      There were no differences in IUD uptake, satisfaction, or discontinuation by receipt of self-removal information. Those who did not receive information about self-removal were more likely to report considering discontinuing use of the IUD. One-third of participants who considered discontinuation faced barriers to IUD removal. Knowledge of self-removability before the study was high in both groups, reducing our ability to find group differences.


      Counseling women on the possibility of self-removal may empower women when they face barriers to removal at facilities. More research is needed to understand whether knowledge of self-removal increases uptake and continuation.
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        • Amico J.R.
        • Bennett A.H.
        • Karasz A.
        • Gold M.
        “She just told me to leave it”: Women's experiences discussing early elective IUD removal.
        Contraception. 2016; 94: 357-361
        • Asker C.
        • Stokes-Lampard H.
        • Beavan J.
        • Wilson S.
        What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: A qualitative study.
        Journal of Family Planning and Reproductive Health Care. 2006; 32: 89-94
        • Dehlendorf C.
        • Levy K.
        • Kelley A.
        • Grumbach K.
        • Steinauer J.
        Women's preferences for contraceptive counseling and decision making.
        Contraception. 2013; 88: 250-256
        • Dehlendorf C.
        • Tharayil M.
        • Anderson N.
        • Gbenedio K.
        • Wittman A.
        • Steinauer J.
        Counseling about IUDs: A mixed-methods analysis.
        Perspectives on Sexual and Reproductive Health. 2014; 46: 133-140
        • Foster D.G.
        • Grossman D.
        • Turok D.K.
        • Peipert J.F.
        • Prine L.
        • Schreiber C.A.
        • Schwarz E.B.
        Interest in and experience with IUD self-removal.
        Contraception. 2014; 90: 54-59
        • Foster D.G.
        • Karasek D.
        • Grossman D.
        • Darney P.
        • Schwarz E.B.
        Interest in using intrauterine contraception when the option of self-removal is provided.
        Contraception. 2012; 85: 257-262
        • Gomez A.M.
        • Fuentes L.
        • Allina A.
        Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods.
        Perspectives on Sexual and Reproductive Health. 2014; 46: 171-175
        • Grunloh D.S.
        • Casner T.
        • Secura G.M.
        • Peipert J.F.
        • Madden T.
        Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use.
        Obstetrics & Gynecology. 2013; 122: 1214-1221
        • Hall K.S.
        • Ela E.
        • Zochowski M.K.
        • Caldwell A.
        • Moniz M.
        • McAndrew L.
        • Ernst .S.
        “I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus.
        Contraception. 2016; 93: 556-564
      1. Hatcher, R. A. (2012). Contraceptive technology. 20th Edition (June 10, 2015). Ardentmedia, Inc (first published 1980).

        • Higgins J.A.
        Celebration meets caution: LARC's boons, potential busts, and the benefits of a reproductive justice approach.
        Contraception. 2014; 89: 237-241
        • Higgins J.A.
        • Kramer R.D.
        • Ryder K.M.
        Provider bias in long-acting reversible contraception (LARC) promotion and removal: Perceptions of young adult women.
        American Journal of Public Health. 2016; 106: 1932-1937
        • Jackson A.V.
        • Karasek D.
        • Dehlendorf C.
        • Foster D.G.
        Racial and ethnic differences in women's preferences for features of contraceptive methods.
        Contraception. 2016; 93: 406-411
        • Lessard L.N.
        • Karasek D.
        • Ma S.
        • Darney P.
        • Deardorff J.
        • Lahiff M.
        • Grossman D.
        • Foster D.G.
        Contraceptive features preferred by women at high risk of unintended pregnancy.
        Perspectives on Sexual and Reproductive Health. 2012; 44: 194-200
        • Rubin S.E.
        • Winrob I.
        Urban female family medicine patients' perceptions about intrauterine contraception.
        Journal of Womens Health (Larchmont). 2010; 19: 735-740
        • Sonfield A.
        Popularity disparity: Attitudes about the IUD in Europe and the United States. Guttmacher Policy Review. 10. Guttmacher Institute, New York2007: 19-24
        • Sznajder K.K.
        • Tomaszewski K.S.
        • Burke A.E.
        • Trent M.
        Incidence of discontinuation of long-acting reversible contraception among adolescent and young adult women served by an urban primary care clinic.
        Journal of Pediatric and Adolescent Gynecology. 2017; 30: 53-57
        • Trussell J.
        Contraceptive failure in the United States.
        Contraception. 2011; 83: 397-404


      Sarah Raifman, MSc, is a Project Director at Advancing New Standards in Reproductive Health at the University of California, San Francisco. Her research interests focus on evaluating current reproductive health policies and new models to improve access to abortion and contraception.


      Rana Barar, MPH, is a Project Director at Advancing New Standards in Reproductive Health at the University of California, San Francisco. Her research interests include the effects of unintended pregnancy and abortion on women's lives.


      Diana Foster, PhD, is Director of Research at Advancing New Standards in Reproductive Health at the University of California, San Francisco. Her research evaluates the effectiveness of family planning policies and the effect of unintended pregnancy on women's lives.