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.
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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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.
Published online: September 04, 2017
Accepted: July 28, 2017
Received in revised form: July 20, 2017
Received: January 11, 2017
Funding Statement: This work was supported by The William and Flora Hewlett Foundation [grant #2012–7378].
Conflicts of Interest: The authors have no conflicts of interest to disclose.
© 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.