Abstract
Objective
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.
Results
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.
Conclusions
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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Biography
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.
Biography
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.
Biography
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.
Article info
Publication history
Published online: September 04, 2017
Accepted:
July 28,
2017
Received in revised form:
July 20,
2017
Received:
January 11,
2017
Footnotes
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.
Identification
Copyright
© 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.
