Abstract
Background
Provider training in intrauterine device (IUD) procedures is a key strategy for improving
evidence-based IUD care. We examined the influence of IUD training on IUD attitudes
and practices among U.S. family planning providers.
Methods
In 2019, we conducted a cross-sectional survey of U.S. family planning providers.
We performed logistic regression to examine associations between training in routine
IUD placement and specific IUD safety attitudes, confidence performing IUD procedures,
and specific IUD practices.
Results
Among 1,063 physicians and advanced practice clinicians, 85.1% reported training in
routine IUD placement. Overall, IUD training was associated with accurately stating
IUDs are safe for queried groups, including patients immediately postpartum (prevalence
ratio [PR] 4.22; 95% confidence interval [CI] 1.29–13.85). Trained providers reported
higher confidence in routine IUD placement for parous (PR 7.71; 95% CI 1.31–45.3)
and nulliparous (PR 7.12; 95% CI 1.17–43.5) women and in IUD removal (PR 2.06; 95%
CI 1.12–3.81). Among providers with IUDs available onsite, IUD training was associated
with frequent same-day IUD provision for adults (PR 7.32; 95% CI 2.16–24.79) and adolescents
(PR 7.63; 95% CI 2.22–26.24). Trained providers were also less likely to routinely
use misoprostol before IUD placement for nulliparous (PR 0.19; 95% CI 0.11–0.33) and
parous women (PR 0.07; 95% CI 0.03–0.16).
Conclusion
Training in routine IUD placement was associated with evidence-based IUD safety attitudes,
confidence in performing IUD procedures, and clinical practices aligned with Centers
for Disease Control and Prevention contraception guidance. Expanding IUD training
might increase evidence-based care and patient access to the full range of contraception,
including IUDs.
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Biography
Jennifer A. Reeves, MD, MPH, is an obstetrician-gynecologist, who specializes in Complex Family Planning, and a guest researcher with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include contraceptive access and abortion surveillance.
Biography
Lauren B. Zapata, PhD, is an Epidemiologist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. She is also a Commander in the United States Public Health Service. Her research interests include improving access to quality family planning services and promoting maternal and child health.
Biography
Kathryn M. Curtis, PhD, is a Health Scientist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her main areas of research include contraceptive safety, effectiveness, and guidelines development.
Biography
Maura K. Whiteman, PhD, is an Epidemiologist with the Division of Reproductive Health at the Centers for Disease Control and Prevention. Her research interests include contraceptive safety, prevention of unintended and teen pregnancy, and improving access to quality family planning services.
Article info
Publication history
Published online: September 18, 2022
Accepted:
August 9,
2022
Received in revised form:
July 18,
2022
Received:
August 10,
2021
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no competing or personal financial interests to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
