Objective To assess the proportion of Washington state clinics that offer the copper IUD in rural vs urban settings. Study design We employed a simulated patient model to survey clinics in the Human Health Resources and Services Administration 340B database to primarily assess the availability of the copper IUD. Results We successfully surveyed 194/212 (92%) clinics. More urban than rural clinics reported copper IUD availability (76/97 [78%] vs 49/97 [51%]; p < 0.01). Conclusions Rural clinics are less likely than urban clinics to have the copper IUD available. Implications The frequency of unintended pregnancies is high in the United States. We should focus our attention on decreasing barriers to the copper IUD as a long-acting reversible contraceptive, particularly for women living in rural settings.

INTRODUCTION: The copper IUD is the only highly effective non-hormonal method of contraception. It is also the most effective form of emergency contraception (EC), when placed within 5 days of unprotected intercourse, and is the only method of EC that provides ongoing contraception. For these reasons, local availability of the copper IUD to women is essential. METHODS: A mystery caller model was employed with a single caller making inquiries to urban and rural clinics in Washington state over a two-month period regarding availability of copper IUDs using a standardized script. Clinic types included OB/GYN, primary care, family planning and multispecialty. Clinics were identified using the HRSA 340B database, with allocation as urban vs rural based on the Office of Management and Budget county designations. The primary outcome was the reported availability of the copper IUD. Secondary outcomes included ability to schedule an appointment for copper IUD placement within 5 days. RESULTS: A total of 97 urban and 97 rural clinics were included in the analysis. A greater proportion of urban clinics reported availability of copper IUDs than rural clinics (78 vs 50%; p <0.001). Only 19 urban clinics and 10 rural clinics were able to schedule an appointment for copper IUD placement within the 5 day window needed for EC use (19 vs 10%, p = 0.07). CONCLUSION: Rural clinics are less likely to have copper IUDs available, even when clinic type is taken into account. Efforts are needed to increase availability of this method, particularly in rural areas.