A missed opportunity for care: two-visit IUD insertion protocols inhibit placement

Bergin, A.; Tristan, Sigrid; Terplan, Mishka; Gilliam, Melissa; Whitaker, Amy K.

doi:10.1016/j.contraception.2012.05.011

Cited by 103 publications

(75 citation statements)

References 15 publications

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“…The Brazilian Unified Health System (SUS -Sistema Único de Saúde) provides several types of contraceptive methods, including long-term reversible ones, such as the copper Intrauterine Device (IUD). It is a safe, highly effective method with extremely low failure rates similar to those observed in female surgical sterilization (0.5%) (2)(3)(4) . It is the most widely used reversible method on the planet (1,5) but remains underutilized in some regions of the world (North America, South Asia, Oceania, sub-Saharan Africa (6)(7) and Latin America) (8) .…”

Section: Introductionmentioning

confidence: 99%

“…The organization of contraceptive care should be given initially by the UBS -and the placement of the IUD is a fully practicable procedure at the primary level of care (3) . It must be acknowledged that its availability, when it occurs anywhere other than where is close to women's homes, can be a barrier to access, as distance and bureaucracy are considered as obstacles (2) .…”

Section: Criteria For Iud Availabilitymentioning

confidence: 99%

“…It is important to note that until the date of the subsequent IUD insertion consultation, a woman may become pregnant or may encounter a number of difficulties that make it impossible for her to return. Studies have shown that insertion of the IUD should occur during the consultation itself, since several return visits to obtain the IUD may decrease the chances of adherence to the method (2) . In addition to prior scheduling, another important barrier that contributes to the difficulty of IUD insertion is the average waiting time for the woman to have the contraceptive inserted -which has exceeded 1 month in more than one third of the municipalities evaluated in the research.…”

Section: Organizational Barriers Associated With Iud Insertionmentioning

confidence: 99%

“…On the other hand, among the individual barriers, the low level of knowledge of the women and the couples about the method stand out; myths and taboos about the IUD, such as belief in the possibility of causing cancer, cause abortions and being ineffective; fear of side effects, such as increased menstrual flow, both in number of days and in volume; and belief that it is not appropriate for nulliparous women, young or single women (2,(13)(14)(15)(16)(17)(18) . Both barriers are experienced in Brazilian Primary Health Care (PHC) (12) and prevent full access to the IUD, contributing to the low frequency of its use and constituting a barrier to the full exercise of sexual and reproductive rights (12) .…”

Section: Introductionmentioning

confidence: 99%

“…Organizational barriers to IUD access are considered unnecessary criteria for their insertion, such as conditioning to participation in educational groups; the insufficient and discontinued supply of the method; inadequate knowledge of health professionals about their mechanisms of action; the lack of qualified professionals -added to the exclusivity of the medical professional for their insertion; and, finally, the absence of simplified protocols (2,(11)(12)(13) . On the other hand, among the individual barriers, the low level of knowledge of the women and the couples about the method stand out; myths and taboos about the IUD, such as belief in the possibility of causing cancer, cause abortions and being ineffective; fear of side effects, such as increased menstrual flow, both in number of days and in volume; and belief that it is not appropriate for nulliparous women, young or single women (2,(13)(14)(15)(16)(17)(18) .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Barreiras organizacionais para disponibilização e inserção do dispositivo intrauterino nos serviços de atenção básica à saúde

Gonzaga

Borges

Santos

et al. 2017

Rev. esc. enferm. USP

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Objective: To identify organizational barriers to IUD availability in Primary HealthCare services from the perspective of women's health coordinators. Method: This is a quantitative study carried out with women's health officials from the municipalities of the southern macro region of Minas Gerais, Brazil, with an on-line completion of a structured instrument and a descriptive data analysis. Results: 79 technicians participated in the study. Among the municipalities, 15.2% do not provide IUDs and 8.3% do not refer women to other services, 53.7% do not provide IUDs at basic health units. Among those who provide the IUD, 68.7% do not have a specific protocol and 10.5% do not adopt pregnancy as a condition that makes it impossible to insert the IUD, and 80.6% adopt unnecessary conditions, such as vaginal infection. As a criterion for IUD access, 86.5% referred to a medical prescription, 71.6% required exams, 44.6% were over 18 years of age and 24.4% participation in groups, none based on scientific evidence. Only the doctor inserted the IUD. Conclusion: Problems in the access to the IUD were identified due to organizational barriers to its availability and insertion, such as the lack of availability of the method or the excess of unnecessary criteria to make it available.

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Section: Introductionmentioning

confidence: 99%

Section: Criteria For Iud Availabilitymentioning

confidence: 99%

Section: Organizational Barriers Associated With Iud Insertionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Barreiras organizacionais para disponibilização e inserção do dispositivo intrauterino nos serviços de atenção básica à saúde

Gonzaga

Borges

Santos

et al. 2017

Rev. esc. enferm. USP

View full text Add to dashboard Cite

show abstract

Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents

2019

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Key PointsQuestionWhat are the cost savings, from the payer’s (insurance) perspective, associated with providing same-day access to long-acting reversible contraception (LARC) for adolescents?FindingsIn this economic evaluation, same-day LARC placement was associated with overall lower costs ($2016 per patient over 1 year) compared with placement at a subsequent visit ($4133 per patient over 1 year). In addition, numbers of unintended pregnancies and abortions decreased in association with providing same-day LARC placement.MeaningThe findings suggest that providing same-day LARC placement may save payers money by preventing unintended pregnancy, and efforts to make this model of care feasible in all clinical settings should be undertaken.

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Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Hale,

Lee,

de Jong

et al. 2024

JAMA Netw Open

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ImportanceEvaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice.ObjectiveTo examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative.Design, Setting, and ParticipantsIn this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024.ExposureThe South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state.Main Outcomes and MeasuresChanges in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021).ResultsA total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama.Conclusions and RelevanceIn this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

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A missed opportunity for care: two-visit IUD insertion protocols inhibit placement

Cited by 103 publications

References 15 publications

Barreiras organizacionais para disponibilização e inserção do dispositivo intrauterino nos serviços de atenção básica à saúde

Barreiras organizacionais para disponibilização e inserção do dispositivo intrauterino nos serviços de atenção básica à saúde

Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

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