US family physicians miss opportunities to discuss IUDs with patients

Intrauterine devices (IUDs) for contraception are safe and effective, but only a small fraction of women in the United States use them.

Now, a national survey of family physicians conducted by researchers at Albert Einstein College of Medicine of Yeshiva University, has found that family physicians typically have gaps in knowledge about IUDs, are often uncomfortable discussing them with patients, and frequently believe that their patients would not be receptive to talking about IUDs. The findings are published in the December 3 online issue of Contraception.

IUDs have a notable advantage over some other, more commonly used contraceptives. They are user-independent – meaning once inserted, they don't require action by the user to be effective. By removing the chance for human error (for example, forgetting to take a birth control pill or incorrectly using a barrier method), IUDs are often more effective in real-world conditions than more popular alternatives.

"IUDs only account for 5 percent of contraception used by women in the U.S., compared with approximately 15 percent worldwide," noted Susan Rubin, M.D., assistant professor of family and social medicine at Einstein and the paper's lead author. "While we acknowledge that a number of factors contribute to the low utilization of IUDs in the U.S., our study set out to determine what factors differentiate those family physicians who insert IUDs in their clinical practice versus those who don't." Family medicine is important to the issue since about one in four U.S. women seeking private family planning care turn to a family physician. Additionally, another national survey of family physicians reported that 99 percent dispense, prescribe or recommend oral contraceptives – but only 39 percent do so with IUDs.

The researchers sent surveys to 3,500 family physicians and received 973 back, of which 869 were validly completed and used for analysis. They categorized the physicians into "inserters" (those who had inserted an IUD in the past 12 months), and "non-inserters" (those who had not). Only 24 percent of responders were categorized as "inserters."

Both inserters and non-inserters were found to have a positive attitude toward IUD safety and efficacy. However, 96 percent of inserters said they felt comfortable discussing IUD use with their patients compared with 79 percent of non-inserters. In addition, 89 percent of inserters believed their patients are receptive to discussing IUDs compared with only 55 percent of non-inserters – a nearly 35 percent difference. Inserters were also more knowledgeable about the devices, correctly answering four questions about IUDs more frequently than non-inserters.

Finally, inserters were found to have performed significantly more IUD insertions during their residencies than did non-inserters. "If educational practices are changed to increase the frequency of insertions learned during residency, this could increase the proportion of family physicians in practice who actually offer IUDs for their patients, thus potentially increasing the use of this effective contraceptive method," said Dr. Rubin.