title: Non-physician insertion of IUDs: clinical outcomes among TCu380A insertions in three developing-country clinics.
abstract: Insertion of IUDs by trained non-physicians is increasing. This secondary analysis of TCu380A IUD acceptors collected at clinics in Nigeria, Turkey and Mexico involved 367 women; 193 insertions were performed by physicians and 174 by non-physicians. Women having their IUD inserted by a non-physician were more likely to experience a pain-free insertion, but also likelier to have the IUD removed for bleeding and pain or to experience an expulsion than women who had their IUD inserted by a physician. Early discontinuation rates were similar between the two groups. Overall continuation rates were statistically higher for IUDs inserted by physicians only at the Mexico site. Trained non-physicians can probably safely insert the TCu380A IUD. Appropriate competency-based training is required to limit the number of expulsions and removals for bleeding and pain by non-physicians.
authors.affiliation: Family Health International, Research Triangle Park, NC 27709, USA.
authors.forename: G
authors.initials: G
authors.lastname: Farr
authors.forename: R
authors.initials: R
authors.lastname: Rivera
authors.forename: R
authors.initials: R
authors.lastname: Amatya
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education / Q000592:standards; D002584:Cervix Uteri / Q000293:injuries; D015331:Cohort Studies; D003267:Contraception / Q000009:adverse effects* / Q000379:methods; D003906:Developing Countries; D005260:Female; D052776:Female Urogenital Diseases / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007435:Intrauterine Devices, Copper / Q000009:adverse effects* / Q000706:statistics & numerical data; D015993:Life Tables; D008599:Menstruation Disturbances / Q000453:epidemiology / Q000209:etiology; D008800:Mexico / Q000453:epidemiology; D009549:Nigeria / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010352:Patient Dropouts / Q000706:statistics & numerical data; D015995:Prevalence; D014421:Turkey / Q000453:epidemiology