Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion.
BACKGROUND
We hypothesize that barriers to IUD insertion are central to low utilization in the USA. This study evaluates methods to minimize barriers, including post-abortal insertion, staff training and simplified screening.


METHODS
We obtained data on IUD utilization during three study periods: a control period (Period 1), a period after initiating post-abortal insertion and staff training (Period 2), and a period with these interventions plus simplified screening for interval insertions (Period 3). We evaluated IUD utilization, associated complications and utilization at a similar local agency in which the interventions were not implemented.


RESULTS
We inserted 2172 IUDs during the study, including 1493 interval and 679 post-abortal insertions. In the control period, there were 28 monthly IUD insertions on average, compared to 71 (a 151% increase) and 122 (a 334% increase) in Periods 2 and 3, respectively. IUD utilization at the nearby agency remained relatively constant. Complications remained low.


CONCLUSIONS
IUD utilization can be substantially increased through relatively simple, low-cost interventions, with significant potential to reduce unintended pregnancy.
Goodman
Suzan
S
University of California, San Francisco, San Francisco, CA 94110, USA. goodmanmd1@aol.com
Hendlish
Sarah K
SK
Benedict
Courtney
C
Reeves
Matthew F
MF
Pera-Floyd
Madeline
M
Foster-Rosales
Anne
A
D000032:Abortion, Therapeutic; D000328:Adult; D000075202:Contraindications; D005193:Family Planning Services / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007318:Inservice Training; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy