title: Temporal and regional trends in IUD insertion: a population-based study in Ontario, Canada.
abstract: BACKGROUND
  Intrauterine device (IUD) use is low in Canada and declined between 1985 and 1995. This study examines temporal and regional trends in IUD insertion in Ontario, Canada, from 1996 to 2006.
  
  
  METHODS
  We used physician billing data to determine annual age-adjusted IUD insertion rates for women aged 15-55 years and proportions inserted by gynecologists and family physicians (FPs). We used small area variation statistics to analyze variation in rates across the province.
  
  
  RESULTS
  Annual insertion rates followed a U-shaped distribution and were lowest in 2001 and highest in 2006. From 1996 to 2006, the proportion inserted by FPs fell from 38.2% to 31.6% (p<.001). In 2006, women in regions with the highest rates were twice as likely to have an IUD inserted as those in the lowest-rate regions.
  
  
  CONCLUSIONS
  IUD insertion rates began to increase in 2001, the year of introduction of the levonorgestrel-releasing intrauterine system. Regional variation in rates suggests that access is not equal across the province and that strategies to support FPs to insert IUDs may be important to ensure adequate access.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada. sheila.dunn@wchospital.ca
authors.forename: Sheila
authors.initials: S
authors.lastname: Dunn
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009313:National Health Programs; D009864:Ontario; D017062:Small-Area Analysis; D055815:Young Adult