title: Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.
abstract: OBJECTIVE
  The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles.
  
  
  METHODS
  We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception.
  
  
  RESULTS
  The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians.
  
  
  CONCLUSIONS
  Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method.
  
  
  METHODS
  III.
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA. harperc@obgyn.ucsf.edu
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Speidel
authors.forename: Eleanor A
authors.initials: EA
authors.lastname: Drey
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
mesh_terms: D000328:Adult; D002140:California; D002983:Clinical Competence; D044363:Contraception, Postcoital; D003625:Data Collection; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000193:education / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007435:Intrauterine Devices, Copper; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009774:Obstetrics / Q000193:education / Q000706:statistics & numerical data; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014932:Women's Health Services / Q000706:statistics & numerical data