title: Strategies for improving the acceptability and acceptance of the copper intrauterine device.
abstract: BACKGROUND
  Intrauterine devices (IUDs) are highly effective and are the most widely used reversible contraceptive method in the world. However, in developed countries IUDs are among the least common methods of contraception used. We evaluated the effect of interventions to increase uptake of the copper IUD, a long-acting, reversible contraceptive method.
  
  
  OBJECTIVE
  To determine effectiveness of interventions to improve uptake and continuation of the copper IUD.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, PsycINFO, PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP) and OpenSIGLE. We also handsearched references of relevant reviews and included studies.
  
  
  METHODS
  We included randomised controlled trials (RCTs) and controlled before and after studies of interventions which measured use and uptake of contraception including copper IUD as an outcome.
  
  
  METHODS
  Two authors independently screened the search results for relevant studies and extracted data from included studies. We used RevMan 5.1 to calculate Peto odd ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes. We conducted meta-analysis by pooling data for similar types of intervention where possible. We used the GRADE system to evaluate the quality of evidence.
  
  
  RESULTS
  Nine studies representing 7960 women met our inclusion criteria, including seven randomised controlled trials and two controlled before and after studies that reported IUD uptake postintervention. We evaluated the quality of evidence as moderate to low. Three studies on contraceptive counselling and referrals by community workers showed an increase in uptake of the IUD among intervention groups (Peto OR 2.00; 95% CI 1.40 to 2.85). Two studies on antenatal contraceptive counselling also favoured the intervention groups (Peto OR 2.33; 95% CI 1.39 to 3.91). One study on postnatal couple contraceptive counselling also showed an increase in IUD uptake compared to control (Peto OR 5.73; 95% CI 3.59 to 9.15). The results of one study evaluating postnatal home visits and two studies on enhanced postabortion contraceptive counselling did not reach statistical significance.
  
  
  CONCLUSIONS
  Community-based interventions and antenatal contraceptive counselling improved uptake of copper IUD contraception. Since the copper IUD is one of the most effective reversible contraceptive methods, primary care and family planning and practitioners could consider adopting these interventions. Although our review suggests these interventions are clinically effective, a cost-benefit analysis may be required to evaluate applicability.
authors.affiliation: 1Department of Primary Care and Public Health, Imperial College London, London, UK. 2University College London, Centre forSexual Health & HIV Research, London, UK. emma.arrowsmith08@imperial.ac.uk.
authors.forename: Myat E
authors.initials: ME
authors.lastname: Arrowsmith
authors.forename: Catherine R H
authors.initials: CR
authors.lastname: Aicken
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D003153:Community Health Services / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic