title: A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women.
abstract: OBJECTIVE
  Intrauterine contracepives (IUCs) are highly effective and safe for use in all women, including those who are nulliparous. However, many myths and barriers prevent more widespread utilisation. The objective of this article was to explore the health care provider (HCP), health system and user issues that prevent more widespread use of IUCs, particularly among nulliparous women, and to present the evidence that supports achieving greater utilisation of these devices.
  
  
  METHODS
  MEDLINE, PubMed and Embase were used to identify studies reporting attitudes and beliefs around IUCs, and clinical studies providing evidence of their risks and benefits.
  
  
  RESULTS
  HCP, health system and user factors limiting use of IUCs were identified. The most widely explored barriers in published studies are those at the HCP level. User barriers are less well documented and health system barriers are mostly assessed through indirect evidence. Many, but not all, of the barriers can be reduced through greater understanding of the evidence.
  
  
  CONCLUSIONS
  Efforts need to be made to disseminate the evidence, which shows that few contraindications exist to IUC use. Addressing HCP lack of knowledge, training and confidence with IUC insertions, particularly in nulliparous women, could make a substantial positive impact on IUC utilisation.
authors: Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, Australia.
authors: Kirsten
authors: K
authors: Black
authors: Pamela
authors: P
authors: Lotke
authors: Kai J
authors: KJ
authors: Buhling
authors: Nikki B
authors: NB
authors: Zite
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D009229:Mythology; D010298:Parity; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D000078329:Workforce
chemical_list: D003271:Contraceptive Agents, Female