Continuation of copper-containing intrauterine devices at 6 months.
BACKGROUND
Intrauterine devices (IUDs) are highly effective at preventing pregnancy and cost-effective. Suboptimal continuation of IUDs places women at risk of unintended pregnancy. Little is known about prevalence or predictors of discontinuation of IUDs within the first 6 months.


METHODS
A retrospective cohort analysis was conducted among 306 family planning patients who had a CuT380A IUD inserted from November 2008-August 2011. Rates of continuation among 283 users were calculated using survival analyses, and predictors of removal within 6 months of insertion were assessed using logistic regression.


RESULTS
Among 306 IUD insertions, 13 (4.2%) full or partial expulsions occurred within the first 6 months: 9 (10.7%) among nulliparous and 4 (2.0%) among parous women (chi-square, p<.001). In the first 6 months, four (1.3%) pregnancies occurred among women without prior removal or expulsion of the device (unadjusted Pearl Index: 2.61 per 100 woman-years at 6 months), all among parous women. Of 283 women in continuation analyses, 26% were under 20 years old and 29% nulliparous. Most (84%) received health education specific to IUDs before insertion. Overall, 11% had their IUD removed within 6 months of insertion. In an adjusted logistic regression model, women who did not receive health education were significantly more likely (Adjusted Odds Ratio=3.37, 95% confidence interval: 1.35-8.39) to have a removal within 6 months, but no significant association was found for age, race/ethnicity or parity.


CONCLUSIONS
Early discontinuation of IUDs was prevalent but lower among women who received method-specific health education.
Public Health Solutions, New York, NY 10013, USA. sgarbers@healthsolutions.org
Samantha
S
Garbers
Jessica
J
Haines-Stephan
Yael
Y
Lipton
Allison
A
Meserve
Leah
L
Spieler
Mary Ann
MA
Chiasson
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D012189:Retrospective Studies; D055815:Young Adult