title: Global survey of healthcare practitioners' beliefs and practices around intrauterine contraceptive method use in nulliparous women.
abstract: BACKGROUND
  Despite the efficacy and safety of intrauterine contraceptive methods (IUCs), healthcare providers (HCPs) are sometimes reluctant to recommend their use, particularly in nulliparous women. This study sought to understand the global practitioner perceived impediments to IUC provision.
  
  
  METHODS
  We developed an online survey for HCPs administered across 4 regions comprising 15 countries. We sought their attitudes to IUC provision; their perceived barriers to IUC use, particularly in nulliparous women; as well as their knowledge of the World Health Organization Medical Eligibility Criteria (WHO MEC) for contraceptive use.
  
  
  RESULTS
  We received 1862 responses from HCPs in 15 countries grouped into 4 regions, with an average country response rate of 18%. For analysis, the results were grouped into these regions: Latin America, 402 (21.6%); USA, 156 (8.4%); Europe and Canada, 1103 (59.2%); and Australia, 201 (10.8%). The two most frequently identified perceived barriers to IUC use in nulliparous women were difficulty of insertion (56.6%) and pelvic inflammatory disease (PID) (49.2%), but responses differed by region and HCP type. Only 49.7% recognized the correct WHO MEC category for IUC use in nulliparous women.
  
  
  CONCLUSIONS
  The results of this survey confirm that, across the four regions, the two main barriers to IUC provision for nulliparous women are concern about the difficulty of insertion and PID. Providers' knowledge of the WHO MEC was lacking universally. A global effort is required to improve understanding of the evidence and knowledge of available guidelines for IUC use.
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Central Clinical School, Camperdown, Sydney, NSW 2050, Australia. Electronic address: kirsten.black@sydney.edu.au.
authors.forename: Kirsten I
authors.initials: KI
authors.lastname: Black
authors.forename: Pamela
authors.initials: P
authors.lastname: Lotke
authors.forename: Josefina
authors.initials: J
authors.lastname: Lira
authors.forename: Tina
authors.initials: T
authors.lastname: Peers
authors.forename: Nikki B
authors.initials: NB
authors.lastname: Zite
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005193:Family Planning Services / Q000193:education; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology; D020407:Internet; D007434:Intrauterine Devices / Q000009:adverse effects*; D008297:Male; D008880:Midwifery; D009726:Nurses; D010298:Parity; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D010820:Physicians; D017410:Practice Guidelines as Topic; D012306:Risk; D000078329:Workforce; D014944:World Health Organization
keywords: Healthcare practitioners; Intrauterine contraception; Intrauterine device; Knowledge; Nulliparous