IUD use in France: women's and physician's perspectives.
OBJECTIVE
While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives.


METHODS
Data are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15-49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010-2011. Analyses were performed using logistic regression models.


RESULTS
Altogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physician's likelihood of recommending IUDs, regardless of specialty.


CONCLUSIONS
The study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France.


CONCLUSIONS
This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health, F-94807 Kremlin Bicêtre, France. Electronic address: cmoreau@jhsph.edu.
Caroline
C
Moreau
Aline
A
Bohet
Danielle
D
Hassoun
Virginie
V
Ringa
Nathalie
N
Bajos
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult
Contraceptive behaviors; Evidenced based medical practices; France; Healthcare professional survey; Intra uterine device; Long acting reversible contraception