Long acting contraception provision by rural primary care physicians.
OBJECTIVE
Unplanned pregnancy is a public health problem in the United States, including in rural areas. Primary care physicians are the main providers of health care to women in rural areas and are uniquely positioned to help reduce unplanned pregnancy in rural women. This study documents provision of contraception by rural primary care physicians, focusing on the most effective, long acting methods, intrauterine devices (IUDs) and contraceptive implants.


METHODS
We surveyed all primary care physicians practicing in rural areas of Illinois and Wisconsin. Bivariate analysis was performed using chi squared and Fisher's exact test, and multivariable analysis was performed with logistic regression to determine factors associated with provision.


RESULTS
The response rate was 862 out of 2312 physicians (37%). Nine percent of respondents place implants and 35% place IUDs. Eighty-seven percent of physicians had not had training in implant placement, and 41% had not had training in IUD placement. In multivariable analysis, factors associated with placement of long acting contraception include provision of maternity care, and female gender of the physician. The most common reasons for not providing the methods were lack of training and perceived low demand from patients.


CONCLUSIONS
Many rural primary care providers do not place long acting contraceptive devices due to lack of training. Female physicians and those providing maternity care are the most likely to place these devices. Increased training for primary care physicians both during and after residency would help increase access to these options for women in rural areas.
1 Department of Obstetrics, Gynecology and Reproductive Science , The Icahn School of Medicine at Mount Sinai, New York, New York.
Britt
B
Lunde
Paul
P
Smith
Manpreet
M
Grewal
Tara
T
Kumaraswami
Allison
A
Cowett
Bryna
B
Harwood
D000328:Adult; D001291:Attitude of Health Personnel; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D004343:Drug Implants / Q000008:administration & dosage; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007087:Illinois; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D014922:Wisconsin
D004343:Drug Implants