title: Obstetrician-gynecologists and contraception: long-acting reversible contraception practices and education.
abstract: OBJECTIVE
  Long-acting reversible contraception (LARC) - the copper and levonorgestrel intrauterine devices (IUDs) and the single-rod implant - are safe and effective but account for a small proportion of contraceptive use by US women. This study examined obstetrician-gynecologists' knowledge, training, practice and beliefs regarding LARC methods.
  
  
  METHODS
  A survey questionnaire was mailed to 3000 Fellows of the American College of Obstetricians and Gynecologists. After exclusions, 1221 eligible questionnaires were analyzed (45.8% response rate, accounting for exclusions).
  
  
  RESULTS
  Almost all obstetrician-gynecologists reported providing IUDs (95.8%). Most obstetrician-gynecologists reported requiring two or more visits for IUD insertion (86.9%). Respondents that reported IUD insertion in a single visit reported inserting a greater number of IUDs in the last year. About half reported offering the single-rod implant (51.3%). A total of 92.0% reported residency training on IUDs, and 50.8% reported residency training on implants. Residency training and physician age correlated with the number of IUDs inserted in the past year. A total of 59.6% indicated receiving continuing education on at least one LARC method in the past 2years. Recent continuing education was most strongly associated with implant insertion, and 31.7% of respondents cited lack of insertion training as a barrier.
  
  
  CONCLUSIONS
  Barriers to LARC provision could be reduced if more obstetrician-gynecologists received implant training and provided same-day IUD insertion. Continuing education will likely increase implant provision.
  
  
  CONCLUSIONS
  This study shows that obstetrician-gynecologists generally offer IUDs, but fewer offer the single-rod contraceptive implant. Recent continuing education strongly predicted whether obstetrician-gynecologists inserted implants and was also associated with other practices that encourage LARC use.
authors.affiliation: Long-Acting Reversible Contraception Program, The American College of Obstetricians and Gynecologists, Washington, DC. Electronic address: aluchowski@acog.org.
authors.forename: Alicia T
authors.initials: AT
authors.lastname: Luchowski
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, Washington, DC.
authors.forename: Britta L
authors.initials: BL
authors.lastname: Anderson
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, Washington, DC.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Power
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, Washington, DC.
authors.forename: Greta B
authors.initials: GB
authors.lastname: Raglan
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.
authors.forename: Eve
authors.initials: E
authors.lastname: Espey
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, Washington, DC; Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, WA.
authors.forename: Jay
authors.initials: J
authors.lastname: Schulkin
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D003267:Contraception / Q000009:adverse effects*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000009:adverse effects; D004343:Drug Implants / Q000008:administration & dosage / Q000009:adverse effects; D004502:Education, Medical, Continuing; D005260:Female; D006176:Gynecology / Q000193:education; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007396:Internship and Residency; D007435:Intrauterine Devices, Copper / Q000009:adverse effects; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects; D009774:Obstetrics / Q000193:education; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D014481:United States; D000078329:Workforce
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D004343:Drug Implants; D016912:Levonorgestrel
keywords: Contraceptive implants; Intrauterine contraceptive device (IUD); Long-acting reversible contraception; Obstetrician–Gynecologists; Same-day insertion