title: Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.
abstract: OBJECTIVE
  Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined obstetrician-gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception.
  
  
  METHODS
  A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership.
  
  
  RESULTS
  After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all obstetrician-gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among obstetrician-gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs.
  
  
  CONCLUSIONS
  Although most obstetrician-gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations.
  
  
  CONCLUSIONS
  This study shows that obstetrician-gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.
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, 409 12th St SW, Washington, DC 20024.
authors.forename: Britta L
authors.initials: BL
authors.lastname: Anderson
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Power
authors.affiliation: Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024.
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, 409 12th St SW, Washington, DC 20024; Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, WA.
authors.forename: Jay
authors.initials: J
authors.lastname: Schulkin
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D001291:Attitude of Health Personnel; D044363:Contraception, Postcoital / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006176:Gynecology; D019538:Health Care Surveys; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D009774:Obstetrics; D010298:Parity; D010820:Physicians; D011181:Postnatal Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012955:Societies, Medical; D014481:United States; D016387:Women's Health; D000078329:Workforce; D055815:Young Adult
keywords: Adolescents; Emergency contraception; Intrauterine contraceptive device (IUD); Long-acting reversible contraception; Nulliparous; Obstetrician–Gynecologists; Postabortion; Postpartum