title: Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: results of a survey of European/Canadian healthcare providers.
abstract: OBJECTIVE
  To evaluate healthcare providers' (HCPs') knowledge, attitudes and beliefs regarding intrauterine contraception (IUC).
  
  
  METHODS
  HCPs in eight European countries and Canada who saw at least 20 women per month for contraception completed an online questionnaire. Responses were evaluated by country.
  
  
  RESULTS
  In total, 1103 HCPs completed the survey: 633 obstetrician-gynecologists, 335 general practitioners and 135 family planning clinicians (physician, midwife or nurse). When respondents in different countries were asked to report their three main barriers to considering IUC, predominant concerns were nulliparity (34-69%) and pelvic inflammatory disease (PID; 14-83%) for women in general, and insertion difficulty (25-83%), PID (17-83%), insertion pain (7-60%) and infertility (6-55%) for nulliparous women. In addition, 4-59% of HCPs reported that they never proactively include IUC in contraceptive counseling for a nulliparous woman, regardless of her age. Furthermore, only 30-61% of respondents correctly identified that, in the World Health Organization medical eligibility criteria for IUC, nulliparity is category 2 (benefits outweigh risks).
  
  
  CONCLUSIONS
  HCPs in Europe and Canada have clear gaps in their knowledge regarding IUC and misplaced concerns persist, particularly regarding use of IUC in nulliparous women; the predominant misconceptions are about PID, insertion difficulty and insertion pain. Further education on the evidence is needed so that IUC is recognized as being suitable for young and nulliparous women and is included in contraceptive counseling.
authors.affiliation: Department of Gynecological Endocrinology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. Electronic address: k.buehling@uke.de.
authors.forename: Kai J
authors.initials: KJ
authors.lastname: Buhling
authors.affiliation: Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hauck
authors.affiliation: Department of Gynaecology, Gynaecological Centre Dermout & Albicher, Alkmaar, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Dermout
authors.affiliation: Department of Gynaecology, Residence Paul Eluard Medical Centre, Seclin, France.
authors.forename: Katty
authors.initials: K
authors.lastname: Ardaens
authors.affiliation: Department of Obstetrics and Gynaecology, Karolinska Institutet, University Hospital, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Marions
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence; D005060:Europe; D005193:Family Planning Services; D005260:Female; D006176:Gynecology; D019538:Health Care Surveys; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D008880:Midwifery; D009726:Nurses; D009774:Obstetrics; D010298:Parity; D010820:Physicians
keywords: Barriers; Healthcare provider knowledge; Intrauterine contraception; Nulliparous; Survey