title: Healthcare Provider Attitudes of Safety of Intrauterine Devices in the Postpartum Period.
abstract: Immediate postpartum intrauterine devices (IUDs) have been underutilized in the United States despite their known safety. Understanding how providers' attitudes contribute to underutilization is important in improving access. Our objective was to examine healthcare providers' perceptions of the safety of immediate postpartum IUDs before publication of United States contraceptive guidelines.
  
  
  
  We analyzed survey data collected from December 2009 to March 2010 from 635 office-based physicians and 1368 Title X clinic providers (overall response rate of 64.8%). Providers were asked how safe they thought copper and levonorgestrel (LNG) IUDs were in postpartum women (very safe, safe, unsafe, very unsafe, and unsure). Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for characteristics associated with considering immediate and delayed postpartum IUDs to be safe.
  
  
  
  Less than 40% of respondents considered immediate or delayed IUD insertion to be safe. Providers with <1 day of family planning training had decreased odds of considering immediate postpartum IUD insertion to be safe compared with unsafe/unsure (aOR 0.18, 95% CI 0.04-0.84 for copper IUD and aOR 0.17, 95% CI 0.04-0.81 for LNG-IUD). Providers without training in postpartum or interval copper IUD insertion had decreased odds of considering immediate postpartum copper IUD insertion (aOR 0.40, 95% CI 0.16-0.79) and delayed postpartum insertion for both IUD types to be safe (aOR 0.34, 95% CI 0.18-0.66 for copper IUD and aOR 0.41, 95% CI 0.21-0.77 for LNG-IUD).
  
  
  
  Before United States contraceptive guidelines, a majority of providers perceived immediate postpartum IUDs to be unsafe.
authors.affiliation: 1 Department of Gynecology and Obstetrics, Emory University , Atlanta, Georgia .
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Rauh-Benoit
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Naomi K
authors.initials: NK
authors.lastname: Tepper
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Zapata
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Maura K
authors.initials: MK
authors.lastname: Whiteman
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Michele G
authors.initials: MG
authors.lastname: Mandel
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Polly A
authors.initials: PA
authors.lastname: Marchbanks
authors.affiliation: 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003271:Contraceptive Agents, Female; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007434:Intrauterine Devices; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel; D049590:Postpartum Period; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: contraception; intrauterine devices; postpartum; providers