Copper Intrauterine Device for Emergency Contraception

8/12/2019 Copper Intrauterine Device for Emergency Contraception

1/23


2/23

The copper-releasing intrauterine device(IUD) can be used safely for emergency

contraception up to 5 days afterunprotected intercourse

The copper IUD not only confers greater

protection from the one act of unprotectedintercourse, but also offers protection for at

least 10 years.9

Surveys of women seeking emergencycontraception or pregnancy testing have

shown that more than 10% would accept acopper IUD.12,13


3/23

Although offering the copper IUD for emergencycontraception is still an innovative approach in the

United States, there are some contraceptiveproviders who do make it available to their patients.

This study assessed clinicians professional training,skills, knowledge, and practices to identify factors

that were associated with having recommended thecopper IUD for emergency contraception.


4/23

We conducted a survey among clinicians (n1,246;response rate 65%) in a California State familyplanning program, where U.S. Food and DrugAdministration- approved contraceptives are

available at no cost to low-income women.

The survey included in the sample all cliniciansserving 100 or more female contraceptive patientsper year; a self-administered written survey was

sent to 1,246 clinicians, identified by unique studyidentification numbers.


5/23

this analysis using logistic regression toassess the recommendation of the copper

IUD for emergency contraception

An information letter was sent, and then 2

weeks later the survey was mailed with acover letter. A reminder postcard was sentlater that week, and another survey wassent to nonrespondents after 4 weeks.


6/23

We asked clinicians whether the followingwomen were suitable candidates:

Nulliparous

immediate postpartum

immediate postabortion

Adolescents

history of ectopic pregnancy

sexually transmitted disease in past 2 years

pelvic inflammatory disease in past 5 years,


7/23

We asked clinicians whether the followingwomen were suitable candidates:

pelvic inflammatory disease in past 5 years

current bacterial vaginosis

human immunodeficiency virus positivity


8/23

The outcome variable we

assessed was clinicianrecommendation of the copper

IUD for emergency

contraception to patients


9/23

The majority of contraceptive providers (85%)reported that they had never recommended the

copper IUD for emergency contraception

A total of 15% of clinicians had recommended the

IUD for emergency contraception: 13% hadrecommended the method one to 10 times, andonly 1.7% had recommended the method more

than 10 times.


10/23

Table 1. Clinician Recommendation of the Copper Intrauterine Device for

Emergency Contraception (n=788)


11/23

Table 1. Clinician Recommendation of the Copper Intrauterine Device for

Emergency Contraception (n=788)


12/23

Multivariable analyses showed insertion skills

were associated with having recommended the

copper IUD for emergency contraception, but the

most significant factor was evidence-based

knowledge of patient selection for IUD use.


13/23

Table 2. Copper Intrauterine Device for Emergency Contraception Recommended

by Clinician: Multivariable Logistic Regression Results (Odds Ratios)


14/23

Clinicians who viewed a wide range

of patients as IUD candidates were

twice as likely to have recommended

the copper IUD for emergency

contraception.


15/23

Although more than 93% of

obstetriciangynecologists were

skilled in inserting the copper IUD,

they were no more likely to have

recommended it for emergencycontraception than other physicians

or advance practice clinicians.


16/23

These data showed that contraceptive providersinfrequently recommend the copper IUD foremergency contraception to their patients.

certain factors shown to be associated with provisionof the most effective reversible contraceptives inprevious research, including younger age, training asa physician, training during residency or core training,

a specialty in obstetrics-gynecology or womenshealth or both, high contraceptive patient volume, ahigh level of knowledge of method attributes and sideeffects, and an expansive view of intrauterinecontraception candidates


17/23

The ob-gyns, who were the clinicians with thehighest skill levels in contraception, were not any

more likely than other clinicians to haverecommended the copper IUD as emergencycontraception, despite their extensive training in

copper IUD insertions

These results indicate a need to emphasize theuse of the copper IUD for emergencycontraception in clinician training and education


18/23

Skill levels inserting thecopper IUD were

important for both generalprovision and for the

purposes of emergency

contraception

One of the most importantelements to include ineducational efforts for

clinicians, including those

in the obstetrics-gynecology specialty,

would be an emphasis onthe wider range of

candidates who qualify for

use of intrauterinecontraception according to

the Centers for DiseaseControl medical eligibility

criteria


19/23

Limitation

the providers were asked whether theyrecommended the copper IUD for emergency

contraception.


20/23

Limitation

the providers were asked whether theyrecommended the copper IUD for emergency

contraception.


21/23

These data showed important missed

opportunities among contraceptive

providers, including highly trained ob-gyns,

for offering women at risk for unintended

pregnancy the most effective method

available for emergency contraception, the

copper IUD.


22/23

An emphasis during clinician training on the use

of the copper IUD for emergency contraception

may help to address high unintended pregnancy

rates. The study also showed the relevance of updating

contraceptive providers on the evidence and

more expansive current criteria for intrauterine

contraception candidates as set out by Centersfor Disease Control medical eligibility criteria.


23/23

Copper Intrauterine Device for Emergency Contraception

Documents