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Obstetrician-Gynecologists and the Intrauterine Device: A Survey of Attitudes and Practice

From the Department of Obstetrics and Gynecology, the Robert Wood Johnson Clinical Scholars Program, the Division of General Medicine, and the Department of Social Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Address reprint requests to: Nancy L. Stanwood, MD, MPH, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Box 668, Room 2-4446, 601 Elmwood Avenue, Rochester, NY 14642-8668; E-mail: nancy_stanwood{at}urmc.rochester.edu.

OBJECTIVE: To assess obstetrician-gynecologists’ clinical use of the intrauterine device (IUD), their attitudes toward the IUD and how they select IUD candidates, and to test the hypotheses that limited residency training in IUDs, fear of litigation, and a belief that IUDs cause pelvic inflammatory disease decrease IUD use.

METHODS: We performed a national mailed survey of 811 practicing obstetrician-gynecologists obtained from systematic sampling of ACOG membership listings to assess use of and attitudes toward the IUD.

RESULTS: The survey response rate was 50%. Most respondents agreed that the copper IUD is safe (95%) and effective (98%). However, 20% of respondents had not inserted an IUD in the past year, and of those who had, most (79%) reported inserting 10 or fewer. Fear of litigation and a belief that IUDs cause pelvic inflammatory disease were associated with lower IUD use; the number of IUDs inserted during residency was not. In selecting IUD candidates, respondents were most restrictive about patient monogamy. Having less conservative criteria for selecting IUD candidates was associated with greater IUD use. Respondents with liberal criteria inserted a mean of nine IUDs in the past year, whereas those with conservative criteria inserted four.

CONCLUSIONS: Because most obstetrician-gynecologists are inserting few IUDs, educational programs should target these physicians to expand their IUD use. Such programs should highlight modern IUD safety and the rarity of litigation. The number of IUDs inserted in residency may be less important than the development of less restrictive, more evidence-based criteria for selecting IUD candidates.

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