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Research Highlights

The IUD Option: Support for an Underused Contraceptive Method

Two recent studies from Albert Einstein College of Medicine and Montefiore Health System spotlight the value of intrauterine contraception.

IUDs and Younger Women

A clinical research team has identified three key factors that may influence young women considering an intrauterine device (IUD): learning about the attributes of IUDs, discussing IUDs with their healthcare providers and being influenced by their mothers.

The research team asked 27 patients aged 16 to 25 who had an appointment for IUD insertion about their values, priorities and preferences. The young women chose the IUD because it was convenient, effective, long lasting and removable. They cited their healthcare providers as highly influential and knowledgeable and were reassured by the demonstrations and visual aids they were shown during contraception counseling. Surprisingly, mothers played a major role in the decision to get an IUD.

Researchers at Albert Einstein College of Medicine and Montefiore Health System study the benefits of intrauterine devices, an extremely effective contraceptive that is underused by American women.
Susan E. Rubin, M.D., M.P.H.
“Considering these factors during contraception counseling may increase the number of young women who view an IUD as a good fit,” said study leader Susan E. Rubin, M.D., M.P.H., associate professor of clinical family & social medicine at Einstein and attending physician at Montefiore. In the United States, only 5 percent of women aged 15 to 24 on birth control use an IUD. Each year, more than half a million young women 15 to 19 years old become pregnant, most of them unintentionally.

“Our results suggest that in discussing intrauterine contraception with their patients, clinicians should be sure to mention device-specific benefits, elicit questions and concerns, ask patients what they may have heard from their friends, and use visual aids—including the device itself,” said Dr. Rubin.

The study was published online September 9 in the Journal of Pediatric and Adolescent Gynecology and will appear in print in the journal’s October issue. Dr. Rubin’s co-authors were from Einstein, Montefiore and Columbia University.

Dr. Rubin is a family doctor whose area of expertise is primary care health systems research with a focus on providing better reproductive healthcare.  Her recent work has focused on adolescent health and contraception—particularly long-acting reversible contraception (LARCs), such as IUDs. In her previous studies, she has looked at family physician’s attitudes and practice with IUDs, the underuse of IUDs and primary care physicians’ views of providing LARC to adolescents. She has written for the Einstein blog, The Doctor’s Tablet, on topics including barriers to affordable contraception and why family planning must be required in family-medicine residency programs.

IUDs After Cesarean Birth

Erika E. Levi, M.P.H., M.D.
Erika E. Levi, M.P.H., M.D.
A second Einstein study, led by Erika E. Levi, M.D., M.P.H., involved 112 women undergoing cesarean delivery who wanted to use an IUD after giving birth. Some of the women were randomly chosen to receive IUDs at the time of cesarean delivery, while the others were scheduled to receive them six or more weeks after delivery. At six months postpartum, 83 percent of women in the cesarean placement group were using an IUD, compared with only 63 percent of the women who had waited.

Since half of women resume sexual activity within six weeks after giving birth, the findings suggest that placing the IUD at the time of a cesarean helps ensure that new mothers receive effective birth control. “This may be an especially good solution for socially or financially disadvantaged women, who face barriers such as lack of transportation, a tendency to relocate and trouble communicating with healthcare providers,” said Dr. Levi, assistant professor of obstetrics & gynecology and women’s health at Einstein and an attending physician at Montefiore. In her study, the most common reason that women did not receive an IUD was missed appointments.

Cesarean delivery represented about one-third of all births in the United States in 2008. “IUD placement at the time of cesarean delivery could be a safe, effective and convenient method of postpartum contraception for 1.4 million women a year,” said Dr. Levi.

The study published in the July 2015 issue of Obstetrics and Gynecology. Dr. Levi’s four co-authors were from the University of North Carolina at Chapel Hill, where the research was conducted. Dr. Levi was a fellow there at the time.

Dr. Levi studies postpartum initiation of reversible contraceptives. She has helped make IUDs and contraceptive implants available to women during the immediate postpartum period in the labor and delivery and postpartum units.

Posted on: Thursday, September 24, 2015