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Health Care Provider Attitudes and Practices Related to Intrauterine Devices for Nulliparous Women

OBJECTIVE: To examine predictors of health care providers perceiving intrauterine devices (IUDs) as unsafe for nulliparous women and of infrequent provision of IUDs to nulliparous women. METHODS: We analyzed questionnaire data obtained during December 2009 to March 2010 from 635 office-based providers (physicians) and 1,323 Title X clinic providers (physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses). Using multivariable logistic regression, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between patient, health care provider, and clinic and practice variables and provider misconceptions about the safety of IUDs for nulliparous women and with infrequent IUD provision. RESULTS: Approximately 30% of respondents had misconceptions about the safety of IUDs for nulliparous women. Factors associated with increased odds of misconceptions about the copper IUD and levonorgestrel-releasing IUD included: being an office-based family medicine physician (copper IUD adjusted OR 3.20, 95% CI 1.73–5.89; levonorgestrel-releasing IUD adjusted OR 2.03, 95% CI 1.10–3.76); not being trained in IUD insertion (copper IUD adjusted OR 4.72, 95% CI 2.32–9.61; levonorgestrel-releasing IUD adjusted OR 2.64, 95% CI 1.34–5.22); and nonavailability of IUDs on-site at their practice or clinic (copper IUD adjusted OR 2.18, 95% CI 1.20–3.95; levonorgestrel-releasing IUD adjusted OR 3.45, 95% CI 1.95–6.08). More than 60% of providers infrequently provided IUDs to nulliparous women. Nonavailability of IUDs on-site (copper IUD adjusted OR 1.78, 95% CI 1.01–3.14; levonorgestrel-releasing IUD adjusted OR 2.10, 95% CI 1.22–3.62) and provider misconceptions about safety (copper IUD adjusted OR 6.04, 95% CI 2.00–18.31; levonorgestrel-releasing IUD adjusted OR 6.91, 95% CI 3.01–15.85) were associated with infrequent IUD provision. CONCLUSION: Health care provider misconceptions about the safety of IUDs for nulliparous women are prevalent and are associated with infrequent provision. Improved health care provider education and IUD availability are needed to increase IUD use among nulliparous women. LEVEL OF EVIDENCE: III