Postpartum women prefer tubal ligation to IUDs

Women in the United States choose intrauterine devices (IUDs) for postpartum contraception significantly less often than tubal sterilization, according to a new study. The finding holds true even among younger women, who may experience post-sterilization regret.

Using data from the 2001-2008 Nationwide Inpatient Sample of about 1,000 hospitals, researchers from the Centers for Disease Control and Prevention identified delivery hospitalizations with procedure codes for IUD insertion or tubal sterilization. The estimated rate of postpartum IUD insertion was 0.27 per 10,000 deliveries compared with 770.67 for tubal sterilization. The IUD rate was similar across age groups. Although tubal sterilization rates increased with age, 15% of tubal sterilizations occurred among women 24 years of age or younger. The study was published online August 11 in the American Journal of Obstetrics and Gynecology.

“Both the proportion of postpartum tubal sterilizations that were performed among women aged 29 or younger (42.4%) and the large difference between the rates of postpartum IUD insertion and postpartum tubal sterilization among younger women were notable, given the previously reported higher rates of post-sterilization regret among younger women,” the authors write. They emphasize the need to consider IUD insertion postpartum, especially for women who may later regret tubal sterilization or fail to return for postpartum visits, citing the reversibility and relative cost effectiveness of IUDs.

The researchers point out that many women may not know about IUDs and some physicians may worry about infection, although that’s not a problem with newer devices. They encourage health care providers to discuss postpartum contraception, including IUDs, with pregnant women. The American College of Obstetricians and Gynecologists has affirmed the immediate postpartum period as an advantageous time for IUD insertion.

Women who delivered at teaching hospitals were more likely than those at nonteaching hospitals to use an IUD postpartum, perhaps because of patient population, provider training in insertion, and advocacy for the devices at some teaching hospitals. Tubal sterilization was more frequent among women who didn’t have private health insurance and those who underwent cesarean rather than vaginal delivery, possibly reflecting lack of patient or provider motivation or barriers such as unavailability of operating rooms.

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