Provider biases squelch IUD availability to nulliparous women

Almost one-third of providers-unconvinced of the safety of IUDs-infrequently prescribe them for nulliparous patients.

More intensive training should discuss misconceptions about safety and insertion technique.

Despite wide dissemination of evidence, a recent study found that nearly one-third of healthcare providers have misconceptions about the safety of IUDs for nulliparous women and that the resulting biases are associated with infrequent provision of the devices.

Data from questionnaires completed by 635 office-based physicians and 1,323 Title X clinic providers (physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses) to determine 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.

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 [aOR], 3.20; 95% Confidence Interval [CI], 1.73–5.89; levonorgestrel-releasing IUD aOR, 2.03; 95% CI, 1.10–3.76); not being trained in IUD insertion  (copper IUD aOR, 4.72; 95% CI, 2.32–9.61; levonorgestrel-releasing IUD aOR, 2.64; 95% CI, 1.34–5.22); and nonavailability of IUDs on site at their practice or clinic (copper IUD aOR, 2.18; 95% CI, 1.20–3.95; levonorgestrel-releasing IUD aOR, 3.45; 95% CI, 1.95–6.08).

More than 60% of providers infrequently provided IUDs to nulliparous women. The primary reasons cited were nonavailability of IUDs on-site (copper IUD aOR, 1.78; 95% CI, 1.01–3.14; levonorgestrel-releasing IUD aOR, 2.10; 95% CI, 1.22–3.62) and provider misconceptions about safety (copper IUD aOR, 6.04; 95% CI, 2.00 =–18.31; levonorgestrel-releasing IUD aOR, 6.91, 95% CI, 3.01–15.85).

“Given that 30% of surveyed health care providers are not up to date on the latest evidence surrounding the safety of IUDs for nulliparous women, additional training and health care provider education are critical to reduce health care provider biases and to potentially increase provision of IUDs,” the authors wrote.

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