A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women

Abstract

Objectives Intrauterine contracepives (IUCs) are highly effective and safe for use in all women, including those who are nulliparous. However, many myths and barriers prevent more widespread utilisation. The objective of this article was to explore the health care provider (HCP), health system and user issues that prevent more widespread use of IUCs, particularly among nulliparous women, and to present the evidence that supports achieving greater utilisation of these devices.

Methods MEDLINE, PubMed and Embase were used to identify studies reporting attitudes and beliefs around IUCs, and clinical studies providing evidence of their risks and benefits.

Results HCP, health system and user factors limiting use of IUCs were identified. The most widely explored barriers in published studies are those at the HCP level. User barriers are less well documented and health system barriers are mostly assessed through indirect evidence. Many, but not all, of the barriers can be reduced through greater understanding of the evidence.

Conclusions Efforts need to be made to disseminate the evidence, which shows that few contraindications exist to IUC use. Addressing HCP lack of knowledge, training and confidence with IUC insertions, particularly in nulliparous women, could make a substantial positive impact on IUC utilisation.

Keywords:

• Intrauterine contraception
• Intrauterine device
• Intrauterine system
• LNG-IUS
• Nulliparous

Acknowledgements

The authors would like to acknowledge Sonya Haslam who provided medical writing support with funding from Bayer HealthCare, and the other members of the INTRA group – Brian Hauck, Tina Peers, Katty Ardaens, Lena Marions, Sylvia Dermout and Josefina Lira Plascencia – who reviewed interim drafts of the manuscript.

Declaration of interest

All authors are members of the INTRA group, an independent panel of physicians with expert interest in intrauterine contraception, the formation of which was facilitated by Bayer Health-Care. This publication and its content was solely the responsibility of the authors. They received editorial support which was paid for by Bayer HealthCare. In addition, all authors had acted as consultants to Bayer HealthCare and received consultancy honoraria.