Research
General gynecology
Postpartum intrauterine device insertion and postpartum tubal sterilization in the United States

https://doi.org/10.1016/j.ajog.2011.08.004Get rights and content

Objective

The purpose of this study was to estimate US rates of postpartum intrauterine device (IUD) insertion and postpartum tubal sterilization.

Study Design

Data from the 2001-2008 Nationwide Inpatient Sample were used to identify delivery hospitalizations with IUD insertion or tubal sterilization procedure codes.

Results

Estimated rates of postpartum IUD insertion and postpartum tubal sterilization were 0.27 and 770.67 per 10,000 deliveries, respectively. Although the rate of IUD insertion was similar across age groups, the rate of tubal sterilization increased with age. Nonetheless, 15% of tubal sterilizations occurred among women who were ≤24 years old. IUD insertion was more likely among women who delivered at teaching hospitals (odds ratio, 3.02; 95% confidence interval, 1.43–6.37); tubal sterilization was more likely among women without private insurance (odds ratio, 2.04; 95% confidence interval, 1.97–2.11).

Conclusion

Among US postpartum women, IUD insertion occurs considerably less frequently than tubal sterilization, even among younger women for whom poststerilization regret is a concern.

Section snippets

Materials and Methods

We used data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) for 2001–2008.10 The Healthcare Cost and Utilization Project is a family of health care databases developed through a federal-state-industry partnership sponsored by the Agency for Healthcare Research and Quality in which state partners contribute data. The NIS is the largest all-payer inpatient care database in the United States and contains data on 7-8 million hospital stays from

Results

During 2001-2008, the estimated rate of IUD insertions that were performed during delivery hospitalizations in the United States was 0.27 per 10,000 deliveries; by contrast, the rate of postpartum tubal sterilization was 770.67 per 10,000 deliveries. The rate of postpartum IUD insertion increased linearly from 0.10 per 10,000 deliveries in 2001-2002 to 0.55 per 10,000 deliveries in 2007-2008 (P for trend, < .001; Figure). A quadratic trend was detected in the rate of postpartum tubal

Comment

The American College of Obstetricians and Gynecologists recently stated that the immediate postpartum period is a particularly favorable time for IUD insertion.12 Although we found that the rate of postpartum IUD insertion in the United States increased from 2001-2002 to 2007-2008, it remains a rare practice and occurs at a rate markedly lower than that of postpartum tubal sterilization. These findings suggest that postpartum IUD insertion is underutilized, particularly for some subgroups.

We

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    Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial

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  • Cited by (32)

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      Although immediate postpartum IUD placement (typically defined as placement within 10 minutes of delivery of the placenta)11 results in a higher rate of expulsion than delayed placement, people who plan on delayed placement often do not attend the postpartum visit or receive an IUD.12–20 Although the uptake of postpartum IUDs is increasing, their use in the United States remains low relative to other methods of contraception.21–23 A 2017 survey by the ACOG found that only 19% of its members reported offering immediate postpartum IUDs.24

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    The authors report no conflict of interest.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    Reprints not available from the authors.

    Cite this article as: Whiteman MK, Cox S, Tepper NK, et al. Postpartum intrauterine device insertion and postpartum tubal sterilization in the United States. Am J Obstet Gynecol 2012;206:127.e1-7.

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