Original research articleAttitudes and beliefs about the intrauterine device among teenagers and young women☆
Introduction
A recent report by the Centers for Disease Control showed the birth rate among teenagers in the United States rose between 2005 and 2007, interrupting a 14-year decline [1]. When compared to other developed countries, the teenage pregnancy rate in the United States (83.6 pregnancies per 1000) is almost twice that of Great Britain (46.7) and Canada (45.7), and much higher than that of Sweden (25.0) and France (20.2) [2]. Since 82% of teen pregnancies and 60% of pregnancies among women in their early 20s are unintended, determining strategies to improve consistent use of birth control by teenagers and young women is of public health importance [3].
Adolescents have higher birth control continuation rates and lower unintended pregnancy rates with methods that do not require daily adherence or decisions at the time of intercourse [4]. One method that requires neither is the intrauterine device (IUD). According to the World Health Organization (WHO) Medical Eligibility Criteria, advantages generally outweigh theoretical or proven risks (Category 2) for women from menarche to age 20 years for initiation and continuation of both the copper and levonorgestrel-releasing IUDs [5]. A recent committee opinion by the American College of Obstetricians and Gynecologists (ACOG) encourages providers to consider the IUD as a first-line choice of contraception for both nulliparous and parous adolescents [6]. Many practitioners, however, do not offer the IUD to their younger patients; a study by Harper et al. [7] found that many physicians, nurse practitioners and physician assistants who provide family planning services do not provide counseling or offer their patients IUDs, and fewer than half (46%) of clinicians considered nulliparous women candidates for IUDs.
Consistent with these findings, use of IUDs among teenagers and women in their early 20s is low. The National Survey of Family Growth data from 2002 showed that only 0.1% of women in the United States ages 15–19 years and 1.1% of women ages 20–24 years were current IUD users [8]. Information on the acceptability of the IUD in teenagers and young women is limited. A study by Stanwood and Bradley [9] found that only half of pregnant women ages 14–25 years presenting for prenatal care or abortion had heard of the IUD, and a larger proportion were not aware of its high efficacy (58%) or safety (71%). Another study by Whitaker et al. [10] that surveyed women ages 15–24 years presenting for care at a general obstetrics and gynecology clinic found that fewer than half of young women had heard of the IUD and the majority of those women (63%) did not have positive attitudes about the method.
Our objective was to study teenagers' and young women's perceptions of and attitudes about the IUD in order to assess the feasibility of efforts to increase use of this method of contraception in this age group. Given the clear gaps in terms of provider behavior and knowledge deficits among potential IUD users, we wanted to assess factors that might influence decision making about the IUD in order to guide intervention development.
Section snippets
Materials and methods
We performed a cross-sectional survey of 252 female teenagers and young women presenting for appointments at the New Generation Health Center (NGHC), a clinic of the University of California San Francisco (UCSF) Department of Obstetrics, Gynecology and Reproductive Sciences, between January 9 and February 27, 2007. Ninety-four percent of NGHC patients are aged 15–24 years. The clinic population's ethnicity is diverse with 42% being Latino, 22% African American and 20% Asian or Pacific Islander.
Results
Demographic and descriptive characteristics of study participants stratified by interest in the IUD are presented in Table 1. The study population was largely English-speaking (93%) young women between the ages of 14 and 27 years. The majority was nulliparous (84%) and currently in a monogamous relationship (85%). Ninety-eight percent had ever had sex, and 80% had more than one lifetime sexual partner. Thirty-eight percent reported a history of at least one STI. The most common form of birth
Discussion
This study demonstrates, as in previous studies, that knowledge of IUDs is low among adolescents and young women. This study also demonstrates, however, that given basic written information about the IUD, the patients in this age group are also reluctant to consider using an IUD. Perhaps the most significant finding from this study is that having heard about the IUD from a health care provider is associated with interest in the method. Although this study is limited by its cross-sectional
Acknowledgment
Special thanks to the New Generation Health Center staff.
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There was no funding source for this study.