Original research articleFear of intrauterine contraception among adolescents in New York City☆
Introduction
Teen pregnancy, while on the decline, continues to pose a significant public health challenge in the United States, and socioeconomic, racial and ethnic disparities persist [1], [2]. The intrauterine device (IUD) is a long-acting, reversible method of contraception that has been available in the United States since the mid-1960s but has not yet gained popularity among adolescents [3]. Only 3.6% of contracepting females age 15–19 report using the IUD [4]. Recent studies have demonstrated that the IUD is not only safe but also more effective at preventing adolescent pregnancy than the contraceptive pill, patch and ring [5].
Few studies have examined knowledge and attitudes about the IUD among adolescents. Those in the literature have consistently found that less than half of adolescents in the United States have ever heard about the IUD [6], [7], [8]. These studies have mainly enrolled participants in settings that specialize in family planning and gynecology [9]. Little is known, however, about how female adolescents with some basic knowledge of the IUD perceive this contraceptive option.
The objectives of this study are to explore the attitudes, knowledge and beliefs of urban female adolescents toward IUDs and to identify barriers to IUD use. Since little is known about this topic, we used a qualitative approach to gain a better understanding of adolescents' perceptions about the IUD.
Section snippets
Study sites and participants
Adolescents were recruited from the waiting rooms of one Bronx federally qualified community health center and two school based-health centers (SBHCs) located in Bronx public high schools, which together served approximately 6700 students [10]. The SBHCs offer a range of primary care services, including reproductive health services. At the time of study recruitment, the majority of students at both high schools (94% at one location and 67% at the other) were enrolled in their SBHC, and neither
Results
In May 2011, 39 female adolescents were approached for the study, 35 agreed to take part in the screening, and 21 were eligible and therefore enrolled. The sole reason for ineligibility of the additional 14 potential participants was never having heard about the IUD. Participants ranged in age from 14 to 19; mean age was 16.4. Fourteen percent of the participants self-identified as Black, 76% as Latina, 5% as both Black and Latina and 5% as other. Teens enrolled in this study reported first
Discussion
Adolescents interviewed for this study, who had heard about but never used an IUD, expressed an almost universal fear of the IUD's internal placement. Participants gave several explanations for why they feared the IUD, some specific (e.g., concern about pain and side effects) and some emotional (e.g., distaste for the idea of a foreign body). The main message communicated was that that fear would be a major barrier to seeking an IUD.
Fear about the IUD has been noted among adult women [15] and
Conclusion
While adolescents interviewed for this study appear to recognize the benefits of using an IUD, our findings suggest that fear hinders them from considering the IUD as an acceptable contraceptive option. These fears may be allayed with improved IUD education and counseling as well as education about female anatomy. We also identified common misperceptions with regard to appropriate IUD candidates (e.g., age, parity) that must be addressed in order for the IUD to become an acceptable birth
Acknowledgments
The authors would like to thank Dr. Marji Gold and Dr. Tara Stein for providing background for this study, Dr. Cynthia Mollen for her assistance with the study design and interview guide, Dr. Neal Hoffman for his assistance with study recruitment and the staff at the Bronx SBHCs where recruitment took place for their assistance and support.
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There are no funding sources or conflicts of interest to disclose, however, Susan E. Rubin received salary support from NIH/NICHD K23HD067247.