Convenience ups interest in post-sex contraceptive

Family planning clinics should consider offering same-day intrauterine device (IUD) insertion to women seeking emergency contraception and walk-in pregnancy testing, according to a new report. Doing this, the findings suggest, will increase interest in and use of IUDs for this purpose.

The morning after pill is the best known form of emergency contraception, although copper-containing IUDs can also be highly effective. Although the IUDs can be inserted up to 5 days after unprotected sexual intercourse, it is recommended that they be inserted as soon as possible. The IUD can then be left in place to provide long-term birth control.

Dr. Eleanor Bimla Schwarz at the University of Pittsburgh and associates, the authors of an article in the journal Obstetrics & Gynecology, note that copper IUDs offer highly effective emergency and maintenance contraception. However, many doctors require two separate appointments for inserting IUDs, including one for STD testing.

The investigators believe that "more US women would use IUDs if it was easier to have them inserted."

To test that supposition, they surveyed 412 girls and women ages 15 to 44 years who sought emergency contraception or pregnancy testing in 2008 at one of four family planning clinics in Pittsburgh. Most subjects were young, low-income, and African American - a population "at particularly high risk of unintended pregnancy."

The surveys contained questions regarding respondents' knowledge of and attitudes toward IUD contraception, as well as their interest in using an IUD.

Results showed that few patients were knowledgeable about IUDs, with the majority answering "don't know" to questions about effectiveness, side effects, costs, and only about a third were acquainted with someone who had ever used an IUD.

Sixteen percent expressed interest in having an IUD inserted that day for free.

"Efforts therefore should be made to expand education about and access to IUD insertions for women seeking either emergency contraception or pregnancy testing, with consideration given to the development and evaluation of same-day insertion services," Schwarz and associates conclude.

They estimate that in this patient population, five women would need to be treated with an IUD in order to prevent one unwanted pregnancy within the next year.

SOURCE: Obstetrics and Gynecology, April 2009.