Access to IUD removal: Data from a mystery-caller study

Jennifer R. Amico, Chiara Heintz, Ariana H. Bennett, Marji Gold

Research output: Contribution to journalArticle

Abstract

Objective: This study describes access and barriers to intrauterine device (IUD) removal appointments in 10 mid-sized cities in the United States. Study Design: This mystery caller study utilized a sampling frame of health centers in 10 mid-sized cities gathered from 3 search engines. We gathered data about the timing of the next available appointment, the requirements for additional appointments prior to IUD removal, and the out-of-pocket cost. We used descriptive statistics to describe the availability and cost of IUD removal visits, and compared results between primary care clinics and family planning or gynecology clinics. Any additional information regarding why a visit was not available or other requirements for IUD removal that was provided to the researcher was also recorded. Results: Of 229 clinics included for analysis, 60.7% could offer an IUD removal appointment to the mystery caller, and the majority of these could provide an initial appointment within 2 weeks (61.2%), with a median of 10 days. Of clinics offering IUD removal, 17.3% required more than one visit before removing the IUD, and 43.2% confirmed that IUD removal would occur at the first visit. Five clinics (5.6%) reported that they would not remove an IUD that was not placed at their clinic. Sliding scale fees were offered at 16.3% of clinics. For the clinics that cited an out-of-pocket cost and did not offer sliding scale fees, the median cost of the IUD removal was $262, with a range of $50 to over $1000. Neither appointment availability nor cost differed between primary care and family planning or gynecology clinics. Conclusions: Overall, timely IUD removal appointments were available at the clinics we sampled, but both financial and clinic policy barriers to IUD removal were documented, including the need for multiple appointments and the total out-of-pocket costs. Implications: In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.

Original languageEnglish (US)
JournalContraception
DOIs
StateAccepted/In press - Jan 1 2020

Fingerprint

Device Removal
Intrauterine Devices
Appointments and Schedules
Health Expenditures
Fees and Charges
Family Planning Services
Gynecology
Costs and Cost Analysis
Primary Health Care
Search Engine
Climate

Keywords

  • Cost
  • Discontinuation
  • Intrauterine device
  • Mystery caller

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Access to IUD removal : Data from a mystery-caller study. / Amico, Jennifer R.; Heintz, Chiara; Bennett, Ariana H.; Gold, Marji.

In: Contraception, 01.01.2020.

Research output: Contribution to journalArticle

Amico, Jennifer R. ; Heintz, Chiara ; Bennett, Ariana H. ; Gold, Marji. / Access to IUD removal : Data from a mystery-caller study. In: Contraception. 2020.
@article{7cb4ae8ebc044514999351d717389ce4,
title = "Access to IUD removal: Data from a mystery-caller study",
abstract = "Objective: This study describes access and barriers to intrauterine device (IUD) removal appointments in 10 mid-sized cities in the United States. Study Design: This mystery caller study utilized a sampling frame of health centers in 10 mid-sized cities gathered from 3 search engines. We gathered data about the timing of the next available appointment, the requirements for additional appointments prior to IUD removal, and the out-of-pocket cost. We used descriptive statistics to describe the availability and cost of IUD removal visits, and compared results between primary care clinics and family planning or gynecology clinics. Any additional information regarding why a visit was not available or other requirements for IUD removal that was provided to the researcher was also recorded. Results: Of 229 clinics included for analysis, 60.7{\%} could offer an IUD removal appointment to the mystery caller, and the majority of these could provide an initial appointment within 2 weeks (61.2{\%}), with a median of 10 days. Of clinics offering IUD removal, 17.3{\%} required more than one visit before removing the IUD, and 43.2{\%} confirmed that IUD removal would occur at the first visit. Five clinics (5.6{\%}) reported that they would not remove an IUD that was not placed at their clinic. Sliding scale fees were offered at 16.3{\%} of clinics. For the clinics that cited an out-of-pocket cost and did not offer sliding scale fees, the median cost of the IUD removal was $262, with a range of $50 to over $1000. Neither appointment availability nor cost differed between primary care and family planning or gynecology clinics. Conclusions: Overall, timely IUD removal appointments were available at the clinics we sampled, but both financial and clinic policy barriers to IUD removal were documented, including the need for multiple appointments and the total out-of-pocket costs. Implications: In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.",
keywords = "Cost, Discontinuation, Intrauterine device, Mystery caller",
author = "Amico, {Jennifer R.} and Chiara Heintz and Bennett, {Ariana H.} and Marji Gold",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.contraception.2019.10.008",
language = "English (US)",
journal = "Contraception",
issn = "0010-7824",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Access to IUD removal

T2 - Data from a mystery-caller study

AU - Amico, Jennifer R.

AU - Heintz, Chiara

AU - Bennett, Ariana H.

AU - Gold, Marji

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: This study describes access and barriers to intrauterine device (IUD) removal appointments in 10 mid-sized cities in the United States. Study Design: This mystery caller study utilized a sampling frame of health centers in 10 mid-sized cities gathered from 3 search engines. We gathered data about the timing of the next available appointment, the requirements for additional appointments prior to IUD removal, and the out-of-pocket cost. We used descriptive statistics to describe the availability and cost of IUD removal visits, and compared results between primary care clinics and family planning or gynecology clinics. Any additional information regarding why a visit was not available or other requirements for IUD removal that was provided to the researcher was also recorded. Results: Of 229 clinics included for analysis, 60.7% could offer an IUD removal appointment to the mystery caller, and the majority of these could provide an initial appointment within 2 weeks (61.2%), with a median of 10 days. Of clinics offering IUD removal, 17.3% required more than one visit before removing the IUD, and 43.2% confirmed that IUD removal would occur at the first visit. Five clinics (5.6%) reported that they would not remove an IUD that was not placed at their clinic. Sliding scale fees were offered at 16.3% of clinics. For the clinics that cited an out-of-pocket cost and did not offer sliding scale fees, the median cost of the IUD removal was $262, with a range of $50 to over $1000. Neither appointment availability nor cost differed between primary care and family planning or gynecology clinics. Conclusions: Overall, timely IUD removal appointments were available at the clinics we sampled, but both financial and clinic policy barriers to IUD removal were documented, including the need for multiple appointments and the total out-of-pocket costs. Implications: In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.

AB - Objective: This study describes access and barriers to intrauterine device (IUD) removal appointments in 10 mid-sized cities in the United States. Study Design: This mystery caller study utilized a sampling frame of health centers in 10 mid-sized cities gathered from 3 search engines. We gathered data about the timing of the next available appointment, the requirements for additional appointments prior to IUD removal, and the out-of-pocket cost. We used descriptive statistics to describe the availability and cost of IUD removal visits, and compared results between primary care clinics and family planning or gynecology clinics. Any additional information regarding why a visit was not available or other requirements for IUD removal that was provided to the researcher was also recorded. Results: Of 229 clinics included for analysis, 60.7% could offer an IUD removal appointment to the mystery caller, and the majority of these could provide an initial appointment within 2 weeks (61.2%), with a median of 10 days. Of clinics offering IUD removal, 17.3% required more than one visit before removing the IUD, and 43.2% confirmed that IUD removal would occur at the first visit. Five clinics (5.6%) reported that they would not remove an IUD that was not placed at their clinic. Sliding scale fees were offered at 16.3% of clinics. For the clinics that cited an out-of-pocket cost and did not offer sliding scale fees, the median cost of the IUD removal was $262, with a range of $50 to over $1000. Neither appointment availability nor cost differed between primary care and family planning or gynecology clinics. Conclusions: Overall, timely IUD removal appointments were available at the clinics we sampled, but both financial and clinic policy barriers to IUD removal were documented, including the need for multiple appointments and the total out-of-pocket costs. Implications: In our current climate focused on improving access to IUDs, it is essential to address and reduce barriers to IUD removal when desired, in order to preserve reproductive autonomy.

KW - Cost

KW - Discontinuation

KW - Intrauterine device

KW - Mystery caller

UR - http://www.scopus.com/inward/record.url?scp=85077367864&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077367864&partnerID=8YFLogxK

U2 - 10.1016/j.contraception.2019.10.008

DO - 10.1016/j.contraception.2019.10.008

M3 - Article

C2 - 31811841

AN - SCOPUS:85077367864

JO - Contraception

JF - Contraception

SN - 0010-7824

ER -