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 language | English (US) |
|---|---|
| Journal | Contraception |
| DOIs | |
| State | Accepted/In press - Jan 1 2020 |
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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 journal › Article
}
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 -