Urban female family medicine patients' perceptions about intrauterine contraception

Aims: Improper and inconsistent contraceptive use contributes to the unintended pregnancy rate. The intrauterine device (IUD) is an effective, safe method of contraception that cannot be used improperly or inconsistently. However, it is relatively underused in the United States. We developed a qualitative study to better understand patient beliefs and attitudes that may act as a barrier to acceptance or use of an IUD. Methods: We conducted semistructured interviews with a convenience sample of 40 reproductive aged women from two Bronx, New York, family medicine practices. Self-report of having heard of the IUD was the main eligibility criterion. We used an iterative process of data collection and analysis. Results: Although respondents appreciate the advantages of an IUD, they express a number of conceptual concerns and fears about the device. These are primarily related to voluntarily placing a device inside the body for a prolonged period of time and to a knowledge gap about internal female reproductive anatomy. The IUD is viewed as a contraception option to use when other methods have failed or after childbearing. Additionally, respondents report a lack of discussion and information about the IUD from healthcare providers, the media, and informal networks. Conclusions: Directly addressing patient reservations that might otherwise be left unsaid could potentially increase acceptance of the IUD. The issues elucidated in this study begin to shed light on specific patient concerns that providers or public health messages may address during IUD contraception counseling. Given the high efficacy and safety of IUDs, increasing use could impact rates of unplanned pregnancy.