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U.S. Physicians Rarely Prescribe IUDs, Survey Shows

Fear of Infections Keeps Contraceptive Device on the Shelf

Thursday, June 19, 2003

The vast majority of obstetrician-gynecologists believe modern intrauterine contraceptive devices (IUDs) are safe and effective, yet IUDs are still not widely prescribed due to lingering concerns over the Dalkon Shield controversy from 30 years ago, a University of Rochester Medical Center researcher concludes.

In a first-ever survey measuring the use of IUDs in clinical practice among a national sample of obstetricians-gynecologists, Nancy Stanwood, M.D., M.P.H. and her co-authors, report that 20 percent of the respondents had not inserted an IUD in the past year and of those who did, 79 percent inserted 10 or fewer. Fear of litigation and a belief that IUDs cause pelvic inflammatory disease are reasons that IUDs are so rarely used in the United States compared to other developed countries, Stanwood says in the February 2002 edition of Obstetrics & Gynecology. In addition, respondents with very restrictive criteria for selecting IUD candidates used IUDs less often in their practices.

The research was funded solely by the Robert Wood Johnson Foundation's Clinical Scholars Program. Stanwood, an assistant professor at the UR Medical Center, conducted the survey while at the University of North Carolina, Chapel Hill, and joined the OB/Gyn faculty at the URMC's Strong Memorial Hospital in July 2001. With a special interest in helping women prevent unintended pregnancies and abortion, her objective was to discover why use of IUDs remains so low in the U.S.

Stanwood says the biggest myth about today's IUDs is that they cause pelvic inflammatory disease, or PID, which was linked in the 1970s to the Dalkon Shield IUD. "It is exposure to sexually transmitted infections such as chlamydia or gonorrhea that causes PID, not IUDs," she says.

Modern IUDs fail less often than other forms of contraception because couples do not have to remember to take a pill or use a condom. For example, with perfect use of oral contraceptives only 0.1 percent of women get pregnant in the first year - but more realistically, some women miss taking the pill on some days and so with typical use about 7 percent of women get pregnant while on the pill. The IUD typical failure rate is only 0.8 percent, and longer term IUDs are as effective at female tubal ligation, but IUDs are totally reversible.

The survey of 811 members of the American College of Obstetrics and Gynecology was conducted in 2000. About 50 percent responded to the study, which showed that 95 percent of the respondents believed modern IUDs were safe and 98 percent believed they were effective at preventing pregnancy. Stanwood and her colleagues conclude that with education about the safety of modern IUDs, more obstetrician-gynecologists would be willing to offer this effective and convenient method of contraception to more women.

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