“It takes the stars aligning”: challenges to providing the copper IUD as emergency contraception (EC) and same-day IUD visits in community health care settings

Abstract

Objectives: We aimed to assess the extent to which community health centers (CHCs) are equipped to offer the IUD as emergency contraception (EC) and same-day IUD placements and to identify barriers to provision of these birth control options. Methods: We surveyed clinicians and staff from 11 CHC sites in the San Francisco Bay Area and interviewed 20 clinicians working in Bay Area CHCs. Results: Among 97 survey respondents (28 clinicians and 69 staff), 40% indicated that in the past 3 years, IUD as EC provision had increased somewhat or very much in their practice, 17% reported that most patients can get an IUD the same day as one is requested, 66% of clinicians reported they had ever placed the IUD and 19% reported they had ever placed an IUD as EC. The most common barriers to same-day IUD placement were the need for pregnancy (37%) and chlamydia/gonorrhea testing (24%), insufficient time within one visit (31%), the need to wait for pregnancy test results (30%) and the patient's need for more time to decide (19%). Qualitative findings indicated that scheduling challenges, pressures to see a certain number of patients a day and unavailability of trained clinicians onsite further contributed to challenges to providing this form of EC. Conclusions: Although access to the IUD as EC and same-day IUD placements appear to be increasing within the CHCs surveyed, significant barriers to provision persist. Clinic policies may need to address a variety of system- and provider-level barriers to better meet the needs of patients and expand access to this form of EC.