Provision Of Intrauterine Contraception Research Articles

Corrigendum. Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial

Corrigendum. Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial

Family planning and Zika virus: need for renewed and cohesive efforts to ensure availability of intrauterine contraception in Latin America and the Caribbean

Objectives: The advantages of intrauterine contraception (IUC) are well established (highly effective, low discontinuation rate, easy to use, low cost, and suitable for immediate postpartum use), but low levels of use in many countries and declining use in others are causes for concern. Due to the ongoing Zika virus outbreak, public health officials are calling for the continued practice of safe sex and the delay of pregnancy. Our study was conducted to assess the current situation of IUC availability and provision in Latin America and to determine the role of national policies in meeting the contraceptive needs of the populations in these countries.Methods: A survey was conducted in Latin America and the Caribbean between December 2015 and January 2016 to assess national policies with regard to IUC provision, availability and accessibility. 18 countries participated.Results: All responding countries had national policies on IUC. Many in the public sector provided the intrauterine device (IUD) free of charge, but the levonorgestrel-releasing intrauterine system (LNG-IUS) was generally available in the private sector. Some countries had very restrictive policies on who was permitted to carry out IUC insertions, but most permitted a range of health professionals to do so. Immediate postpartum IUC insertion was uncommon. Some countries placed restrictions on IUC use in women who were nulliparous, young, at high risk of catching a sexually transmitted infection or who had multiple sexual partners.Conclusions: IUC is underused in Latin America. The study reveals policy level barriers that may impede access to IUC, one of the most effective, long-acting, non-hormonal, reversible contraceptive methods. Governments should consider reviewing and rethinking their policies on contraception to ensure IUC service provision among populations at high risk of unplanned pregnancy, especially those vulnerable to Zika virus.

Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion: first-year results of a randomized controlled trial.

Can the need of subsequent abortion be reduced by providing intrauterine contraception as a part of the abortion service? Provision of intrauterine devices (IUDs) in association with first trimester abortion more than halved the incidence of repeat abortion during the first year of follow-up. Following abortion, the incidence of subsequent abortion is high, up to 30-40%. In cohort studies, intrauterine contraception has reduced the need of repeat abortion by 60-70%. A randomized controlled trial. The main outcome measure was the incidence of subsequent induced abortions during the follow-up. Altogether 751 women seeking first trimester induced abortion were recruited and randomized into two groups. Randomization was accomplished by computer-assisted permuted-block randomization with random block sizes of four to six. The investigators did not participate in randomization, which was done before commencing the study. The participants were recruited between 18 October 2010 and 21 January 2013. The inclusion criteria were age ≥18 years, duration of pregnancy ≤12 weeks, accepting intrauterine contraception, residence in Helsinki and signing the informed consent form. Women with contraindications to intrauterine contraception, such as uterine anomaly, acute genital infection or pap-smear change requiring surgical treatment were ineligible to participate.This study was conducted in collaboration between the Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, and Centralized family planning of the City of Helsinki.The intervention group (n = 375) was provided with intrauterine contraception (either the levonorgestrel-releasing intrauterine system or copper-releasing intrauterine device) immediately following surgical abortion (18.1%) or at a follow-up 2-4 weeks after medical abortion (81.9%). Women in the control group were prescribed oral contraceptives and advised to contact their primary healthcare unit for a follow-up visit and further contraceptive services according to national guidelines. The women were followed-up to 28 February 2014 by using the Finnish National Abortion Registry, Helsinki University Hospital electronic database and clinical follow-up visit at 1 year. The median age of the whole study group was 27 years and 44% had a history of induced abortion(s). During the follow-up year the number of women requesting subsequent abortion was significantly lower in the intervention than in the control group (9/375 [2.4%] versus 20/373 [5.4%], difference -3.0 [95% CI -6.0 to -0.2] percentage points, P = 0.038, according to intention-to-treat analysis and 5/346 [1.4%] versus 20/357 [5.6%], difference -4.2(-7.2 to -1.4) percentage points, P = 0.003, according to per-protocol analysis, respectively). Provision of intrauterine contraception was safe with rate of infection and expulsion similar to those reported previously. The power calculation was calculated for a 5-year follow-up. However, significant differences between the two groups were already seen after 1 year. The present study was performed in a single clinic, where, ∼15% of all abortions in Finland are performed. In order to decrease the need of subsequent abortions, IUDs should be provided at the time of abortion. The study was registered at www.clinicaltrials.gov (NCT01223521). 18 October 2010. 18 October 2010.

Qualitative Assessment of a High-Fidelity Mobile Simulator for Intrauterine Contraception [101

INTRODUCTION: Our goal was to evaluate the comfort, competence, and value of using the ARMS PelvicSim, a high-fidelity mobile training model for insertion of intrauterine contraception, to train clinicians in intrauterine contraception provision. METHODS: Clinicians at ambulatory reproductive health care clinics participated in the PelvicSim training and completed a self-administered survey from January to July 2014. The survey assessed experience with levonorgestrel (LNG) and copper intrauterine contraception insertion, pretraining and posttraining competence and comfort inserting intrauterine contraception, and opinions regarding the value of the PelvicSim. RESULTS: The 140 respondents were primarily female (95.7%) and nurse practitioners (65.5%). Nearly half had inserted more than 50 LNG20 devices (46.4%) or copper t380A devices (48.3%), although 98.3% had never inserted the LNG14 device. For these devices, participants reported feeling more independently competent after training. We observed the largest influence on the LNG14; the proportion of participants who felt independently competent pretraining and posttraining increased significantly from 19.2% to 50.0% (P<.001). The majority of participants reported increased comfort with minimizing patient pain (76.7%) and inserting intrauterine contraception in a live patient (69.0%). Among respondents, 89.6% reported the PelvicSim intrauterine contraception insertion activities to be “valuable” or “very valuable.” All participants would recommend the PelvicSim for intrauterine contraception training, and nearly all (95.6%) reported that the PelvicSim was a better method to teach intrauterine contraception insertion than the manufacturers' models. CONCLUSION AND IMPLICATION: Clinicians reported increased competence and comfort regarding intrauterine contraception insertion after PelvicSim training. The PelvicSim was acceptable as an intrauterine contraception training tool, and nearly all participants found it superior to the manufacturers' models.

Intrauterine contraception: impact of provider training on participant knowledge and provision

BackgroundIn California’s Medicaid family planning expansion, the Family Planning, Access, Care and Treatment (Family PACT) Program, only 1.9% of contracepting women received intrauterine contraception (IUC) in 2006. Ten skills-based IUC provider trainings were offered from 2007 to 2010. ObjectiveThe objective was to evaluate the impact of these trainings on participant knowledge of the broad range of appropriate IUC candidates and measure changes in IUC provision following training. Study DesignWe evaluated changes in provider knowledge using a nine-item IUC Candidate Selection Scale on pre- and posttraining surveys. Changes in provision of IUC following the training were measured using Family PACT claims data. We compared changes in insertions posttraining to pretraining levels as well as to matched comparison sites that did not send trainees. ResultsMost participants at the training were advanced practice clinicians (70%) specializing in general primary care (77%) and practicing at community clinics (45%). Training participants increased their understanding of appropriate candidates (mean change in raw summary score=8.6, p<.001), from an average of 58% correct responses to 81%. Provider sites that participated in training provided a mean of 4.6 more women with IUC following training than during baseline (p<.01), an increase of 25% compared to only 7% increase among comparison sites. The impact of the training differed by practice size such that the largest and smallest clinics both changed IUC provision the most and had the largest differences over comparison sites. ConclusionsThis study shows that skills-based training is an important strategy for the increase of IUC provision.