“I think maybe 10 years seems a bit long.” Beliefs and attitudes of women who had never used intrauterine contraception

Abstract

Aim: To explore, in general practice settings the concerns, beliefs and attitudes about intrauterine contraception reported by women, who had never used the methods.Method: We used a sequential mixed-method (QUAL/quant) approach. A pragmatic, self-selecting sample of thirty women, aged 18-46 years, who had never used intrauterine contraception (IUC), was recruited through seven general practices in South East England. Themes arising from qualitative interviews were used to construct a quantitative survey, completed by a pragmatic sample of 1195 women, aged between 18-49 years, attending thirty-two general practices in the same region, between February and August 2015.Findings: Qualitative themes were concerns about the long acting nature of IUC, concerns about bodily boundaries, and informal knowledge of IUC, especially "friend of a friend" stories. Women were not sure if the devices could be removed before their full 5 or 10 year duration, and felt that these timeframes did not fit with their reproductive intentions. Quantitative survey data showed that the most commonly endorsed concerns among never-users were painful fitting (55.8%), unpleasant removal of the device (60.1%), and concern about having a device 'inside me' (60.2%).Conclusions: To facilitate fully informed contraceptive choice, information provided to women considering IUC should be tailored to address the concerns expressed by never-users, particularly around the details of insertion and removal, and concerns about adverse long-term effects of the device.Women need to be reassured that IUC can be removed and fertility restored at any time following insertion.

Provider-based barriers to provision of intrauterine contraception in general practice

“…The effect of this is likely to be unnecessary restriction in recommending IUC for women for whom it is a valid and safe contraceptive option. Our study of the views of never-users of IUC, reported in another article that appears in this journal , suggests a double barrier effect: IUC is not offered to women because they do not request it, but women do not have good knowledge of IUC, and opportunities to discuss the method are being missed 17. This impasse is reinforced by the barriers identified around training, which is not seen as a priority when low demand does not justify its time and expense.…”

Understanding barriers to using long-acting reversible contraceptives (LARCs) in primary care: a qualitative evidence synthesis

“…Seven included studies were conducted in the USA 28–34. The remaining studies were conducted in Australia (n=3),35–37 New Zealand (n=2),38 39 UK (n=2),40 41 France (n=1)42 and the Ireland (n=1) 43. Eight studies focused on the views of HCPs, six on contraceptive users and two on both groups.…”

“…Of the eight studies which included users or members of the public, one study purposively recruited women from African American groups,28 four papers included detailed ethnicity of participants29 31 32 41 and three studies had no mention of ethnicity 35 42 43. The papers that did not include ethnicity did mention purposive sampling for socioeconomic groups or various urban/rural locations 35 42 43.…”

“…The reliance on the social network for information and their unfamiliarity compared with contraceptive pills, has resulted in LARCs becoming subject of anecdotal or ‘friend of friend’ reports. Negative reports and ‘horror stories’ featured heavily in most included studies 28 32 34 41–43. Interviewees appeared to be heavily influenced by these testimonies; some reflected typical side effects of LARCs while others referred to rare complications or effects seldom reported in scientific literature.…”

“…Several papers referenced the ‘T’ shape of IUDs. However, other terms seemingly associated with the word ‘coil’ (a colloquial term for the IUD) were also used, including ‘giant spring’41 and ‘piece of scrap iron’ 42. Many participants reported unease at the prospect of having a ‘foreign body’ inside them.…”