“I wish they could hold on a little longer”: physicians' experiences with requests for early IUD removal

Amico, Jennifer; Bennett, A. E.; Karasz, Alison; Gold, Marji

doi:10.1016/j.contraception.2017.05.007

Cited by 48 publications

(33 citation statements)

References 21 publications

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“…Physicians are also less likely to provide sexual and reproductive health to SMW, including contraceptive counseling (Agénor et al, ; Everett et al, ). SMW of color are likely to have notably different experiences given that providers are often more likely to recommend contraception to women of color than to White women and that women of color often report pressure to use some sort of contraceptive method (Amico, Bennett, Karasz, & Gold, ; Becker & Tsui, ; Dehlendorf et al, ; Gomez & Wapman, ). As such, SMW of color may be more likely to use regular contraception than their White counterparts.…”

Section: Sexual Orientation Disparities In Unintended Pregnancymentioning

confidence: 99%

Racial/Ethnic Differences in Unwanted Births: Moderation by Sexual Orientation

Everett

Mollborn²,

Jenkins

et al. 2020

J of Marriage and Family

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Objective The objective of this study was to explore sexual orientation disparities in unwanted births by race/ethnicity. Background Previous research has documented that sexual minority women (SMW) are more likely to report unintended pregnancy than heterosexual women and that Black and Latina women are more likely to report unintended pregnancy than White women. No research has examined how pregnancy intention varies at the intersection of these two identities. Method Data come from the pregnancy roster data in Waves 4 and Wave 5 subsample in the National Longitudinal Study of Adolescent to Adult Health. We used live births as the unit of analysis (n = 8,527) and multilevel logistic regression models to account for clustering of births within women. Women were asked if they “wanted” to be pregnant at the time of pregnancy. The authors conducted models stratified by race/ethnicity as well as models stratified by sexual identity. Results Among White women, SMW were more likely to describe their births as unwanted than were their heterosexual counterparts. Conversely, among Black and Latina women, SMW were less likely to describe their births as unwanted than were their heterosexual counterparts. Results stratified by sexual identity underscore these contrasting patterns: Among heterosexual women, White women were less likely to describe their births as unwanted when compared with Black and Latina women; among SMW, White women were more likely to describe their births as unwanted than were Black and Latina women. Conclusion Traditional race/ethnicity trends in pregnancy intention (i.e., greater unwanted pregnancy among Black/Latina than White women) are reversed among SMW.

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Section: Sexual Orientation Disparities In Unintended Pregnancymentioning

confidence: 99%

Racial/Ethnic Differences in Unwanted Births: Moderation by Sexual Orientation

Everett

Mollborn²,

Jenkins

et al. 2020

J of Marriage and Family

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“…Even though method satisfaction may be higher for IUDs than for other methods, some people will choose to discontinue them in the first year of use 26–30 for reasons including general method dissatisfaction, side effects—such as changes in bleeding volume and frequency, cramping and pain—and the desire for pregnancy 26,29,31 . However, patients have reported resistance from providers when requesting IUD removals, 8,32 and some clinicians acknowledge discouraging or actively resisting such removals in the hope that the patients’ symptoms will resolve 33 …”

mentioning

confidence: 99%

The Fine Line Between Informing and Coercing: Community Health Center Clinicians’ Approaches to Counseling Young People About IUDs

Biggs¹,

Tome

Mays

et al. 2020

Perspect Sexual Reproductive

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CONTEXT While community health centers (CHCs) are meeting increased demand for contraceptives, little is known about contraceptive counseling in these settings. Understanding how clinicians counsel about IUDs in CHCs, including whether they address or disregard young people's preferences and concerns during counseling, could improve contraceptive care. METHODS As part of a training program, 20 clinicians from 11 San Francisco Bay Area CHC sites who counsel young people about contraception were interviewed by telephone in 2015 regarding their IUD counseling approaches. An iterative grounded theory approach was used to analyze interview transcripts and identify salient themes related to clinicians’ contraceptive counseling, IUD removal practices and efforts to address patient concerns regarding side effects. RESULTS Most clinicians offered comprehensive contraceptive counseling and method choice. While several clinicians viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher‐efficacy methods and respecting patients’ choices. Many clinicians engaged in what could be considered coercive practices by trying to dissuade patients from removals within a year of placement and offering to treat or downplay side effects. CONCLUSIONS Providers try to promote their young patients’ autonomous decision making, but their support for high‐efficacy methods can result in coercive practices. More training is needed to ensure that providers employ patient‐centered counseling approaches, including honoring patient requests for removals.

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“…As with the Mann study, several women in our study expressed that ease of removal was important in helping them to make the decision for immediate postpartum LARC. This is especially relevant given other studies that show evidence of provider resistance to LARC removal, which may deter women from these methods in the long-run [2,3,18].…”

Section: Discussionmentioning

confidence: 99%

“…However, this can also be an especially vulnerable time for women as they are typically exhausted and have just experienced childbirth; these factors likely influence their outlook on contraception and the consent process. Furthermore, LARC methods are provider-controlled, so once placed, a woman may have diminished reproductive autonomy if she is subsequently unable to access removal due to lapsed insurance, lack of interaction with the healthcare system, or provider resistance or refusal to discontinue the method [2,3] Table 1.…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions of immediate postpartum long-acting reversible contraception: A qualitative study,

2020

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Objectives: The objective of this study was to explore perceptions and experiences of immediate postpartum long-acting reversible contraception (LARC) counseling and decision-making, with a focus on reproductive autonomy. We aimed to assess the potential for reproductive coercion. Study design: This was a qualitative study using semi-structured interviews with Spanish and English speaking women who received an intrauterine device or contraceptive subdermal implant immediately postpartum. They were recruited before discharge from two hospitals in Baltimore, MD. We analyzed interviews using directed content analysis. Results: We interviewed a diverse group of 17 women. Participants praised the convenience of LARC and the ease of immediate postpartum placement. Some women reported feeling pushed by providers during counseling and were critical of their experiences. Women expressed a desire for comprehensive, objective information early and often during antepartum contraceptive counseling, and some valued counseling from multiple providers. They wanted autonomy in their contraceptive decision-making and described making internally motivated decisions based on their life goals and individual priorities. Conclusions: Some women felt pressured to choose immediate postpartum LARC, while others expressed enthusiasm for immediate postpartum LARC. Our data suggest that providers should start contraceptive counseling early in prenatal care and readdress it at multiple visits. Patients may benefit from speaking with multiple providers. Implications: Our study supports immediate postpartum LARC as a favorable contraceptive option for some women when discussed during prenatal care. Providers should take care to avoid coercion during counseling and focus on delivering comprehensive, objective information about all contraceptive methods, including side effects and removal options.

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“I wish they could hold on a little longer”: physicians' experiences with requests for early IUD removal

Cited by 48 publications

References 21 publications

Racial/Ethnic Differences in Unwanted Births: Moderation by Sexual Orientation

Racial/Ethnic Differences in Unwanted Births: Moderation by Sexual Orientation

The Fine Line Between Informing and Coercing: Community Health Center Clinicians’ Approaches to Counseling Young People About IUDs

Patient perceptions of immediate postpartum long-acting reversible contraception: A qualitative study,

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