A missed opportunity for care: two-visit IUD insertion protocols inhibit placement

Area of Science:

• Reproductive Health
• Contraception
• Public Health

Background:

• Intrauterine devices (IUDs) are safe, long-acting, and highly effective reversible contraceptives.
• Current two-visit protocols for IUD insertion may create barriers to uptake and utilization.

Purpose of the Study:

• To evaluate the impact of a two-visit protocol on IUD insertion rates.
• To identify factors associated with women not returning for IUD insertion after initial request.

Main Methods:

• Retrospective database review of Medicaid-insured women who requested IUDs.
• Analysis of return rates for IUD insertion using bivariate and multivariable methods.
• Comparison of insertion rates between women who returned and those who did not.

Main Results:

• Only 54.4% of women who requested an IUD returned for insertion.
• Single women, those living >10 miles from the clinic, and those ordering at obstetrics visits were less likely to return.
• No significant association was found between race, age, or IUD type and insertion probability.

Conclusions:

• Two-visit protocols significantly hinder IUD insertion rates, with almost half of women not completing the process.
• Eliminating barriers, such as simplifying insertion protocols, is crucial to improve access to IUDs.
• Further research into optimizing IUD insertion workflows is warranted to enhance contraceptive access.