Trends in Intrauterine Device Use Before and After National Eligibility Guideline Changes

To examine changes in intrauterine device (IUD) use after national guideline updates (2010-2014) that expanded eligibility to include adolescents and nulliparous women in the United States.

Using cross-sectional data from the 2002-2023 waves of the National Survey of Family Growth, we analyzed contraceptive use among sexually active female individuals 15-44 years of age. An interrupted time series analysis compared changes in IUD use and other contraceptive methods before and after the guideline updates by parity, with parous women (two or more prior births) used as a partial comparison group to account for secular trends.

Use of IUDs increased from nearly 0 in 2002 among nulliparous women to 17.3% (95% CI, 13.0-21.5%) by 2023. After the 2014 guideline update, there was an immediate level increase of 6.1 percentage points and an accelerated post-period slope of 1.32 percentage points/y (95% CI, 0.8-1.8). Among parous women, IUD use increased steadily through 2014 and then plateaued (post-2014 slope 0.05 percentage points/y, 95% CI, -0.48 to 0.58); the differential post-2014 slope was statistically significant (P<.001). Condom-only use declined by approximately 6 percentage points immediately after the guideline change and by 0.56 percentage points/y thereafter among nulliparous women, consistent with method substitution. In insurance-stratified sensitivity analyses, the differential post-guideline trend was present among both insured (+1.1 percentage points/y) and uninsured (+1.6 percentage points/y) women, with no significant difference between groups (P=.624).

National guideline updates expanding IUD eligibility were associated with an immediate and sustained increase in IUD use among nulliparous women that was not present among parous women and did not vary by insurance coverage, although the absolute magnitude remained modest more than a decade after the change.