1. INTRAUTERINE DEVICES (IUDS)
Dispelling the myths

2. Learning Objectives Participants will be able to:
Understand the indications and contraindications to IUD use
Describe the pros and cons of hormonal vs non-hormonal IUD use
Explain the role of higher efficacy, non-user dependent, contraceptive methods like the IUD in the prevention of unintended pregnancy
Before we go on, lets dig a little on these issues.
Lets start with abortion: what do people say about women who get abortions? Who can do them? Where are they provided?
What about contraception? Does it work? Who uses it?

3. Contraceptive use in the United States
61 million women of childbearing age in the U.S.
43 million (70%) of them are sexually active and do not want to become pregnant.
About 62% of all women of reproductive age are currently using contraception
Couples who don’t use contraception have ~85% chance of experiencing pregnancy over the course of a year
Reference: Guttmacher Institute: Contraceptive Use in the United States Fact Sheet. Accessed: September 2016.

4. Unintended Pregnancy (n = 2.8 million)
Contraception use and unintended pregnancy proportions:
Perfect use: 5%
Inconsistent or incorrect use: 41%
No contraception or gaps > 1 month: 54%
42% of unintended pregnancies end in abortion
45% of all pregnancies in the US are unintended.
Reference: Guttmacher Institute: Unintended pregnancy in the United States Fact Sheet. Accessed: September 2016.

5. Contraceptive Methods in the U.S.
-Highly effective methods of contraception are still underuse, but gaining traction.
-In 2012, about 12% of women using contraceptives relied on a long-acting reversible contraceptive method, or LARC. The proportion using LARCs has risen over the past decade, from 2% in 2002 to 6% in 2007 and 9% in 2009.
-An overall decrease in unplanned pregnancies is likely due to an increased use of more effective contraception, like LARC
*RHAP recognizes that not only women can get pregnant. Instances in which gendered language is used is a reflection of the methods used by researchers when conducting studies.
References:
Daniels K, Daugherty J and Jones J, Current contraceptive status among women aged 15–44: United States, 2011–2013, National Health Statistics Reports, 2014, No. 173, 
Kavanaugh ML, Jerman J and Finer LB, Changes in use of long-acting reversible contraceptive methods among United States women, 2009–2012, Obstetrics & Gynecology, 2015, 126(5):917–927.
Finer LB, Jerman J and Kavanaugh ML, Changes in use of long-acting contraceptive methods in the United States, 2007–2009, Fertility and Sterility, 2012, 98(4):893–897.

6. Case: Shani 21 year old G2P2 Postpartum 4 weeks
Asking about tubal sterilization
Shani is a 21 year old G2P2 single mother who returns for her 4 week post-partum visit, wants a very effective method
Photo accessed:

7. Sterilization by Education
If graduated college, 13% had BTL
If some college, 29% had BTL
If graduated HS, 42% had BTL
If no HS graduation, 55% had BTL
Discuss- is this provider bias?
National Survey of Family Growth, 2004
*Could not find updated statistics with this breakdown.
*Does this photo need credit?

8. Young Women and Sterilization
20% of women selecting sterilization at age 30 years or younger later express regret
Looked at >11,000 women who had sterilization under 30 yrs, 20.3% regretted; older than 30, 5.9% regretted.
Women in study up to 14 yrs post-procedure
Reference: Hillis, SD, et al. (1999) Poststerilization Regret: Findings From the United States Collaborative Review of Sterilization. Obstet Gynecol. 93:

9. Updated July 2017