"Birth Control Can Take a Back Seat": Challenges Providing IUDs in Community Health Care Settings

copper IUD
Community Health Centers (CHCs) are becoming the primary source of care for a growing number of reproductive age women. CHCs serve uninsured, marginalized populations, and they are an essential part of the healthcare safety net. When Title X and family planning specialty providers face budget cuts, CHCs are often expected to serve their displaced patients. New research from ANSIRH and Bixby shows that significant barriers exist to CHCs providing intrauterine devices (IUDs).

The research team conducted surveys and interviews to assess the capacity of CHCs to provide streamlined IUD services. While placing an IUD on the same day is considered best practice, most practices surveyed required multiple visits to place an IUD. They cited the need for pregnancy and STI tests, insufficient time in one visit and the lack of priority given to women’s health as barriers.

In in-depth interviews, clinicians brought up several challenges to offering IUDs.

  • Contraception takes a back seat to “more urgent health needs.” Providers noted that it is particularly challenging to prioritize contraception over their patients’ other pressing primary care needs.
  • Short appointment times and packed schedules. The 15-20 minute time slots with patients did not allow enough time to address primary care concerns, discuss contraception, perform the necessary screening tests and place an IUD. There was also concern about coercion if the conversation with the patient was rushed. The packed schedules also limited providers’ ability to train others or increase their own skills and comfort with IUD placement.
  • Challenges using IUDs as emergency contraception (EC). Most clinicians had positive views about using IUDs as EC, but with limited appointment time and the time-sensitive nature of a potential unintended pregnancy, it was often easier to prescribe EC pills to patients.

The interviews did offer solutions to reduce barriers to providing IUDs in CHCs. Providers suggested integrating contraceptive counseling in routine primary visits; training clinicians and staff on IUD placement; having support staff help with screening, counseling and setup; and ensuring availability of supplies.