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