For many women, the fact that the Intrauterine Device (IUD) is provider-controlled is a barrier to its use. In keeping with ANSIRH’s commitment to novel and forward-thinking approaches to reproductive health research, the IUD Removal Options Study examines the feasibility and appeal of self-removal of the IUD. For many women, control over one's fertility may be a critical factor in choosing a method; however, many methods of contraception that can be discontinued easily, such as condoms, diaphragms, the pill, the patch and the ring, have higher failure rates than IUDs and are not long-acting. In studying the feasibility of self-removal of IUDs, our ultimate goals are to improve women’s knowledge and attitudes about IUDs and increase use of this effective method of contraception among women who desire a long-acting form of contraception.
Why are we doing this study?
IUDs are one of the most effective, convenient-to-use and cost-effective methods of preventing pregnancy. However, according to the CDC, among women using a contraceptive method in the U.S., fewer than 10% use an IUD. Two studies conducted at ANSIRH assessing the importance that women place on different features of various contraceptive methods revealed that being able to stop using a method at any time is extremely important. Among the women surveyed, half said this feature was extremely important and about a third said it was somewhat important. Putting the ability to stop using an IUD back into a woman’s hands may make the method more appealing to some women (Lessard, 2012).
How did we conduct the study?
The IUD Removal Options Study was conducted in two separate phases.
The purpose of the first phase, conducted in early 2013, was to determine whether women are willing and able to remove their own IUCs. Women seeking IUD removal were recruited from clinics in Salt Lake City, St. Louis, San Francisco, New York and Philadelphia. 326 women were recruited for the study and were given the option of having the clinician remove their IUD or trying to remove it themselves in the clinic. All women were given anonymous surveys about their attitudes towards the IUD before removal and about their removal experience after the device was removed. The women opting to try self-removal were given a flyer (in English or Spanish) describing how to remove one’s own IUD.
The second phase of the study is designed to determine whether adding self-removal as a feature of IUDs will encourage more women to adopt the method and how knowledge of self-removability affects whether women continue to use the method. To assess the effect of knowledge of self-removal on women choosing the IUD, we monitored IUD uptake in four family planning clinics for six months. During the first three months, all women received regular contraceptive counseling. During the second six month period, women received information about self-removal in addition to regular contraceptive counseling. During the study period, we also recruited women choosing the IUD as their method and are assessing their continuation of and satisfaction with the method for a period of six months after insertion.
What did we find?
An impressive 59% of women opted to try to remove their own IUD. Of those who tried self-removal, one in five was successful.
Furthermore, more than half of all participants, whether or not they tried self-removal and whether or not they were successful, reported being more likely to recommend the IUD to a friend knowing that it might be possible to remove one’s own device. This was particularly true for African American women (Foster, 2012).
Results from the second phase of the study assessing the effect of knowledge of self-removal on uptake, continuation, and satisfaction will be available in 2016.