A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs).

An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses.

A third of respondents (33.6%) reported training in IUCD fitting but 13.2% did not fit IUCDs in their current role. Those trained in IUCD fitting were more likely to work in practices that were commissioned to provide IUCD services.

When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.

There was an apparent dissonance between respondents’ knowledge about the suitability of IUCDs for some women and actually recommending IUCDs to these patients. Even though most felt that more women could be using IUCDs, they did not feel that they could recommend their use to younger or nulliparous women, unless other methods had failed. Virtually all respondents (97%) agreed with the statement ‘IUCDs can be used in all patients with no previous pregnancies’ but fewer than two thirds (63%) would recommend them to nulliparous women. Likewise, three-quarters of respondents agreed that ‘Currently available IUCDs are suitable for all ages’ but under half (42%) would recommend them to teenagers.

Four themes were identified from the qualitative study: proactive selection of women, risk aversion, assumption of what women wanted and confidence and competence with respect to fitting IUCDs.

There was a perception that IUCDs were riskier in terms of risk of infection, or more difficult to fit for certain types of women. The perception that IUCD fitting was a risky procedure was identified as a strong theme. Some thought IUCD fitting could lead to complaints or even litigation.

Many assumed that patients had already made their minds up about what type of contraception they wanted, and some had adverse views about IUCDs. Hearing women’s negative experiences about having an IUCD fitted also made them feel more reluctant to recommend them.

The cost of, and access to, training to fit IUCDs was a barrier but some respondents thought that there might not be enough demand from patients to justify it and to maintain competency sufficiently.

I agree with the authors that education and training especially for those not trained to fit IUCDs might address some attitudinal barriers to recommending them to patients, particularly as some perceptions about acceptability and suitability of IUCDs were not based on evidence.

Dr Richard Ma

Hoggart L, Walker S, Newton VL, Parker M. Provider-based barriers to provision of intrauterine contraception in general practice. BMJ Sex Reprod Health 2018; 0:1–8. doi:10.1136/bmjsrh-2017-101805