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January 2004, Vol. 10, No. 1 Reproductive Health As the longest-acting method of reversible contraception available, the intrauterine device (IUD) has long been considered one of the most effective—and cost-effective—of contraceptive options. Once placed in the uterus, the device requires little attention and remains functional for ten years. Medically, the IUD is well suited for women who are in a stable, mutually monogamous relationship and are not at risk for sexually transmitted infections (STIs) and pelvic inflammatory disease. Like other nonbarrier methods of birth control, the IUD does not protect against HIV/AIDS or other STIs, but it can be combined with condom use when a woman desiring long-term contraception is unsure of her partner’s HIV or STI status. When researchers and policymakers in Ghana and Guatemala noticed a drop in IUD use over the past few years, they wondered why. Had the method gained a bad reputation, were clients poorly informed, was the quality of services poor? Although the research teams were working separately—using different survey questions and methods of analysis—their findings point to the same explanations: lack of knowledge among providers and clients, logistical problems, and cumbersome clinic guidelines. Myths and rumors also surrounded the method, with both providers and potential clients misinformed about the IUD’s side effects and contraindications. The researchers concluded that efforts to increase use should include more comprehensive training of providers; better counseling to make sure that providers discuss not only IUDs, but all relevant methods; more comprehensive training of providers; and logistical support for clinics. The studies in Ghana and Guatemala were sponsored by the Population Council’s Frontiers in Reproductive Health program, designed to improve the delivery of family planning and reproductive health services in developing countries. Researchers surveyed public, private, and nongovernmental health clinics in both rural and urban settings. They relied on focus groups, in-depth interviews, and visits to providers by women who posed as clients to examine providers’ and clients’ knowledge and attitudes about IUDs. According to study authors Carlos Brambila and Berta Taracena, IUD use in Guatemala is considered low relative to the estimated demand for long-term methods. The prevalence of contraceptive use among women in marriages and partnerships in Guatemala is 38 percent; of these only 2 percent use IUDs. Surprising findings Women in both countries mentioned known side effects such as cramping and bleeding as reasons for not using the IUD; in focus groups, however, the IUD was also blamed for causing marital disharmony, cancer, and abortion. Women worried that IUDs could fail, cause heavy bleeding, get lost inside the body, or stick to the unborn child. In Guatemala, close to 90 percent of clinics had the necessary facilities (a clean, private room) and at least one worker trained in IUD insertion and removal, but about half lacked the supplies and equipment (IUD insertion kits and gloves) to offer these services. The reverse was true in Ghana, where only 56 percent of the clinics had the facilities to offer IUDs, but 91 percent had the necessary supplies available. Furthermore, focus group members in Guatemala said that the need to travel to urban clinics made IUDs too expensive. In Ghana, only doctors and midwives—not nurses—are allowed to insert IUDs, a policy that further restricts access. Policy implications Already changes are underway. In Ghana the study’s findings are being disseminated to providers nationwide; in Guatemala, nurse auxiliaries are being trained in IUD service provision, including counseling and clinical care. Furthermore, researchers in both countries are developing and testing strategies to increase people’s awareness of the IUD’s advantages. Sources Brambila, Carlos and Berta Taracena. 2003. “Availability and acceptability of IUDs in Guatemala,” FRONTIERS Final Report. Washington, DC: Population Council. (PDF) Outside funding See Also | ||||||||||||||||||||||||||||||||||||||||||||||||||
